17 Oct 23

Healthcare Fraud Whistleblowing: When to Hire an Attorney

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Last Updated on: 28th October 2023, 07:16 pm

Healthcare Fraud Whistleblowing: When to Hire an Attorney

If you work in healthcare and suspect fraud, you may be wondering if you should blow the whistle and report it. But reporting healthcare fraud can get complicated fast, so you might also be wondering if you need to hire a lawyer. This article will give you the lowdown on healthcare fraud whistleblowing, and help you decide if and when you need an attorney on your side.

What Exactly is Healthcare Fraud?

Healthcare fraud refers to illegal schemes to get more money from Medicare, Medicaid, TRICARE, or other federal or state healthcare programs. Some common types of healthcare fraud include:

  • Billing for services that were never provided
  • Billing for more expensive services than were actually provided (upcoding)
  • Performing unnecessary medical procedures to increase profits
  • Receiving kickbacks for patient referrals
  • Prescribing medications for reasons other than medical need

If you see anything shady like this going on, you may want to report it. But be prepared – whistleblowing is not for the faint of heart.

The Pros and Cons of Healthcare Fraud Whistleblowing

On the pro side, reporting fraud helps stop wasteful and illegal activities. It protects patients and saves taxpayer money. You may even get a financial reward if your tip leads to fines or settlements. But there are also some big potential cons:

  • You may face retaliation at work. Your employer might demote you, deny promotions, or even fire you.
  • You may be ostracized by co-workers for being a “snitch.”
  • You’ll likely need to spend significant time cooperating in investigations. This can disrupt your life.
  • Your career may take a hit, especially if your name becomes public.
  • You probably won’t qualify for whistleblower rewards if you were involved in the fraud.

As you can see, whistleblowing is not easy. So if you decide to report healthcare fraud, having a lawyer on your side can help navigate all the potential pitfalls.

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When Should You Hire a Healthcare Fraud Whistleblower Attorney?

Here are some key times when an attorney can be useful if you’re reporting healthcare fraud:

1. Before you blow the whistle

Consulting a lawyer beforehand helps ensure you have solid evidence of fraud. An attorney can advise if your case may qualify under the federal False Claims Act (FCA) or similar state laws. If so, you may get 15-30% of any money the government recoups thanks to your tip. An experienced whistleblower lawyer can walk you through exactly how to file an FCA qui tam lawsuit as the whistleblower (or “relator”).

2. If your employer retaliates

Several laws prohibit employers from retaliating against whistleblowers. An attorney can help you file complaints with federal or state agencies if you face retaliation for reporting fraud. They can also represent you in lawsuits against employers who punish or fire fraud whistleblowers.

3. If you get sued for defamation

A healthcare company you implicate in fraud may try suing you for defamation or libel. An attorney can defend you against these types of SLAPP lawsuits aimed at silencing whistleblowers. Lawyers can also help get defamation cases dismissed quickly so they don’t drain your time and money.

4. If you’re confused about where to report fraud

An experienced whistleblower attorney will know exactly where and how to report the fraud you’ve witnessed. They can advise if your evidence is strong enough to justify moving forward. Lawyers are also familiar with how various agencies like the Department of Justice typically handle healthcare fraud cases.

5. If you’re asked to testify or be deposed

During fraud investigations, you may need to give depositions answering questions under oath. An attorney can prepare you for this high-stakes process to avoid legal missteps. Lawyers can also represent you if you’re ever called to testify at trials about the fraud.

6. If you need anonymity

Whistleblower lawyers can file fraud reports on your behalf to keep your identity secret. They can also take steps like filing qui tam lawsuits under seal to avoid tipping off the fraudsters during investigations.

How to Find the Right Whistleblower Attorney

Not all lawyers have expertise in whistleblower laws and healthcare fraud cases. When choosing an attorney, look for these important qualifications:

  • Extensive experience with False Claims Act cases
  • A proven track record of results in healthcare fraud suits
  • Willingness to work on contingency, taking a percentage of any reward money
  • Resources to go up against large healthcare corporations
  • Ability to build strong cases while protecting your identity
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Whistleblower attorneys with all of these attributes provide the best chance of success. But beware lawyers who pressure you to sign retainers before fully assessing your case’s merits.

Should You Hire an Attorney to Blow the Whistle?

Here are some good rules of thumb on deciding whether or not to hire a whistleblower lawyer:

  • If you have extensive, irrefutable evidence of major fraud, an attorney can help maximize rewards.
  • If you’re unsure about the strength of your evidence, consult a lawyer for an honest assessment before proceeding.
  • If you face retaliation or legal threats for whistleblowing, an attorney can defend your rights.
  • If navigating complex fraud reporting seems daunting, a lawyer’s expertise can help guide you.
  • If you want to remain anonymous during investigations, experienced attorneys know how to make that happen.
  • If you were involved in minor ways in the fraud, legal advice may prevent whistleblower disqualification.
  • If your employers have deep pockets for legal defense, you need your own lawyer to level the playing field.

On the other hand, if your evidence of fraud is questionable or you face no retaliation, hiring a lawyer may not be necessary. Carefully weigh the pros and cons for your specific situation.

The Bottom Line

Blowing the whistle on healthcare fraud is commendable, but can have serious personal and professional consequences. Having an experienced whistleblower attorney on your side can help maximize success while minimizing risks. Lawyers with expertise in fraud cases and whistleblower laws can provide invaluable guidance and protection. If you have solid evidence of fraud and are willing to see the process through, hiring a lawyer may well be worth it.