The False Claims Act protects and awards whistleblowers who report Medicare and Medicaid fraud. Anyone with direct or indirect knowledge of fraud against government programs may become a whistleblower.
The most common type of fraud under the False Claims Act is healthcare fraud, specifically Medicare and Medicaid fraud. Whistleblowers may file “qui tam” lawsuits on behalf of the government against individuals or companies who commit healthcare fraud. Whistleblowers, called “relators,” may receive up to 30% of any recovery and up 25% of any recovery when the government intervenes.
Because most whistleblowers are inside employees who report fraud by their employer, the False Claims Act has provisions that protect whistleblowers from workplace retaliation. If retaliated against, a whistleblower may recover:
- Back pay
- Reinstatement of employment
- Severance pay
- Specific damages
- Punitive damages
- Attorneys’ fees and court costs
In 2018, the Department of Justice recovered $2.8 billion dollars in healthcare fraud under the False Claims Act. Medicare and Medicaid were hit harder by fraud than any other government programs. Examples of Medicare and Medicaid fraud include:
- Marketing of prescription drugs and devices through kickbacks
- Billing drugs or devices that not approved by the FDA
- Billing for unnecessary medical procedures
- Billing for work or tests not performed
- Unbundling billing
- Billing for physician when service was provided by an assistant or nurse