Healthcare Fraud: What Whistleblowers Need to Know

Whistleblowers play a vital role in making sure that businesses, individuals, and even the government are abiding by the law and ethical rules designed to keep the public safe and free from abuse. Perhaps nowhere is the role of the whistleblower more important than in reporting healthcare fraud. If you are a healthcare worker and believe that you may have evidence of healthcare fraud in your workplace or in a workplace with which you are familiar, consider consulting with an attorney specializing in representing whistleblowers in the healthcare context. Your information and observations may be crucial to keep patients safe. Here are a few frequently asked questions and answers regarding healthcare whistleblowing:

  • What is healthcare fraud? Healthcare fraud can take a variety of forms. A common example is a physician who prescribes unnecessary treatment to take advantage of insurance companies, or the government in the form of Medicaid or Medicare. Other types of healthcare fraud may involve pharmaceutical companies who market a new drug to treat patients or illnesses not supported by scientific evidence or appropriate testing. Other instances of healthcare fraud may involve conflicts of interest, such as a doctor referring a Medicare or Medicaid patient to a speciality practice in which he or she has a financial interest, in violation of the Stark Law. 
  • How do I report healthcare fraud? Exactly where you report healthcare fraud depends on your state and the type of fraud. For example, if you have evidence regarding private insurance fraud, your state most likely has an independent insurance fraud agency that is equipped to deal with your report. If, however, you have evidence regarding fraud against Medicaid or Medicare, you will likely need to contact your state’s department of health and human services. Other types of fraud may require different reporting authorities and it is best to consult with a whistleblowing attorney who can guide you to the correct reporting channels.
  • Is my job in danger if I report healthcare fraud? In short, yes. However, there are many protections available to whistleblowers. For example, if you are fired because of your whistleblowing activity, or even “blacklisted” from getting future employment in your field, you may be able to sue your former employer for wrongful termination. Though you may not be able to get your job back, you may be able to recover monetary compensation for your hardship. Even if you are not fired, if you are experiencing workplace retaliation for whistleblowing, you may have some legal remedy as well. If, for instance, you received a demotion, pay cut, or a change in job duties that make your job less desirable, you may have a legal case against your employer for employment discrimination. A qualified whistleblowing attorney can help you identify what recourse might be available to you if you are fired or retaliated against after reporting healthcare fraud. 

If you have evidence of healthcare fraud, you may be in a unique position to help and protect vulnerable patients from abuse. Consider reaching out to an experienced lawyer, like a whistleblower retaliation claim lawyer from Eric Siegel Law, today to get started with your report.