What is Healthcare Fraud?

Why Does the Government Care About Health Care Fraud?

Whistleblowers in healthcare fraud cases are often doctors, or those who work within individual health care organization systems. During the course of their duties, they often notice that things are amiss. Some of the types of fraud that whistleblowers often report in qui tam lawsuits include medicare fraud, as well as billing fraud, kickback schemes, and more.

These types of fraud cases cost the federal government around $60 billion dollars each year, and the government is inclined to want to recoup some of these losses. That’s where whistleblowers come in. The government wants its money back, and whistleblowers with knowledge and evidence of healthcare fraud can help them with that. 

Whistleblowers who report fraud that leads to the recovery of money are entitled to a portion of the recovered money. Their portion is generally between 15-20% of the recovered money.  More than this though, many whistleblowers experience ethical satisfaction knowing that they are doing the right thing.

Attorneys working on a case

Contact Us For a Free Case Review

Our legal team will speak to you about your potential claim

Examples of Healthcare Fraud Reported by Whistleblowers

Healthcare fraud can take many forms, but there are some ways that it appears most frequently. One of the most common types of healthcare fraud is billing fraud. 

Billing fraud is when government programs like Medicare and Medicaid are billed for services that were not appropriate for the patient. Sometimes this can mean billing for medical treatments that never happened, or adding additional services to pad the bill. Healthcare fraud can also be exaggerating the level of illness a patient has in order to bill for more expensive services.

What Evidence Do You Need for a Healthcare Fraud Whistleblower Case?

A successful healthcare fraud whistleblower lawsuit needs evidence to prove that fraud is taking place. Whistleblowers should document everything that could prove fraudulent activity. This includes meetings, conversations, receipts, emails, and other documents. It’s important that these documents be obtained legally; they should not be stolen. 

Creating a record of how the documents were obtained, which includes the date, time, and place is important. Cases are stronger when whistleblowers show that their information comes from direct contact with the people committing fraud.

Whistleblowers have legal protections that help shield them from any potential recourse. These claims are “under seal,” which means that the whistleblower’s name is not publicly available for at least 60 days. Other legal protections include the False Claims Act. The False Claims Act says that if an employee is fired, harassed, or discriminated against for whistle, he or she may be eligible to get their job back with back pay and compensation for legal fees.

This page was last updated:

Contact Us Now

Google Reviews Logo

As an experienced leader in these types of lawsuits, we were confident the firm would have the expertise. However, what surprised us most was the high level of excellent customer service from the firm’s staff!

Pat R.

I can’t recommend this firm enough. They have an outstanding team that truly care for their clients…I have been awarded a fair six figure settlement.

Nate M.

When I say “they went to bat” for me…this Law Firm literally did just that. They persevered to bring the hard-nosed Manufacturer to settle and provide me some recompense for everything I had to endure which led to this suit.


Read our Client Testimonials