Whistleblowing refers to disclosing or reporting either evidence or suspicion of illegal activity. This includes healthcare fraud, criminal activity, corruption, or any practice that endangers a patient. Any private individual-employee or not- who has information about such activities can be a healthcare whistleblower. This individual is called a realtor. A healthcare whistleblower can report unlawful conduct internally through their institution or externally to regulators, watchdogs, or the media. Either way, whistleblower information is crucial in exposing institutional wrongdoing, especially in healthcare industries.
What Can a Whistleblower Report?
There are many ways a hospital or healthcare company can commit fraud, but there are a few common types, including:
- Billing for services never performed
- Overcharging for a procedure or charging separately for procedures done together (unbundling)
- Changing medical records
- Schemes to sell unneeded prescription medication
- Any Stark Law violation
Any of these practices are grounds for a healthcare fraud lawsuit which a whistleblower can report.
Whistleblower Regulations, Protections, and Compensation
Though it may seem that whistleblowing is culturally frowned upon and may even be a crime, that is not the case. Whistleblowing is a legally protected right, and many laws exist to support anyone who has blown the whistle. The major laws are:
- The Whistleblower Protection Act (WPA)
- The Occupational Health and Safety Act (OSHA)
- The False Claims Act (FCA)
- Qui Tam laws
There can also be state-specific laws that apply whistleblower protections on top of federal regulations. Some states even offer reimbursement to a whistleblower for a successful suit. The WPA forbids any punitive action against federal employees from their employers when revealing illegal conduct, mismanagement or waste of funds, an abuse of power, or a danger to public health.
OSHA protects healthcare workers from any retaliation as a result of blowing the whistle on criminal activity. This includes being demoted, transferred to another department, or being fired. If an employee feels that any retaliation, disciplinary action, or harassment occurred because of whistleblowing, then a case can be opened under this law. The FCA compensates and protects anyone who reveals fraud or any illegal activity that causes the federal government to suffer a financial loss. Many violations of this act occur in the healthcare industry.
Qui Tam laws involve a healthcare worker prosecuting healthcare fraud, Medicare or Medicaid fraud, or violations of the Anti-Kickback Statute. An individual can receive up to 30% of the total collected settlement.
Can a Healthcare Whistleblower Remain Anonymous?
Whether a whistleblower can remain anonymous depends on the type of case. In most cases, however, it is difficult to achieve total anonymity for a whistleblower. Federal Rule of Civil Procedure dictates that a lawsuit must name all parties involved in a case. Even if a whistleblower cannot stay anonymous moving forward, all of the laws listed above offer protection from retaliation.
For example, when an FCA claim is first filed, it is sealed by the U.S. Circuit Court. While the government investigates the validity of a claim, the whistleblower will remain anonymous. However, once a case is unsealed and goes public, it may not be possible to keep the whistleblower’s identity hidden.
In Qui Tam suits, there are procedures for filing under a pseudonym, but the guidelines and requirements are strict. Considerations for a pseudonym can include:
- Information that is highly sensitive or personal
- The whistleblower fears retaliation
- A suit challenges government or private parties
- The plaintiff is in danger if their identity is revealed
- A plaintiff’s identity is already confidential
- A pseudonym enhances public interest
- The public interest is weak based on presented information
- The use of a pseudonym prejudices a defendant
- Other ways to protect the plaintiff exist
Most courts deny using a pseudonym, even when there is a legitimate fear of retaliation against a whistleblower.
Things to Keep in Mind and Prepare for Before Blowing the Whistle
There are some things to consider before deciding to blow the whistle. First, figure out if your company has an internal system for reporting whistleblower claims. Second, keep track of any relevant documents or communications that show proof of any violations of the law. If you leak any documents that you do not have access to, then a company can fire you on a non-retaliatory basis. Be careful when gathering data, and make a written report, so it is difficult to dispute the validity of a whistleblower claim.
There is no blanket law covering public health and safety whistleblowing. Any disclosures need to be framed under existing laws. Reports or documents for a claim need to pinpoint exactly what law was broken or how an action constitutes healthcare fraud. Reporting a healthcare law violation on time is also essential. The federal statute of limitations for healthcare fraud according to statute 18 USC 3282 is five years. After that time, a non-capital offense cannot be prosecuted, tried, or punished. There are also state-specific statutes of limitations to be mindful of as well.
How Healthcare Whistleblower Fraud Attorneys Can Help
If you find yourself in the position to blow the whistle, you should first contact a law firm experienced in healthcare fraud cases. Attorneys that know the ins and outs of healthcare law can help you put together the documents you gather, analyze the data, and give you advice on how to proceed with a case. The Norman Spencer Law Group has the expertise required to handle all types of cases, especially healthcare fraud. We take on even complex issues at both the state and federal levels. If you think you have a whistleblower claim on hand, do not hesitate to contact us.
Individuals that file a healthcare fraud claim do not have to pay and will get a share of the successful litigation. We offer free consultations, in person or online, and our representatives can meet with you virtually, no matter where you live. Call or team today!