Medical providers billing federal insurance programs for false claims unquestionably contribute significantly to fraud-related medical losses in the United States. However, policing medical billing can be very difficult for the government to do, which is one reason why fraud allegations often result from the actions of a whistleblower.
Under the False Claims Act, individuals with information about false claims and fraudulent billing practices can bring qui tam claims against their employer in court. Effectively, a whistleblower involved in a qui tam claim sues a company on behalf of the federal government and uses their own knowledge to provide evidence to validate their claims.
There are certain protections for whistleblowers in place under the False Claims Act which make qui tam claims more reasonable for an individual to pursue.
How the government protects whistleblowers
First of all, there are federal rules that specifically prohibit employer retaliation against whistleblowers. If an individual alerts regulatory agencies, a government official or management within the company itself about potential illegal billing and claims activity, that individual has protection from retaliatory actions by their employer.
Common forms of retaliation include termination, abuse in the workplace, fewer or worst shifts or even poor performance reviews despite nothing changing in the worker’s performance.
Not only does your employer face consequences if they retaliate against you for initiating qui tam proceedings, but you also stand to potentially gain a financial reward for doing the right thing, as the government allows those who bring qui tam proceedings to potentially claim a portion of the amount fraudulently billed, up to 30% of any amount recovered.