Whistleblowers Who Report Fraud and False Claims Against the Government Stand to Receive Large Rewards - Part 1

Wednesday, March 13, 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities.  Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government.

This is the first blog of a two-part series. Throughout these two blogs, I will explain types of false claims, the reward programs for coming forward with a false claim, who can file a whistleblower/qui tam lawsuit and what is needed to be a successful whistleblower.

Types of False Claims.

If you are asked to file claims or provide documentation that care was given to a patient when it wasn't, this would be fraud.  If you are asked to file a claim stating a date of service other than the actual date when the patient was seen, this could be a false claim.  If you know that medical testing is being provided to a patient when there is no medical necessity for that testing, this could be a false claims case. If you are aware that codes are being billed that indicate a more serious condition than the patient actually has, this is the typical false claims case.

Whistleblowers Stand to Make a Lot of Money.

The government wants you to report these fraudulent activities.  In order to encourage it, there are systems of rewards for those who come forward and do this. The larger the amount at stake, the bigger the possible reward for the one bringing it to the government's attention. If the government pays any portion of the health care program at issue, then there is a reward program that applies.

The way that offers the biggest reward for someone who reports fraud being committed against the government is to obtain an attorney and file what is known as a qui tam or whistleblowers suit.  The term "qui tam" means one who acts for the king [or government]." There are lawyers who have a lot of experience in this type of lawsuit and the most common arrangement is that the client does not pay anything unless there is some type of recovery.

Who Can File a Whistleblower/Qui Tam Lawsuit.

The federal government has had a whistleblower's reward law, called the False Claims Act, since the Civil War.  Most states now have similar laws that apply to filing any false claims against the state's Medicaid program or any other false claims for payment by the state. Sometimes these laws provide a minimum reward for the person making the claim, regardless of how much is actually recovered.

Often these whistleblowers have been doctors who are aware of wrongdoing by a hospital, hospice, nursing home or medical group.  In many cases a nurse or even the person responsible for billing has become the whistleblower.

It does not matter who you are.  You may even be one of the people who were actively involved in the wrongdoing. Believe it or not, this does not disqualify you from reporting the false claims activity or receiving a reward for doing so. In order to encourage persons with knowledge of fraudulent activity to come forward, the government will usually not seek to prosecute you or punish you in any way; additionally, you may receive a percentage of any recovery the government makes.

Of course, the larger the amount of money the government has been defrauded the more likely it will be that the government will be interested in pursuing the case you report and the larger the reward you will receive if there is a recovery.  It is not unusual to see payments in the millions of dollars received by whistleblowers in recent years.

Check Our Website for the Second Part of this Blog.

In my next blog I will discuss what you need to be a successful whistleblower and how much whistleblowers stand to make for reporting fraud. Be sure to check our website.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

How much do you know about whistleblower/qui tam lawsuits? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tag Words: false claims, Medicare false claims, false claims act, unnecessary procedures, false billing, Medicare, Medicare fraud, Medicare audit, whistleblower, qui taim, qui tam suits, qui tam relator, whistleblower attorney, whistleblower lawyers, whistleblower protection, legal representation, Medicaid false claims, Medicaid, Medicaid fraud, Medicaid audit, TRICARE, CHAMPUS, Veterans Administration, doctor, hospital, hospice, nursing home, medical group, nurse, attorney’s fees, The Joint Commission

The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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