I Think the Medical Provider I Work for May Be Committing Fraud. What Should I Do?


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Finding out that your employer may be doing something that is not only unethical, but also illegal, can be a stressful situation, wrought with anxiety. When your employer is a healthcare provider, it may be even worse, because it’s expected that those in the medical profession are focused on helping people, not taking advantage of them. 

If you believe that the doctor or hospital you work for is committing fraud, you are likely wondering what steps you should take to stop it. You may also be hesitant to be a whistleblower because you don’t know what will happen to you and your career. There are some steps that you should take as you decide what to do to protect yourself. 

The Most Important Step When You Suspect Your Employer of Fraud

The first, and most important, step is to contact an attorney who is experienced with whistleblowing cases. That way you will have someone in your corner who is able to advise you about your rights and how you should proceed. Your attorney will also be able to help you determine the best way to report your employer’s behavior to the correct authorities, as well as advising you on practical aspects, like whether and to what extent you can secure evidence from your employer’s office. 

What is the False Claims Act and What Do I Need to Bring a Claim? 

The False Claims Act allows someone with evidence of fraud involving federal contracts or programs to file a claim against the offender on behalf of the U.S. Government. In these types of actions, called Qui tam, the government has the right to join the action that is filed. If they decline to do so, the plaintiff can proceed with their own claim. 

To have a successful whistleblower case, you have to adopt the mindset of an investigator, thinking to yourself about what evidence you need in order to prove that your employer is committing fraud. When you report your suspicions to your attorney, you will likely be advised about what you will need to prove your claim. For example, if you suspect that the physician you work for is operating with electronic health records (EHR) software that doesn’t meet the federal requirements of confidentiality, and the provider knows it, then you may gather evidence that proves as much.  

Gathering this type of evidence can be difficult, which is yet another reason to work with an attorney who is experienced with whistleblower cases, one who can provide advice to you in your evidence collecting efforts. Additionally, the False Claims Act limits the situations where a whistleblower can file a case pro se (on his or her own), so an attorney is required. 

It’s advisable that you begin to document the fraud that you suspect by making your own notes – the more details the better. These types of investigations can be very lengthy, so it’s important that you are able to recall all the details that could potentially become hazy over time. 

Do I Have to Report the Fraud Internally? 

If you work for a large organization, you may wonder about reporting your suspicions internally, perhaps to another department. While you can make such reports (some companies even have an anonymous hotline to report suspected violations), but under the False Claims Act, you are not obligated to do so. If you suspect your employer of Medicare or Medicaid fraud, you may also submit a complaint to the Office of the Inspector General for the Department of Health and Human Services. 

Again, it’s important that you discuss these options with your attorney before you act. While there are protections in place for whistleblowers, you can suffer personal and professional consequences as your complaint or claim is being investigated. Having an attorney to advise you about the decision of whether to report your claim internally may help you avoid some of those negative consequences. 

Steps for Whistleblower Cases 

To sum up, if you believe that the medical provider that you work for is committing fraud, there are three important steps you should take. The first is to find an experienced whistleblower attorney to walk you through the next steps. Next, gather evidence to support your suspicions. Finally, with your attorney, determine whether you will report your employer internally. 

If you suspect that your employer is committing fraud against the government and you want to do the right thing, Ross Feller Casey can help you with how to proceed. Our whistleblower attorneys are experienced with these types of case and they can ensure that your rights are protected. 

Contact the offices of Ross Feller Casey for an evaluation of your case and advice on how to proceed with your claim. 

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