What is a healthcare fraud whistleblower?
Healthcare fraud whistleblowers are defined as those who provide information about Medicare fraud, Medicaid fraud, and other healthcare fraud that costs the government money. Their insider information prompts healthcare fraud investigations through “qui tam” (whistleblower) lawsuits that can ultimately stop healthcare fraud. Qui tam lawsuits help return billions of dollars to the government that otherwise would have disappeared. Healthcare whistleblowers are vital for our nation’s healthcare system and patients.
Healthcare whistleblowers also help stop harmful practices that endanger the health and lives of Medicare and Medicaid patients – children, senior citizens, nursing home residents, cancer patients, dialysis patients, and many others.
In addition, qui tam lawsuits can stop healthcare fraud that steals money from TRICARE, the health insurance program for the military.
How common is fraud in the healthcare industry?
More than 8,000 qui tam lawsuits have been filed exposing healthcare fraud. Those whistleblower cases and other False Claims Act cases have helped the government recover more than $43 billion that otherwise would have been lost to fraud. Billions more have been recovered through related criminal fines and by state Medicaid programs as a result of those whistleblower cases.
How much compensation have healthcare whistleblowers been awarded?
Those who have filed “qui tam” lawsuits under the False Claims Act alleging healthcare fraud have been awarded more than $6 billion in whistleblower rewards. The law also provides whistleblowers job protection through provisions that offer recourse to those who suffer job retaliation for whistleblowing.
How can I report fraud in healthcare?
Phillips & Cohen is the nation’s top law firm representing healthcare fraud whistleblowers. For more than 30 years, Phillips & Cohen attorneys have had unmatched success in Medicare and Medicaid whistleblower cases, both in the number of successful qui tam cases as well as the total amount of money recovered.
Our victories in healthcare fraud cases include record-setting settlements with pharma companies GlaxoSmithKline ($3 billion) and Pfizer Inc. ($2.3 billion) as well as major settlements against Davita Healthcare, Quest Diagnostics and many hospitals, medical testing labs and medical device companies.
If you are aware of any Medicare fraud, Medicaid fraud or TRICARE fraud and would like to discuss with an attorney how to proceed as a healthcare whistleblower in your situation, please contact us. Phillips & Cohen works with whistleblowers on a contingency basis, which means there is no payment unless the government recovers funds from the case and pays the whistleblower a reward.
What are the most common types of healthcare fraud?
Some common types of healthcare fraud involve the following:
- Medicare Advantage risk-adjustment fraud
- Medical loss ratio fraud
- Off-label marketing, kickbacks and other fraud by pharmaceutical companies
- Medical devices and implants
- Upcoding and unbundling/fragmentation
- Stark Law
- False certifications and information
- Lack of medical necessity
- Telemedicine fraud
- Electronic health records (EHR) fraud
- Kickbacks through physician speaker programs
- Grant or program fraud