Cases of fraud committed in the health care industry are obviously of paramount importance, because of the obvious issues of public safety. They also can make for successful False Claims Act cases because of the fact that the government is in an unusual position with regard to health care providers. Unlike many government programs, with health care, the government is an insurer and does not directly receive the benefit of its spending. Therefore, it can be relatively easier to pursue such cases. To learn more about the experience of being a whistleblower in the Healthcare industry, consult with a DC attorney today.
The first is fairly obviously safety. Usually, not always, but usually, fraud involving healthcare also affects the health and well being of people relying on such care. For that reason, everybody is a little bit sensitive to healthcare fraud cases.
For example, if there is no medical necessity to provide a service in healthcare, that means a person, for example, could be getting an X-Ray they don’t need. It may mean a person could even be getting a surgical procedure for no reason, or drugs they do not need. The incentive to provide un-needed care is extensive and of course can create a public safety and public health issue, and create a situation under which people are harmed as well as the government loses money.
#2 Government’s Relationship
The major reason that healthcare fraud cases present a different kind of case from other kinds of frauds committed against the government is that the government’s relationship to the provider of the healthcare service is very different than in, another general contracting situation. The government is essentially an insurer, a third party in most healthcare-related cases. The patient is the one who receives the service.
As a result, government officials don’t have a direct relationship with the provider. They have no way of knowing exactly what went on in the provision of the service. Usually, that can place the whistleblower in a stronger position to file the case against the defendant, the defendant cannot claim that the government had accepted the service or was aware of the fraud in this instance.
The Environment for Whistleblowers in the Healthcare Sector
Healthcare whistleblowers may have rights to provide information to the government, including the right to speak to counsel. They need these rights as all whistleblowers must be careful to avail themselves of such counsel since often, employers don’t like somebody coming along and pointing out that they are committing fraud against the government or that they are engaged in a practice that is harmful to people. Of course, being a whistleblower in the Healthcare industry is not going to win a lot of popularity contests. So it is not an activity that anyone should enter into lightly.
Whistleblowers should obtain counsel to know their rights and to try to change any organization involved in committing fraud. Unfortunately, most organizations do not really change through anyone’s effort to report directly or internally the fraudulent activity. Usually, such real change requires a lawsuit.