Founder
Healthcare fraud drains billions of dollars from our healthcare system every year, affecting patients, providers, and taxpayers alike. As a healthcare professional, you are uniquely positioned to identify and report fraudulent activities that might otherwise go undetected. Taking action not only helps protect patients but also preserves the integrity of our healthcare system.
As a healthcare employee, you have protections under the law when it comes to avoiding repercussions for reporting fraud in your workplace. However, it is essential to know what steps to take to report fraud effectively while protecting your rights.
Recognizing Common Healthcare Fraud Schemes
Before reporting suspected fraud, it helps to understand what constitutes fraudulent activity. Some typical schemes include:
- Billing for Services Never Performed – Healthcare providers submit claims for procedures that didn’t actually take place
- Upcoding – Providers charge for more expensive procedures than what they actually performed
- Medically Unnecessary Services – Providers perform and bill for treatments that patients don’t need
- Kickback Arrangements – Providers pay for patient referrals or prescribe certain medications in exchange for compensation
- Unbundling – Providers break up a procedure into separate components to increase reimbursement
Whether you suspect one of these activities or another unscrupulous practice, a knowledgeable attorney can help you know what steps to take to file an effective report.
Effective Steps to Report Healthcare Fraud
If you’ve witnessed fraudulent activities in your healthcare workplace, follow these steps to report them effectively:
- Document Everything – Record dates, times, people involved, and specific details about the suspected fraud.
- Gather Evidence – Collect copies of relevant documents, emails, or other materials that support your allegations.
- Consult with an Attorney – Speak with a lawyer experienced in whistleblower cases before taking further action.
- File a Report – With legal guidance, submit your information to the appropriate authority.
- Maintain Confidentiality – Limit discussions about your report to your attorney and authorized investigators.
Whistleblower Protections
The law recognizes how much courage it takes to report fraud and provides strong protections for whistleblowers. The False Claims Act and other federal and state laws prohibit employers from retaliating against employees who report healthcare fraud. These protections cover:
- Wrongful Termination – You cannot be fired for reporting fraud.
- Harassment or Discrimination – Employers cannot create a hostile work environment because you reported fraud.
- Demotion or Reduction in Hours – Your position and schedule cannot be negatively altered as retaliation.
- Blocklisting – Employers cannot interfere with your future employment opportunities.
The Role of a Whistleblower Attorney
Working with an experienced whistleblower attorney offers several advantages. To begin, they can assess the strength of your case before you take action. Your attorney can then use their legal knowledge and experience to help you understand which laws apply to your situation and how to proceed. Once you begin the process, they can give you guidance on everything from filing the initial report to potential litigation.
Most importantly, attorney-client privilege protects your communications. Furthermore, whistleblower attorneys typically work on a contingency basis, meaning you pay nothing unless your case results in a recovery.
Financial Incentives for Whistleblowers
While protecting patients and the healthcare system motivates many whistleblowers, the law also provides financial incentives. Under the False Claims Act, whistleblowers can receive between 15 and 30 percent of funds recovered by the government. These awards recognize the personal and professional risks whistleblowers take when reporting fraud.
Contact Herman Law Group Today
At Herman Law Group, we understand the challenges healthcare professionals face when reporting fraud. Attorney Louise Herman has successfully represented whistleblowers who have exposed fraudulent practices and helped recover millions in taxpayer dollars. If you suspect healthcare fraud in your workplace, contact us today for a confidential consultation. Together, we can work to reduce fraud in our healthcare system and help resources go toward quality patient care rather than fraudulent schemes.