What is Whistleblowing in Healthcare

If you’ve been accused of healthcare fraud or violating the Anti-Kickback Statute based on an act of whistleblowing in healthcare, you could be facing a complex legal case. These claims are serious and can result in penalties as severe as the loss of your medical license or practice whether you committed the violations intentionally or not.

The top healthcare fraud defense attorneys at Sellers Law Firm are here to help identify what constitutes whistleblowing, help you understand why you might have been charged, and explain how we can help stand up for your rights.

What is whistleblowing?

The term “whistleblower” refers to anyone who reports evidence or has reasonable suspicion of wrongdoing including healthcare fraud, criminal activity, risk of patient safety, and/or corruption. Anyone in the healthcare systems, including former and current employees, who has evidence of fraud or misconduct can be a whistleblower.

Whistleblowers are protected by the False Claims Act, the Whistleblower Protection Act, and Qui Tam Law. These laws encourage individuals to blow the whistle and provide incentives to do such. If you are found guilty of violating any one of these regulations, you, your reputation, and/or your medical practice could face substantial penalties. Thus it’s important to understand what might constitute a violation.

False Claims Act

So, what is the false claims act in healthcare? The False Claims Act rewards and protects anyone who reports healthcare fraud and other criminal activity resulting in a financial loss to the federal government. Each individual violation counts as one claim meaning that if you are charged with multiple violations, you could be facing multiple penalties. The amount you will be fined depends on the number of violations as well as the date of those violations and could range from $5,000 up to $23,000+.

Whistleblower Protection Act

The healthcare Whistleblower Protection Act is set in place to protect healthcare workers from any sort of retaliation — including being demoted, transferred, or fired — for reporting corrupted, fraudulent, or criminal activity. A former or current employee may open a legal case against you if they felt like they faced harassment, disciplinary action, or wrongful termination on account of whistleblowing.

Qui Tam Law

Qui Tam Law refers to when a healthcare worker sues or prosecutes for healthcare fraud, Medicare fraud, or violations of the Anti-Kickback Statute (AKS). Lawsuits of this nature were brought about by the False Claims Act. As a reward for blowing the whistle said individual can receive up to 30% of the amount collected in a successful settlement.

Hiring a healthcare fraud lawyer can help ensure that you are implementing all of the steps necessary to avoid a Qui Tam Lawsuit. This can include instituting company wide-policies, whistleblowing programs, and internal monitoring processes.

What are some examples of whistleblowing?

Whistleblowing in healthcare can revolve around malpractice including healthcare fraud, violations of Stark Law or Anti-Kickback Statute, any medical decisions that intentionally risk patient safety, and more.

Some examples of concerns that could lead to whistleblower lawsuits include:

Unsafe patient care
Failure to properly safeguard patients
Falsifying research results
Inadequate administration of medications
Violation of laws or regulations
Improper use of testing and labs to increase payment
Unsafe working conditions
Upcoding of medical services
Unethical medical billing practices
Falsely diagnosing patients and administrating expensive treatments
Accepting kickbacks for recommending a prescription, product, or service

Wondering, “what is a kickback?” A kickback is an instance where a medical provider accepts any form of compensation in return for referrals. These actions are prohibited by the Anti-Kickback Statute (AKS) and violations can result in hefty fines, up to five years in prison, and more.

If you’re facing any type of lawsuit stemming from a whistleblower claim, don’t wait to hire an experienced healthcare fraud attorney from Sellers Law Firm. We understand just how complex your industry is and are ready to help build and defend your case.

How can a healthcare fraud attorney help?

If a whistleblower has reported you or your medical practice on account of healthcare fraud or violations of Anti-Kickback Statute, Stark Law, False Claims Act, or the Whistleblower Protection Act, you need a trial-tested attorney on your side. We can help you minimize and in some cases avoid the serious consequences you face by:

Analyzing the legal claims against you
Defining the different legal options available including what to do if you don’t have a favorable outcome
Working to dismiss the claims against you
Representing you in court if your case goes to trial
Filing all legal documents and ensure that nothing gets missed
Reviewing your current processes and regulations to avoid future claims

Looking for a top healthcare fraud defense firm? Contact Sellers Law Firm.

Whistleblowing in healthcare can lead to burdensome fines, asset forfeiture, the loss of your medical practice and license, and in some cases, jail time for the accused. As soon as you suspect that a case might be made against you, you need to call a healthcare fraud attorney at Sellers Law Firm.

We have decades of experience defending our clients from violations and claims of fraud. Let us work to defend your reputation and protect your name from these allegations.

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