The False Claims Act is a powerful shield for whistleblowers who report Medicare fraud and Medicaid fraud.  The FCA allows whistleblowers to file claims as “relators” on behalf of the government, and the Act rewards the whistleblower from 15% up 30% of funds that are collected.

The False Claims Act does not stop there: it also protects whistleblowers from workplace retaliation. Under Section 3730(h), an employee who is harassed, demoted, fired, or otherwise discriminated against for reporting, in good faith, or making a claim under FCA, may be entitled to:

  • Reinstatement;
  • Double back pay;
  • Compensation for any special damages including litigation costs and reasonable attorneys’ fees.


HIPPA and Fraud Reporting

Another law, 45 C.F.R 164.502, contains an exception to HIPPA privacy rules. Under this exception, it is permissible for an employee or business associate of a covered entity to disclose personal health information (PHI) if that individual believes in good faith that the covered entity has:

  • Engaged in unlawful conduct;
  • Engaged in conduct that violates professional or clinical standards; or
  • Provided care, services or conditions that potentially endanger patients, workers or the public.

IMPORTANTLY, the disclosure of PHI must be made ONLY to:

  • A health oversight agency or public health authority legally authorized to investigate the alleged violations;
  • A healthcare accreditation organization, for the purpose of reporting violations of professional or clinical obligations; or
  • An attorney retained by the worker or business associate for the purpose of determining their legal options with respect to the observed misconduct.

It is important to speak with a lawyer who has experience in the False Claims Act prior to reporting Medicare and Medicaid fraud.  Understanding Medicare & Medicaid fraud is crucial for a successful outcome under the False Claims Act.

If you are considering becoming a whistleblower, contact Miller Law Group for a free consultation, or call 919-348-4361.