Medical errors are the eighth leading cause of death in the United States. More people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS. The estimated annual cost of additional medical and short-term disability expenses associated with medical errors is $19.5 billion.
Government-imposed penalties are increasingly being used to incentivize and enforce patient safety. For example, the Hospital Acquired Condition Program is a Medicare value-based program that reduces payments to hospitals based on their performance on measures related to hospital-acquired conditions.
Similarly, the Hospital Readmissions Reduction Program seeks to reduce readmissions for certain specified conditions. Between fiscal year 2012 and fiscal year 2017, hospitals experienced nearly $1.9 billion in penalties related to “excess” readmissions.
Whistleblowers often spur investigations of conduct that threaten both the health of patients and the financial integrity of the Medicare and Medicaid programs. The Department of Justice has long viewed the False Claims Act as a tool to enforce patient safety, recover taxpayer money, and deter future patient harm.
For example, whistleblowers have been essential in uncovering and prosecuting cases involving adulterated pharmaceuticals, unsafe pharmaceutical promotional practices, and physicians who perform medically unnecessary procedures, including invasive cardiac procedures, radical hysterectomies, or unnecessary administration of chemotherapy.
How whistleblowers can report healthcare fraud
Healthcare industry insiders are critical to the government’s efforts to stop Medicare and Medicaid fraud as well as misconduct and improper practices by hospitals, doctors and pharmaceutical companies.
The False Claims Act empowers whistleblower to report dangerous and fraudulent healthcare practices by filing “qui tam” lawsuits against entities that are defrauding Medicare, Medicaid and other government healthcare programs. After a qui tam lawsuit is filed, the government investigates the allegations to decide whether to pursue the case.
The law provides whistleblowers protection against employment retaliation as well as rewards based on the amount of money recovered as a result of a whistleblower’s qui tam case. Whistleblowers are entitled to 15% to 30% of the amount recovered.
[Learn more about the False Claims Act.]
If you are aware of healthcare fraud and would like to talk to experienced whistleblower lawyers about your matter, please contact us for a free, confidential review of your matter.
This is an expanded version of an article originally posted as part of the “Fraud by the Numbers” series for the Fraud in America website by Taxpayers Against Fraud Education Fund, a public interest, non-profit organization dedicated to fighting fraud against the government by working to protect whistleblowers and strengthen whistleblower law.
About the author
Molly Beth Knobler has significant experience representing US and international whistleblowers in whistleblower protection and reward programs.
She has handled “qui tam” cases involving Medicare and Medicaid fraud, Stark violations, kickbacks in the healthcare industry, overcharging by government contractors, cybersecurity vulnerabilities in tech products, customs fraud and other types of fraud against the government.
She also represents clients in whistleblower claims with the IRS and the US Securities and Exchange Commission whistleblower programs, including cases involving violations of the Foreign Corrupt Practices Act, a US anti-bribery law. has been recognized as a "Rising Star" for her work representing US and international whistleblowers.
Talia Mermin of Phillips & Cohen also contributed to this blog post.