What Can I Do If I Think My Employer is Committing Healthcare Fraud?

Healthcare fraud results in billions of dollars in losses for the government each year. For citizens, healthcare fraud contributes to increases in insurance premiums and taxes. 

If you suspect your employer is committing healthcare fraud, you can file a lawsuit under the False Claims Act. By reporting healthcare fraud, you help prevent unscrupulous companies from stealing money from the government.

What is the False Claims Act?

Congress enacted the False Claims Act  (FCA) in 1863. The federal statute allows the government and individuals to pursue claims against parties who knowingly submit false claims to the government. The FCA imposes a civil penalty for each violation, plus an amount equal to three times the damages caused by the fraud.

The penalty adjusts for inflation. The current penalty for a violation under the False Claims Act is between $11,803 and $23,607. Because a single lawsuit may include multiple violations, the penalties and damages can total millions of dollars for a single lawsuit filed under the False Claims Act.

How Do I Use the False Claims Act to Report My Employer’s Healthcare Fraud?

Private citizens can file claims on behalf of the government by using the False Claims Act. The lawsuits are called “qui tam” suits. You file a lawsuit against your employer alleging healthcare fraud on behalf of the government. If your employer is found guilty, you are entitled to a portion of the penalties and interest assessed against your employer.

“Qui tam” lawsuits are filed under seal. They are whistleblower lawsuits. Usually, the defendant does not find out about the lawsuit until the government investigates the allegations in the lawsuit. 

Can I Lose My Job if I Report My Employer for Healthcare Fraud?

Lawsuits under the False Claims Act are whistleblower claims. Therefore, the Act protects against employer retaliation for employees who report fraud against the government. It is unlawful for your employer to fire, suspend, demote, discriminate, threaten, or harass you in any way for reporting healthcare fraud.

If your employer retaliates against you, you could be entitled to:

  • Reinstatement of your job
  • Reasonable attorneys’ fees
  • Twice your back pay
  • Court costs
  • Damages for defamation
  • Interest on back pay
  • Mental anguish and emotional distress
  • Punitive damages for egregious conduct by an employer

The above damages for whistleblower retaliation would be in addition to any money received from the “qui tam” lawsuit. 

However, you must follow specific procedures for reporting fraud and filing a whistleblower complaint for healthcare fraud. If you do not handle the situation correctly, you might not receive protection from employer retaliation. 

Working with an experienced San Diego whistleblower lawyer ensures that you take the correct steps to protect yourself from employer retaliation and receive compensation for bringing the lawsuit. 

Common Examples of Healthcare Fraud

Healthcare fraud takes many forms. The common factor when an employer commits healthcare fraud is greed. The person intentionally deceives the government to receive unlawful payments. 

Examples of healthcare fraud that you might undercover as an employee include, but are not limited to:

  • Submitting multiple bills for the same service
  • Billing more than once for the same service
  • Filing claims for more expensive services than the service performed
  • Billing for services or supplies that the patient never received
  • Paying kickbacks for referring business
  • Performing and billing for medically unnecessary tests and procedures
  • Inflating bills for services provided to patients
  • Submitting bills as a covered service for non-covered services
  • Incorrect diagnosing patients to bill for additional services

If you are unsure whether your employer’s actions are fraudulent, talk with a lawyer. Your conversations with a whistleblower attorney are confidential.

What Should I Do if I Suspect My Employer Is Committing Healthcare Fraud?

The sooner you seek legal advice from an experienced attorney, the better. Waiting to report healthcare fraud could result in implications that you were involved, especially if the fraud is in your department. Seeking legal advice promptly could avoid legal issues for you.

An attorney advises you of your legal rights and the options for notifying the government of healthcare fraud. An attorney also advises you of the extent to which you can copy records and gather evidence of fraud.

Furthermore, a whistleblower attorney explains the potential consequences of filing a lawsuit, according to the False Claims Act. For example, your employer could be prohibited from retaliating against you for filing a whistleblower complaint, but there could be other consequences to consider. 

You are not obligated to report the healthcare fraud to your employer through internal channels. Weigh all your options carefully before taking any steps. You want to ensure you consider your best interests while taking steps to stop your employer from committing healthcare fraud.