What Happens If I’ve Been Retaliated Against for Reporting Hospital Fraud?

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Hospital fraud may not be a term that you are familiar with but, the National Health Care Anti-Fraud Association estimates that it costs Americans and the nation between 3 to 10 percent of total health care expenditures. This results in billions of dollars wasted because of fraud. Healthcare or hospital fraud is one of the most damaging forms of healthcare fraud. In many cases, these facilities are squandering taxpayer dollars while they collect government funding through programs like Medicare and Medicaid.

It can be hard to combat this type of substantial fraud without the help of internal whistleblowers, those with inside information on fraudulent activities. Thankfully, experienced hospital fraud attorneys know how to hold these healthcare providers accountable for their actions while protecting the whistleblower that comes forward.

If you or someone you know has information about hospital or healthcare fraud, contact The Vaughn Law Firm right away. The consultation is free and confidential.

What is Hospital Fraud?

Hospital fraud is also referred to as healthcare fraud. Healthcare fraud is a broad term that encompasses the behavior of a few dishonest healthcare providers. Although there are a wide variety of different types of hospital fraud, hospital fraud is generally when a medical facility seeks to increase its profit margin by engaging in false or fraudulent practices. Hospital fraud may increase the facility’s compensation and boost their bottom line, but it comes at the expense of taxpayers and those with private health insurance.

Common Types of Fraud in Healthcare 

There are several different ways that a hospital or other healthcare provider can commit fraud. They may “skim” a little money off the top here or there, or they may employ deeper and more troubling fraudulent tactics. Either way, healthcare fraud is illegal. Healthcare fraud isn’t a victimless crime either. The American taxpayer ends up spending more in healthcare costs to foot the bill while the hospital reaps the financial windfalls.

Some common examples of healthcare fraud include:

  • Charging for services not rendered
  • Charging for supplies not used
  • Upcoding for services rendered
  • Double billing
  • Bundling and unbundling bills
  • Providing kickbacks
  • Submitting falsified records
  • Falsifying medical necessity
  • Research grant fraud
  • Physicians with improper financial interests
  • Medicare or Medicaid fraud
  • Inflating or falsifying cost reports
  • Marketing drugs or devices for non-approved purposes

These types of practices can net a healthcare provider and shareholders substantial amounts of money.

Who Could Be a Healthcare Fraud Whistleblower?

Unfortunately, it can sometimes be difficult to track down which providers are fraudulently taking advantage of patients and the government. Often, it takes someone on the inside, with knowledge of these practices, coming forward to hold these healthcare providers accountable. These people are often known as “whistleblowers.”

A healthcare fraud whistleblower is an individual who is a current or former employee of a hospital. This person has clear knowledge or proof that fraudulent activity is being committed at the facility. Hospitals don’t always employ private staff to carry out all their daily activities. They often make use of independent contractors, consultants, and third-party vendors. These individuals may also be classified as potential health fraud whistleblowers.

What Compensation Is Available for a Hospital Fraud Case?

The False Claims Act, or FCA, makes it illegal to submit a false claim for payment if you are a government contractor, which most hospitals are. There is a provision of the False Claims Act called “qui tam.” This provision allows some whistleblowers to recover compensation for filing a complaint under the FCA.

Generally, a whistleblower may be eligible for between 15 and 25 percent of the total recovered funds if the government acts on the information provided. If a whistleblower chooses to pursue the matter with the help of their own attorney, and they are successful in holding the healthcare provider accountable in court, the whistleblower may be entitled to 25 to 30 percent of the recovered funds.

The Department of Justice secured over $2.2 billion in settlements and judgments from False Claims Act cases at the end of the 2020 fiscal year. Healthcare fraud cases involving drug companies, hospitals, and kickback schemes contributed to the total settlements for the year.

Can an Employer Retaliate Against a Healthcare Whistleblower?

This question is tricky. Can an employer retaliate against a whistleblower? Yes, they could choose to fire or take other measures against a whistleblower, which is why so many potential whistleblowers fear coming forward. Perhaps the more important question is, is it legal to retaliate against a whistleblower. The answer is no.

The False Claims Act offers protection to whistleblowers and prohibits employers from retaliating against these individuals. If an employer violates this section of the FCA, they can face more legal liability. The employee may also then become eligible for reinstatement if they were fired. An employee may also be entitled to additional compensation for lost income.

Contact Our Employment Attorneys for Help Today 

Fraudulent hospitals and healthcare providers will do anything to protect their profits. Who is going to protect you when these practices end up costing you your job? If you were retaliated against for reporting hospital fraud, contact an experienced employment attorney to talk about your legal options.

Fraud impacts everyone. Take a stand and fight back. Reach out to the legal team at The Vaughn Law Firm to speak with one of our experienced employment lawyers about your rights and legal options. Call us or reach out to us online today