Healthcare Whistleblower FAQ

Healthcare Whistleblower

A healthcare whistleblower claim is a formal submission, in the form of a civil complaint, of alleged fraud or misconduct made to the state or federal government. The United States and the state governments spend billions of dollars on healthcare programs and seek to ensure that those dollars are not lost to fraud, waste, or abuse. Here are some of the most frequently asked questions from healthcare whistleblowers:

Who commits healthcare fraud?

Fraudulent healthcare infractions are committed by healthcare workers including doctors, pharmaceutical companies, hospitals, and more. Many government agencies work to expose and investigate health care fraud including, the FBI, HHS/OIG, and the state Medicaid Fraud Control Units. The following entities or their employees could be responsible for committing healthcare fraud:

  • Chiropractors
  • Home health and hospice organizations
  • Hospitals
  • Laboratories and testing facilities
  • Managed care groups
  • Medical device and durable medical equipment (DME) manufacturers or distributors
  • Pharmaceutical companies
  • Providers
  • Skilled Nursing Facilities (SNF)

What can healthcare whistleblowers report?

Healthcare whistleblowers often report fraudulent activities related to kickbacks, improper marketing of prescription drugs, fraudulent clinical trial submissions, fraudulent risk adjustment claims which fraudulently exaggerate the severity of a patient’s condition, billing for services not provided, providing unnecessary services, and most commonly some form of upcoding. It is impossible to speculate on all the ways that individuals will try to cheat the healthcare system, but whistleblowers need to speak with healthcare whistleblower law professionals if they have questions about healthcare fraud. 

What is the False Claims Act?

The False Claims Act serves as the foundation for whistleblower laws and was enacted in 1863 but last amended in 2010. Private citizens can serve as relators, individuals who bring whistleblower lawsuits on the government’s behalf and can be rewarded between 15-30% of the proceeds of the action or settlement of the claim.

How does the False Claims Act protect private citizens?

If a person is discharged, demoted, harassed, or otherwise discriminated against for participating in a False Claims Act (FCA) case, or attempting to stop or prevent a violation of the False Claims Act, the employee could be reinstated to their previous position, offered double-back pay, and could be compensated for litigation costs. 

What is a qui tam case?

Qui tam translates as “in the name of the king” and permits private individuals and entities to sue others on behalf of the state and federal government for committing fraudulent acts. The government can take over the case, intervene, or if the government decides not to be involved, declines to intervene, then the private individual and their whistleblower attorney may proceed on their own. It is important to be represented by an attorney that understands the intricacies of the FCA and healthcare whistleblower cases. 

Are healthcare whistleblowers allowed to remain anonymous?

It is possible and an involving area of the law. Prior to filing a case, your whistleblower attorney should discuss the risks and benefits of an attempt to remain anonymous.

Can a healthcare whistleblower file an FCA case if they participated in the misconduct?

Those who initiate and plan fraudulent activities aren’t normally rewarded for making a whistleblower claim, but some could receive a reduced award even when involved in the misconduct.

How can I become a healthcare whistleblower?

Anyone with evidence of healthcare fraud and misconduct can be a whistleblower.

Are healthcare whistleblower attorneys necessary?

If you have witnessed healthcare fraud and misconduct, and have evidence that fraud was committed, then a whistleblower attorney can help you put a stop to the activity while earning you a reward. 

If you are a healthcare whistleblower, Michael C. Rosenblat can help. You can reach Chicago whistleblower attorney Michael C. Rosenblat at 847-480-2390. 

The information and articles on this website are for general information only and are not intended and should not be taken as legal advice.