Whistleblowers may report alleged violations of federal laws that prohibit fraud and abuse. The Federal False Claims Act prohibits medical practitioners from submitting falsified bills to the government. As noted by the United States Office of Inspector General, fraud includes overcharging the government for services provided to Medicare patients.
If an employer appears to abuse the public’s medical system, employees may decide to blow the whistle on the alleged activities. Qui tam lawsuits filed against an employer for unlawful billing practices may result in criminal or civil penalties.
Alleged violations of the Anti-Kickback Statute
The federal Anti-Kickback Statute prohibits physicians from making referrals in exchange for benefits. Medical professionals may not refer patients to each other in exchange for “remuneration.” The American Bar Association notes that remuneration includes “anything of value.”
Doctors receiving money or equipment after prescribing certain drugs may appear to breach the law. Knowingly and willingly accepting benefits for referrals that the government pays for may lead to an employee becoming a whistleblower. A qui tam lawsuit may allege acts violating the AKS.
Whistleblower employees may receive rewards
The U.S. Department of Justice files whistleblower claims over unlawful actions in the healthcare industry. When they result in settlements, the employees who blew the whistle on those violations may receive a portion of the court’s award.
As reported by the Arizona Star’s Tucson.com, a qui tam lawsuit against a national healthcare company with two locations in the Grand Canyon State resulted in a $17 million award. An employee blew the whistle on the owner receiving kickbacks for referring patients. The whistleblower reportedly received over $3 million from the settlement.
The federal government requires medical practitioners to follow strict rules and guidelines. An alleged violation may result in an employee becoming a whistleblower, which may lead to the individual receiving a financial reward.