What should you do if you’ve encountered health care fraud and you want to stop it? You have options, and there isn’t one right or wrong answer. It will depend on the type of fraud, who is perpetrating it, how much you want to remain anonymous, and more.
File a Complaint with the Inspector General
The Department of Health and Human Services (HHS) has an Inspector General (IG) who investigates allegations of waste, fraud, and abuse relating to Medicare, Medicaid, and other HHS issues. This may be your best option for smaller issues, such as concerns about an individual physician. (But don’t discount one doctor’s fraud as being insignificant. In 2020, the Department of Justice issued a $4.25 million fine against one doctor who paid kickbacks to a hospital.)
However, be mindful of the fact that the IG receives many complaints, so you may not hear back on the result if that is your only action.
File a “Qui Tam” Lawsuit
Consider filing a False Claims Act “qui tam” lawsuit in federal court. With this private cause of action, you can sue on behalf of the government, and if you’re successful, you can keep as much as 30% of the government’s recovery. Also, keep in mind that, when you file the complaint, the suit is kept under seal for 60 days, to give the government time to decide if it wants to take over the prosecution of your case.
File an SEC Complaint
For publicly-traded companies, consider filing a report to the Securities and Exchange Commission (SEC). Fraud in one area may reveal other wrongdoing that falls under the SEC’s jurisdiction.
Before taking any action, however, get qualified legal representation. An attorney can identify your best reporting options, address the likelihood of receiving a reward, and ways to insulate yourself from retaliation.
If you are thinking of becoming a whistleblower on health care fraud, talk to experienced attorneys at The Silver Law Group and the Law Firm of David R. Chase. They can help you assess the situation and decide on the best course of action. For a free, confidential consultation, email us or call today at (800) 975-4345.