Does the Government Want to Take Healthcare Fraud Whistleblower Cases?

Below healthcare fraud whistleblower lawyer Tony Munter discusses the government’s attitude toward healthcare fraud whistleblower cases and how the government decides whether or not to take on a case. To learn more or discuss your case call today to schedule a free consultation.

Why Do You Think There Are So Many Healthcare False Claims Cases?

There are a lot of reasons. One of the reasons is that, first of all, there is a ton of money spent on healthcare. It’s going to be about $600 billion for Medicare alone this year, so obviously there’s a huge pool of money that’s involved. The other thing I think that’s interesting is that the contractual relationship between the government and the healthcare provider is different than it is in almost every other false claims type of case.

In these cases, the government pays for the service, but the government doesn’t actually receive the healthcare, an individual goes in and fills the prescription or is treated at the hospital or whatever. So, strangely enough, that can make it an easier case to bring as a False Claims Act matter than many other types of cases.

That contractual relationship can make it a more attractive case for lawyers to bring cases and obviously the importance of the subject matter is another reason why people are always considering bringing healthcare cases.

How Does the Government Decide Whether to Take a Healthcare Fraud Case?

I think it’s a little tricky to say what the government is looking for because there’s no rule book. I would say though that the government probably is looking for pretty much the same things that everybody is looking for in a case like this. They get many cases and they don’t have the resources to join the action in every single one of them. They want to know that the case is good from the standpoint of being provable in terms of liability and that the credibility of the information presented to them is real. They want to know that there is some real money at stake so that if they pursue it, then they have a chance of making a real recovery for the government.

Also, you do have the issue of patient harm. If there is patient harm, then understandably I think the government treats the case with even more seriousness. Everybody wants to be able to prevent practices that create patient harm. After all, the government has an interest in the healthcare of its citizens and if the False Claims Act can facilitate better healthcare, then that’s a good thing. So, I think those are the things that the government looks for.

These cases are complex and require a lot of analysis. They’re usually analyzed on an individual basis to determine just how good they are.