Medical Whistleblowers and Healthcare Fraud

Movies like “The Insider,” “Michael Clayton,” and “Serpico,” as well as several forthcoming projects about fugitive National Security Agent leaker Edward Snowden, tell the stories of average Americans who courageously "blow the whistle" on companies or individuals that are defrauding the United States government. These inspirational citizens, commonly referred to as whistleblowers, help the federal government protect itself from fraud and financial abuses, which can be difficult due to its gigantic size and diverse functions. Hundreds of millions of dollars are lost every year through fraudulent use of public funds, most commonly by:

  • Healthcare Fraud
  • Contractor Fraud (especially defense contractors)
  • Violation of Contracts with the General Services Administration (GSA)
  • Environmental Fraud

Under the False Claims Act of 1863 (also known as Lincoln's Law, the Informer's Act, or the Qui Tam Statute), plaintiffs can file civil actions on behalf of the government. These qui tam lawsuits are filed under seal (off the public record) to allow the Department of Justice 60 days to investigate and take action. If the Department of Justice chooses to take over the case, it usually wins. Among the cases it joined from 1987 through 2010 that had outcomes, 95% produced settlements or judgments, entitling the whistleblower to between 15% and 25% of the money recovered. Plaintiffs can still pursue a lawsuit if the government declines to join and are then entitled to a greater percentage of recovery, but the track record is much less successful for these types of lawsuits. Several states have also enacted False Claims Act statutes, which allow money to be recovered at a state level.

The majority of qui tam suits involve the field of healthcare. In 2012, Health and Human Services Secretary Kathleen Sebelius announced an additional $300 million in her budget to pursue healthcare fraud. Two-thirds of the 753 qui tam suits filed in the fiscal 2013 year were in healthcare and concerned a variety of improper activities such as false certifications for claim submissions, cost inflating, billing for services that were not medically necessary, billing for services that were not provided, billing more than once, billing with Medicare/Medicaid service codes to increase reimbursement, and billing with codes individually rather than submitting them as a group.

Accusations of fraud are serious charges that can come at great personal risk. Many whistleblowers have suffered retaliation such as wrongful termination, discrimination, harassment, and threats after speaking out about violations of the law at their workplace. If something like this has happened to you after reporting unlawful conduct, you are protected by the False Claims Act -- even if the government decides not to proceed with a lawsuit. Columbia, SC Medical Whistleblower Attorney Bert Louthian "want[s] workers in South Carolina and elsewhere to understand that they are legally protected when they report fraud and other misconduct in business. But in order to reap the benefits of the law’s protection, they often need the assistance of a law firm that employs experienced False Claims Act attorneys." 

If you work in the healthcare profession and believe your employer may be defrauding the government contact the Louthian Law Firm today toll free at 888-662-0434 or locally at 803-454-1200 or fill out our convenient online form.  We will review your case at no charge to you, advise you about whether you may be able to file suit under the False Claims Act, and inform you about how the Act protects whistleblowers from retribution. Even if the government passes on your case, we may pursue it independently. We are proud to help those that want to see justice done and those who may have been unfairly retaliated against for doing the right thing.

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