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How to Blow the Whistle on Health Care Fraud in Five Straightforward Steps

Are you an employee or an independent contractor working in the health care field? If so, you’ve probably heard rumblings about health care fraud crackdowns in the industry. Perhaps you’ve even witnessed instances of health care fraud yourself. Or maybe you aren’t sure.

Unquestionably, medical fraud is a problem in the United States, and the federal government has invested tremendous amounts of money in an effort to stop it. Today, the law offers powerful incentives and rewards for people who step up and do the right thing by blowing the whistle on fraudulent activity. This activity might include:

  • Medicare fraud
  • Submitting bogus claims for payment from government healthcare programs
  • Falsifying patient paperwork or invoices
  • Providing medically unnecessary treatment
  • Stark Law violations
  • False Claim Act violations
  • Anti-kickback statute violations  

What do you do if you witness this kind of fraudulent behavior? What if the wrongdoing isn’t isolated to a single individual but is pervasive throughout the company? Which steps do you take to protect yourself?

Oberheiden, P.C. constitutes an experienced team of former federal prosecutors who have substantial experience in helping whistleblowers in the health care industry. Federal law gives you enormous protection when you do the right thing.

You can help to protect yourself, too, by following these five steps.

1. Be Certain of Your Allegations

The key takeaway here is this: before you make a formal allegation of fraud against your employer, take a moment to step back and make sure the behavior really amounts to fraud.

We aren’t suggesting you need to become an attorney overnight. It goes without saying that health care fraud is an extremely complex area of law, but you don’t need to know everything to come forward.  Healthcare fraud whistleblowers are rarely experts.

But you do want to take time to ensure you really understand the situation and the behavior you’re about to report. Remember: for a violation to constitute fraud, it must be done willfully, knowingly, or intentionally.

This is a big decision, so you want to feel confident that you’re doing the right thing. Make sure you really see what you think you see. Once you feel certain that you do, proceed.

2. Document Everything

Why is documentation so important? We can think of at least three reasons:

  1. The wrongdoer might try to cover his or her tracks later.
  2. The person you report might try to come after you, accusing you of making things up. They might even say you were the one committing fraud. Documentation can protect you against those tactics.
  3. The law protects whistleblowers’ rights, but sometimes, you have to initiate legal action to take advantage of those protections. Documentation from the time the fraud was happening can be a critical tool in those cases.

As a general rule, the more documentation you gather, the better. Examples include:

  • Documents
  • Text messages
  • Emails
  • Relevant photographs
  • Internal memorandums
  • Contemporaneous notes you make at the time you witness the fraud
  • Your own detailed, written record of when and how you discovered the fraud

3. Talk to a Superior (if Possible)

If the fraud is being committed by an individual or small group of individuals, it’s often a good idea to bring your suspicions to a supervisor or higher-up with authority over those individuals. Schedule a private meeting and bring along copies of all your documents and evidence (but leave the originals in a safe place or at home).  

Unfortunately, supervisors have a tendency to dismiss employees’ fraud complaints. The fraudulent activity might be making a lot of money for your company, so there’s an incentive for supervisors to adopt a “don’t ask, don’t tell” attitude. Moreover, the people perpetuating the fraud might be among the highest-ranking or highest-earning people in the company, making it difficult for the supervisor to take action, for example fearing to rock the boat. Alternatively, they might simply not believe you. It’s helpful to anticipate these attitudes before you go into the meeting.

4. Consider Resigning

There are several situations in which you should give serious consideration to resigning from your current position and leaving the company altogether:

  • You do not feel comfortable bringing your suspicions to a superior.
  • The fraud is pervasive throughout the company, and even the highest authority figures are involved.
  • You reported your suspicions to a superior, but the meeting did not go well.

In any of these situations, staying in your current position could lead to problems down the road. For one, you might be fired, or you could face other hostile or adverse employment conditions. More seriously, you could become personally liable for the fraud yourself if you know about it and don’t do anything — especially if you then participate in any way (merely submitting a Medicare invoice, for instance, could be enough for a federal agent to charge you with a crime).

5. Talk to an Experienced Defense Attorney About Becoming a Whistleblower

When you report health care fraud to the federal government as a whistleblower:

  • You can report your claims anonymously.
  • The lawsuits are initially filed under seal.
  • It becomes illegal for your employer to fire you or retaliate against you because of your whistleblowing.
  • If you are an original source of information about the fraud, you may be able to file a qui tam lawsuit on the government’s behalf, in which case you would be entitled to keep a portion of the government’s total recovery in the fraud case (usually 15 to 25 percent). This may amount to a very large amount of money for you personally.

But you should talk to an experienced team of health care whistleblower defense law attorneys before you become a whistleblower.

The lawyers at Oberheiden, P.C. have many years of experience in this highly sophisticated area of law. We are standing by 24/7 — even on weekends — to talk about your options.

Please contact us online or call (888) 727-0472 right away.

National Health Care Whistleblower Defense Law Firm. Primary Office in Dallas, TX.
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503