Medicare fraud costs the government and taxpayers billions of dollars every year. For employees and contractors in the healthcare sector, witnessing fraud can be jarring. Deciding what to do with that information can make the experience even more challenging. Prospective healthcare whistleblowers may find themselves considering whether to report the fraud internally, directly to Medicare, Medicaid or TRICARE, or to file a whistleblower case with the help of an attorney.
The primary factors that help determine which route to take include:
- The scale of the fraud you’ve witnessed.
- Whether your employer has a safe, reliable internal reporting system.
- How much taxpayer funding has been defrauded.
- The impact of the fraud on the government, the public, and patients.
Understanding these factors makes it easier to determine whether you should report the fraud directly to the healthcare program in question, or if hiring a contingency-fee attorney to help you file a qui tam case is the smartest choice.
Why report healthcare fraud?
Regardless of how you choose to proceed, it’s important to act promptly when you’ve witnessed fraud. The Medicare program encourages anyone with information about fraud, waste or abuse committed against the program to submit a report. If, for example, a few instances of upcoding have occurred at a hospital, and the hospital has failed to take action, you may want to contact Medicare directly. It is possible to remain anonymous when you choose this route.
Medicare is a massive program, and it can be difficult for the government to promptly catch individual instances of fraud as they occur. They rely on healthcare employees to speak up when something isn’t right.
If, however, the fraud you’ve witnessed seems to involve several hundred or thousands of false claims submissions, it’s a good idea to first consult with an attorney about the possibility of filing a qui tam lawsuit.
Any qualified qui tam attorney will not charge you anything for this consultation, and if your case is accepted it will be on a contingency-fee basis. If your case leads to a substantial recovery for the government, you are then eligible to collect a substantial monetary award.
How can qui tam attorneys help?
Whistleblower cases are complex, and even the most successful cases can take several years to resolve. It’s important for whistleblowers to have adequate legal and emotional support throughout this extensive process. Having an experienced attorney on their side is often an essential part of building that support system.
Before your case is even filed, it’s best to have an experienced qui tam attorney thoroughly review all of the facts and ensure that there’s enough evidence to support your claim. If more evidence is needed, that attorney can help you access it without alerting your employer to the investigation.
Substantial evidence is vital in qui tam cases; the government receives a lot of reports about fraud every year, and it will only intervene in cases that are likely to lead to a successful resolution. Typically, the qui tam relator’s evidence needs to demonstrate that the fraud committed was intentional and widespread.
Protection against retaliation
One of the major fears whistleblowers have when reporting fraud is that their employers may find out about the investigation and retaliate against them.
Qui tam cases are filed under seal, which means that the whistleblower’s identity is kept confidential for as long as possible. Once the government reaches a settlement or judgment with the fraudulent company, however, the whistleblower’s identity is revealed. This is why the financial award is such an important incentive in qui tam lawsuits.
The False Claims Act contains protections for whistleblowers that report fraud, so that employers cannot legally fire, demote, harass or otherwise discriminate against an employee just for telling the truth about false claims act violations.
Having a qui tam attorney will help ensure that if retaliation has occurred, you can seek damages for lost wages, or even reinstatement to your job if you were unlawfully dismissed.
Companies that commit fraud often rely on the idea that whistleblowers are simply disgruntled employees, so it’s important to have an attorney that can consistently and effectively advocate on your behalf.
Learn more about what qui tam attorneys do, or contact us today to report fraud safely and confidentially.