If you’re a witness to wrongdoing by another physician, a hospital, or a pharmaceutical company, you can share in up to 15% of a settlement that’s often in the vicinity of tens of millions of dollars, according to an article in JD Supra.
Whistleblowers were responsible for $3 billion of the $3.8 billion-plus recovered by the US Department of Justice in 2013 under the False Claims Act. Of the total recovered, $2.6 billion came from healthcare entities. And whistleblower-physician plaintiffs are getting rewarded mightily for successful claims—typically receiving a percentage of the government’s recovery, plus attorney fees.
“Whistleblower claims in the healthcare industry have become commonplace, particularly in matters relating to Medicare or Medicaid compliance,” wrote attorneys Michael Joseph and Ron Shinn in the JD Supra article. These claims can involve a range of practices, such as billing, coding, and claims submissions by hospitals, surgery centers, medical device manufacturers, medical group practices, nursing homes, or others. The authors added, “They can also arise based on prohibited referrals under the Stark law and illegal kickback arrangements involving healthcare providers, physicians or others.”
An increasing number of whistleblower claims for fraud against the government may be due in part to the Affordable Care Act, which expanded individuals’ ability to bring a claim and offered protections against employer retaliation. A growing number of cases are being brought by physicians, and apparently, when physicians talk, prosecutors listen—especially in cases of healthcare fraud.
Fraudulent healthcare practices can be difficult to unearth, let alone prove, but physicians often have access through workplace meetings or discussions when wrongdoing might be revealed. They are also considered reliable sources of information because of their physician status and medical knowledge.
Of the 67 healthcare-related lawsuits unsealed in recent months, according to the National Law Review,85% of the plaintiffs were current or former employees of the defendants, including former executives.
Motivation for blowing the whistle varies, aside from the obvious financial incentive. It ranges from an honest desire to stop abuse to disagreements with colleagues, competitive concerns, and post-termination vengeance. The range of plaintiffs is wide and has even included hospitals chiefs of staff, academic department chairs and mainstream physicians. There’s even a Medical Whistleblower Advocacy Network, if there’s a wrong you’d like to right.