How Do Whistleblower Cases Combat Fraudulent Activity in the Health Care Industry?

Thousands of health care facilities have had to pay an aggregate of billions of dollars in penalties for committing fraud against the government and the taxpayer in the form of Medicare Fraud and Medicaid Fraud.  When employees of a facility committing fraud detect the misconduct, they can come forward with accusations and file a whistleblower case, also known as a Qui Tam action.

For some actions, like CFTC whistleblower actions, SEC whistleblower actions, and IRS whistleblower actions, the identity of the individual can remain confidential throughout the entirety of the process.  For the most common case filed, under the False Claims Act (FCA), while the identity of the whistleblower is initially sealed from the defendant, it is revealed when the case becomes unsealed after the government has had time to investigate the matter.  Many employees fear the potential consequences of their actions, but certain and aggressive laws have been implemented to ensure these employees are not only rewarded but also thoroughly protected against retaliation.

Understanding how Qui Tam lawsuits work is an important factor for employees who witness fraudulent activity in their workplace. When an employee in the healthcare industry finds that their employers is conducting fraud – such as when false claims are made to the patients’ health care policies, then the employee may come forward with evidence in order to file a case against their employer.  This fraud may happen in many ways such as overbilling, upcoding, billing for services not rendered, and a variety of other health frauds that are often creative ways to overbill Medicare and Medicaid.

The False Claims Act specifies that any citizen is able to sue a business or a person who conducts fraud that leads to a loss of governmental funds. If you suspect or know of a fraud, you should consult with a Qui Tam attorney to learn about your rights and the pros and cons of proceeding with a whistleblower lawsuit.

The only parties who will be notified of the lawsuit during the early stages of the case are the government. The case is kept secret from the party that is being accused. The government can then decide if they would like to intervene in the case. If the government decides not to intervene, the whistleblower can still continue with the case with the whistleblower attorney they have retained to represent them.  Under the False Claims Act, you must have an attorney to file the case with you; you can not file the case without one.

The government after reviewing the complaint will conduct what is known as a relator interview, that is it will sit down and interview the individual complaining of the fraud.  From that interview it will determine whether there are any leads that should be followed, the course of the qui tam investigation and whether to intervene or not.  At some point the Defendant will be made aware of the investigation, and the whistleblower will be given a head’s up before that occurs.

If the case is settled, or if there is a judgment obtained, and the government has recovered the funds they have lost due to the fraudulent activity, a reward between 15% and 30% the settlement amount is provided to the whistleblower.

Conclusion

Even though many individuals observe misconduct in the workplace, often resulting in fraud, employees are often not sure what to do about it or how exactly whistleblower cases work. Fortunately, with appropriate guidance, the whistleblower can put together a solid case and even be rewarded in the process. Choosing the right lawyer becomes an essential factor here, so it is important to consult with a firm like Brown, LLC who has successfully handled whistleblower cases in the past, and can educate you about your rights.