Whistleblowers Matter: Enhanced Efforts To Root Out Fraud Can Enhance Health Care Reform

Many of the issues being discussed in Congress under the rubric of health care reform are already being addressed by a small band of Whistleblowers and their lawyers who bring cases under the Federal False Claims Act 31 USC  3729-3733. This relatively simple law (recently strengthened by Congress) allows anyone who knows of fraud against the federal government to bring suit on behalf of the U.S. Treasury and if suit is successful to claim a bounty from the proceeds of any recovery to the federal treasury. The billions of dollars spent through the Federal Government’s Medicare, Medicaid and Champus (healthcare for the military). A recent $2.3 Billion settlement with Pfizer for illegally promoting and billing these federal government programs for off label use of their product is just the tip of the iceberg.

On a smaller scale, unethical physicians, hospitals and businesses are committing millions if not billions of dollars of fraud every day by billing for unnecessary services, misrepresenting the value of the services for which they bill, self-referring in violation of the Stark Law or violating the Federal Anti-Kickback law. Fraud by such medical providers have been exposed by a diverse group of whistleblowers including billing staff, competitors, sales and marketing staff for drug companies and other providers and patients.

Those involved in submitting the claims or marketing false schemes not only risk personal financial liability but also the possibility of criminal prosecution.

It is not just the work of Congress to reform healthcare policy in the United States.  Any person who suspects medicare, Medicaid or Champus fraud should consider whether or not they have an obligation report the fraud.

As one would imagine, those accused of fraud and facing potential civil damages and even criminal liability will fight allegations of fraud vigorously.

That is why it is critical that anyone who suspect that they know of fraud against the government (in healthcare or other fields) should seek the counsel of a lawyer experienced in the area of False Claims (also known as Qui Tam).

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Posted in Uncategorized, Whistleblower Law

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