Fraud in our healthcare system is rampant. The National Health Care Anti-Fraud Association estimates that fraud cost our nation more than $90 billion in 2014. That amounts to about 3% of the $3 trillion spent on healthcare in the United States last year. As the politicians in Washington say, a billion here and a billion there - pretty soon you’re talking about some real money.

What created this situation, and why are so many health-care firms caught up in fraud scandals? Of course, waste, fraud and abuse in government programs is nothing new, but the aggressive pursuit of these firms involved in fraud is new. The government has a secret weapon and it lies within a revamped federal law known as the False Claims Act. Used in the 1980s to tackle fraud among defense contractors, the False Claims Act allows whistleblowers to file a lawsuit without a defendant’s knowledge, until the U.S. Department of Justice decides whether to join the case.

Also known as qui tam lawsuits, whistleblower civil cases brought under the False Claims Act reward persons who assist the government in stopping fraud. The veil of secrecy provided by this federal law encourages employees of companies involved in fraud to come forward without fear of immediate reprisals from their employers. But, the real motivation for whistleblowers may be the generous rewards provided by the False Claims Act.

Whistleblowers are entitled up to 30% of the dollar amount recovered. Douglas Durand, a whistleblower in two health-care fraud cases was rewarded with a $125 million bounty. John Kopchinski was awarded $51 million for his role in blowing the whistle on Pfizer pharmaceutical company.

A rash of health-care fraud cases have come to light in recent years. The nation’s largest for-profit healthcare provider, HCA Inc., agreed to pay $881 million to settle Medicare fraud charges. GlaxoSmithKline agreed to pay $3 billion to settle a case alleging the company promoted off-label use of some its drugs. DaVita Healthcare Partners paid $400 million to settle a case alleging it paid kickbacks to doctors. AstraZeneca, a British pharmaceutical company, settled with the U.S. government for $355 million. This company was allegedly providing American doctors with free drug samples knowing that these same doctors were billing Medicare for unwarranted reimbursement. And the list goes on.

Here's another story about someone blowing the whistle on healthcare fraud in nursing facilities. 

Northrop Grumman Corporation agreed to pay an $80-million joint settlement of two civil False Claims Act complaints filed by the U.S. Department of Justice. This settlement stemmed from allegations that Northrop Grumman made improper charges and defective products in contracts with the U.S. Department of Defense.

Whistleblower laws also apply to those who provide information about tax fraud, tax underpayment, or fraudulent practices in the banking and securities industry. 

The Tax Relief and Health Act of 2006 provides rewards to whistleblowers who provide information about tax fraud exceeding $2 million to the IRS.  

The Dodd-Frank Wall Street Reform and Consumer Protection Act rewards whistleblowers for revealing fraudulent practices in the banking and financial industry.

Bradley Birkenfeld, a former banker, was awarded $104 million in a tax evasion case against UBS bank. Another whistleblower was awarded over $30 million for exposing a fraudulent securities scheme.

You must get competent legal advice.  Let the Dunbar Law Office, P.C. guide you.  

If you think your company or anyone else is involved in cheating any government program including Medicare, Medicaid, Department of Defense contracts, the IRS, or banking and securities regulations, consider the protection and rewards provided by the False Claims Act. Also consider the importance of obtaining competent legal counsel in these high-stakes claims.

Whistleblower laws provide protection for those persons exposing fraud. Your identity can be kept secret initially while the claim is being investigated. There are also provisions in the law that protect you should you be fired, demoted, suspended, threatened, or discriminated against in any way by your employer. Good legal guidance is a must, however, to insure your rights.

Contact Attorney Thomas Dunbar at (601) 366-3170 for a free, initial consultation. It is very important not to delay reporting any acts of retaliation against you by your employer as quickly as possible. Several federal whistleblower laws have statutes of limitations as short as 30 days from the date of the act of retaliation.