Unmasking Healthcare Fraud: A Whistleblower’s Journey

August 25, 2023
Unmasking Healthcare Fraud: A Whistleblower’s Journey

The Prevalence and Impact of Healthcare Fraud

Health care fraud is a serious offense with far-reaching consequences, impacting individuals businesses and resulting in substantial financial losses amounting to tens of billions of dollars annually. These civil and criminal components of healthcare fraud are  far from victimless, affecting society as a whole by contributing to increased health insurance premiums, subjecting people to unnecessary medical procedures and thereby potential patient harm, and even driving up tax burdens. 

Perpetrators of health care fraud include not only medical providers but also patients and other individuals who intentionally deceive the health care system to gain unlawful benefits or illicit payments.  However, some of the best whistleblower law firms only file cases against the entities that defraud the system, not against the patients.  Addressing and combating health care fraud is essential to protect the integrity of the health care system and ensure that it serves its intended purpose of providing genuine care and support to those in need.  

Common Types of Healthcare Fraud

  1. False Billing: In the healthcare industry, false billing occurs when medical providers submit claims for a variety of schemes, such as services never rendered to patients. 
  2. Unnecessary Treatments: Even worse than billing for something that wasn’t done, is billing for something that was done to the patient that didn’t need to be done.  Some doctors and facilities engage in healthcare fraud such as Medicare and Medicaid Fraud by providing unnecessary treatments solely to bill insurance policies.  
  3. Double Billing: This scheme involves billing a patient’s insurance policy twice for a single appointment, using duplicate claims with minor alterations.
  4. Service or Item Upcoding: Healthcare providers use higher-paying codes for services or medical devices than those actually provided to increase profits.  The provider may exaggerate the amount of time spent with the patient versus 

The Critical Role of Whistleblowers in the Healthcare Industry

Whistleblowers play a crucial and invaluable role in protecting the integrity of the healthcare industry. Their courageous actions in exposing fraud, misconduct, and deceptive practices help protect patients, taxpayers, and the overall healthcare system. By shedding light on wrongdoing, whistleblowers initiate investigations that can lead to substantial recoveries of misspent funds and hold accountable those who engage in unethical practices.

The significance of whistleblowers is further emphasized by the availability of whistleblower awards under laws like the False Claims Act. These awards provide financial incentives to individuals who come forward with credible information about fraud, leading to successful recoveries of up to 30% of what the government recovers. By partnering with a reputable whistleblower law firm experienced in handling such cases, whistleblowers can maximize their chances of success. An experienced law firm not only ensures that the case is meticulously prepared but also provides essential guidance and support throughout the complex legal process.

Speak with the Lawyers at Brown, LLC Today!

Over 100 million in judgments and settlements trials in state and federal courts. We fight for maximum damage and results.

How Brown, LLC Assists in Bringing Healthcare Fraud to Light

Brown, LLC stands as a formidable force in litigation, with an impressive history of securing hundreds of millions of dollars in settlements and judgments, although past results don’t guarantee future success. Our seasoned litigation team has a proven track record of taking cases to verdict in State and Federal Courts nationwide, including obtaining maximum relief under the law on numerous occasions. We are driven by passion and dedication to our clients.

We prioritize your needs, making ourselves available for questions and concerns beyond regular business hours and even on weekends. Confidential consultations are offered free of charge on a wide range of matters. Reach out to our litigation lawyers at (877) 561-0000, and experience how we  take on some of the most formidable adversaries in the country  – and often win….

At our whistleblower law firm, we appreciate  the significance of fighting for whistleblowers and standing against injustice. If you are considering blowing the whistle on wrongdoing, we have the experience to support you throughout the process and strive to achieve the best possible outcomes.

Legal Protections and Potential Rewards for Healthcare Whistleblowers

Healthcare whistleblowers play a vital role in uncovering fraud, abuse, and unethical practices within the industry. Recognizing the importance of their contributions, several legal protections and potential rewards are available to support and incentivize whistleblowers:

  1. False Claims Act (FCA) Protections: The FCA offers legal protection to healthcare whistleblowers prohibiting retaliation by their employers. If a whistleblower faces adverse actions such as termination, demotion, or harassment as a result of their disclosures, they can seek remedies under the FCA.
  2. Whistleblower Rewards: Under the FCA, whistleblowers may be eligible for financial rewards if their disclosures lead to successful recoveries of funds by the government. The rewards typically range from 15% to 30% of the total amount recovered, providing a significant incentive for individuals to come forward with credible information.

Client Experiences: Successful Healthcare Fraud Cases Handled by Brown, LLC

One of the most recent cases whistleblower settlements under the False Claims Act by Brown, LLC was for $22.9 million involving kickbacks in exchange for Medicare patients. The whistleblowers asserted that the defendant paid doctors to serve as sham “medical directors,” enticing them to refer their Medicare and TRICARE patients, even though the payments were just a disguise for the kickback and the directorships didn’t carry any substantive duties. Some of the biggest whistleblower settlements have been for kickback schemes,

The wide world of healthcare fraud is very vast.  If you see something, say something or else the government may view you as part of the problem, not the solution.  If you suspect healthcare fraud is going on, learn about your rights and call (877) 561-0000 for a free confidential consultation.