Role of Medical Professionals in Healthcare Fraud Cases

In the healthcare industry, medical professionals play important roles in managing and reviewing the care, treatment, and procedures that are often at the heart of healthcare fraud whistleblower cases. Unfortunately, sometimes medical professionals are the individuals perpetrating the fraud, but in many cases they are the whistleblowers brave enough to step up and report the bad behavior.

If you have witnessed fraud or other illegal acts and believe you may have a case, consult with a False Claims Act healthcare lawyer today to discuss your case. The following is information on how medical professionals including doctors and nurses can be involved in healthcare fraud cases and whether doctors are often targets of FCA cases.

Can the False Claims Act Target Individual Doctors?

As a matter of fact individual doctors have been the target of False Claims Act cases. It isn’t the most prominent type of suit. Generally, you see more suits against larger institutions, but there have been individual doctors who have been sued under the False Claims Act successfully.

I have to say the cases that I’ve seen against doctors have been unbelievably egregious and one can’t imagine a normal doctor who goes about his or her business of providing a medical care appropriately getting anywhere near being sued under the federal False Claims Act. You really have to go out of your way to be ordering procedures that are completely unnecessary strictly for the purpose of making yourself more money.

I’ve seen doctors under those circumstances get sued under the False Claims Act, but it’s not an everyday occurrence, that’s for sure.

Is Healthcare Fraud Common Among Healthcare Professionals?

No, healthcare fraud is not typical for healthcare professionals. In fact, normally healthcare professionals (e.g., doctors, nurses) are the ones who come forward with information about large institution or corporation committing fraud. Normally, I find medical professionals to be the ones that come forward with the information about the fraud.

Typically medical professionals get upset because the fraud in a medical case tends to also undermine the care for the patient and most medical professionals get upset when that happens. It’s not that they’re out there looking over every bill or anything, but they notice when the institution, organization, or medical service provider is compromising care as a result or an attempt to make extra money.

I would say medical professionals come forward with information and expertise as well, but mostly with information as to how the government is being ripped off.