The Importance of Whistleblowers to Help Detect Crime and Fraud

Whistleblowers are people who expose activities or information that are considered unethical or illegal. Some government programs, such as Medicare, rely heavily on whistleblowers to report criminal activity. In a recent interview, former U.S. Attorney General Jeff Sessions said more than 10 percent of Medicare’s budget is lost to waste and fraud. He stated that far too many taxpayers’ dollars are lost due to healthcare fraud and the taxpayers must remain vigilant to help combat such fraud. Every dollar lost to healthcare fraud is less money available for life-saving services required for Medicaid and Medicare beneficiaries.

Whistleblowers and the False Claims Act

The federal False Claims Act (FCA) includes some of the strongest whistleblower protections designed to combat fraud and reward the whistleblower for reporting it. Under the FCA, a whistleblower with evidence of wrongdoing involving a Government contract or program has the authority to sue the perpetrator on behalf of the Government. These actions are referred to as qui tam actions, and the Government has the right to intervene in (take over) the lawsuit. In the event the Government declines intervention, the whistleblower may pursue the claim, through his or her own lawyer, on behalf of the Government.     The latter involves a higher reward for the whistleblower, but the case proceeds without the benefit of the Government’s resources.

In the 2017 fiscal year, the U.S. Department of Justice recovered nearly $4 billion in judgments and settlements that involved false or fraudulent claims submitted to the United States government. Of this total, $2.4 billion was related to fraud committed by those in the healthcare industry, including hospitals, laboratories, pharmacies, physicians, and drug manufacturers. This number reflects federal losses only. Many of these lawsuits also included millions of dollars in state Medicaid programs.

What Actions are Illegal Under the FCA?

A number of activities are deemed illegal under the FCA. Some of these include:

• Conspiring to present a false claim;
• Billing the Government for services or products that were not provided;
• Charging Government payors more for a product or service than is charged to others;
• Purchasing property from a Government employee or officer who doesn’t have legal authority to sell it;
• Presentation of a false or fraudulent claim to the Government for payment; or
• Using a false statement or record that is material in relation to paying an obligation to the Government.

Whistleblowers often have proven key to the Government’s detection and recovery of dollars paid out for false claims.

Retaining a Whistleblower Qui Tam Attorney

It is a reality of the marketplace that companies and people commit fraud  daily, including the submission of false or fraudulent claims to the Government. Under the FCA, the Government encourages whistleblowers who know about fraud against the Government to report it  and to bring an action under the FCA.

The FCA and the federal statutes and regulations that govern different industries, including healthcare, are complex.  As a result, it’s important that if you have information demonstrating a fraud against the Government for which you want to receive a reward, you should speak with a skilled whistleblower qui tam attorney. The attorneys at Rabin Kammerer Johnson have national experience in successfully pursuing whistleblower qui tam claims on behalf of the Government, resulting in millions of dollars in recoveries. To schedule a consultation, call our office at 561-659-7878 or toll free at 877-915-4040.

Resources:

aarp.org/money/scams-fraud/info-2018/jeff-sessions-interview.html

justice.gov/opa/pr/justice-department-recovers-over-37-billion-false-claims-act-cases-fiscal-year-2017