Any employee could become a whistleblower. A professional who discovers illegal activity or unsafe working conditions may need to notify their employer of the issue. Other times, when it is clear that the organization knows about the problem, it might be necessary to involve regulatory agencies.
Workers who report their concerns internally or who cooperate with government agencies have protection as whistleblowers. Some workers may also choose to take legal action against their employers as whistleblowers.
Under the False Claims Act, professionals with information about inappropriate billing practices involving the government can initiate a lawsuit against their employer on behalf of the government. Medical professionals are among those who may need to consider initiating a qui tam lawsuit.
What happens during a qui tam lawsuit?
A medical billing specialist, insurance coder or office manager might learn that their employer has engaged in billing fraud. Newly-licensed professionals working at a medical practice may recognize that how the company bills is inappropriate.
Maybe the hospital that hired them bills Medicare for appointments that patients do not attend. Perhaps management has instructed coding specialists to unbundle discounted medical procedures to charge more than the agreed-upon amount for medical services. When health care professionals are aware of billing fraud, they file a qui tam lawsuit as a relator.
They are a plaintiff taking action on behalf of the government. The government may choose to assume control over the lawsuit or may allow the relator to oversee the litigation process. The relator must present evidence that proves that their employer has engaged in fraudulent billing.
If the lawsuit is successful, the medical business may face an order to compensate the government for inappropriate billing practices. The whistleblower who acted as a relator can receive a portion of those funds in compensation for their services.
Not only do whistleblowers who file successful qui tam lawsuits have the right to a portion of the money recovered through litigation, but they also have legal protection from employer retaliation. They should not lose their jobs or face other career consequences for taking necessary actions.
Choosing to speak up as a medical whistleblower can leave professionals anxious about their income and their future professional prospects. Having accurate information about the process and appropriate support when contemplating a qui tam lawsuit can help medical whistleblowers protect themselves.
