Reporting healthcare fraud is important. When healthcare entities provide medically unnecessary services or improperly bill the federal government for services provided (or not provided) to Medicare and Medicaid patients, it is often up to their personnel, contractors, and other individuals to come forward and help protect the integrity of the healthcare system. In most cases, this involves initiating a whistleblower case under the federal False Claims Act (FCA), and talking to an experienced healthcare whistleblower attorney is the first step in the process.
The FCA protects whistleblowers who expose healthcare providers’ fraud, waste, and abuse, and it also provides financial incentives in many cases. Under the FCA, the U.S. Department of Justice (DOJ) can pursue both civil and criminal enforcement actions in cases of suspected fraud, and these enforcement actions can be critical for both holding healthcare entities accountable and preventing additional fraudulent practices going forward.
“For individuals who have information about fraud in the healthcare sector, reporting wrongdoing to the federal government plays an important role in the government’s never-ending fight against healthcare fraud, waste, and abuse. Healthcare whistleblowers can expose all types of fraudulent schemes, and they can hire an experienced attorney to represent them at no out-of-pocket cost.” – Dr. Nick Oberheiden, Founding Attorney of Oberheiden P.C.
While engaging legal representation isn’t required when reporting healthcare fraud under the FCA, there are several benefits to hiring an attorney who has experience representing whistleblowers in these cases. If you think you may be able to report healthcare billing fraud under the FCA—or report any other form of healthcare fraud—this article provides an overview of the factors you should consider when choosing a healthcare whistleblower attorney to represent you.
Here Are Some Key Considerations for Choosing a Healthcare Whistleblower Lawyer
Here are 10 key considerations for choosing a healthcare whistleblower attorney to help you report healthcare billing fraud (or any other type of healthcare fraud) to the federal government:
1. Level of Experience Representing Healthcare Fraud Whistleblowers
The first key consideration, and potentially the most important, is the attorney’s level of experience representing healthcare fraud whistleblowers. Healthcare fraud cases are complex, so you will want to look for an attorney who has successfully represented clients in these cases in the past.
The attorney you choose should be intimately familiar with federal whistleblower law and the False Claims Act’s (FCA) prohibitions on fraudulent billings and other forms of fraud under Medicare, Medicaid, Tricare, and other federal healthcare programs. An attorney who has extensive experience exposing “false and fraudulent” claims in healthcare should be able to help you make informed decisions and represent you effectively if you decide to come forward.
2. Level of Experience Representing Clients in the Healthcare Industry
Along with experience representing healthcare fraud whistleblowers, you may also want to look for a lawyer who has experience representing clients in the healthcare industry. A lawyer who helps healthcare entities manage federal billing compliance and avoid violations of the False Claims Act, Anti-Kickback Statute, and Stark Law will likely have the insights needed to thoroughly evaluate the information you have in your possession and determine whether a clam for Medicare or Medicaid fraud is warranted.
Some prospective whistleblowers assume that they don’t want a healthcare industry lawyer on their side. But, this isn’t necessarily the case. Any law firm that takes on your whistleblower case has a legal and ethical obligation to put your best interests first. Not only that, but a law firm that represents healthcare entities in federal matters is likely to have experience working with the DOJ and other relevant government agencies as well, and will be able to use this experience to help you report fraud efficiently, effectively, and confidentially.
3. Knowledge of Healthcare Billing Fraud and Other Common Issues in Healthcare
In any case, you will want to choose a whistleblower law firm with attorneys who are knowledgeable about healthcare billing fraud and other common issues in healthcare. Medicare fraud, Medicaid fraud, and other common forms of healthcare fraud implicate a variety of federal statutes, rules, and regulations. Since coming forward and securing whistleblower protection under the FCA involves filing a qui tam lawsuit in federal court, it is imperative that your legal team is intimately familiar with all of the substantive and procedural requirements that apply.
4. Knowledge of the Procedures Involved in False Claims Act Cases
Speaking of the procedural requirements that apply in healthcare whistleblower cases, there are specific procedures for coming forward to expose violations of the False Claims Act. Even if you have information about phantom billing, upcoding, accepting illegal kickbacks, or any other violation of the law, if you don’t disclose this information correctly, you won’t qualify for whistleblower protections or a financial reward. Experienced healthcare fraud attorneys will know what it takes to establish your legal rights as a whistleblower, while those who practice in other areas may not immediately know where to start.
5. Prior Experience Prosecuting Healthcare Fraud for the Federal Government
Another factor you may want to consider is whether a particular attorney has prior experience prosecuting healthcare fraud for the federal government. Some healthcare whistleblower attorneys prosecuted healthcare fraud at the DOJ before entering private practice. These trial lawyers may have particular insight into how and when the DOJ prioritizes healthcare fraud enforcement, and they will almost certainly be familiar with the procedures for disclosing alleged fraud in healthcare under the False Claims Act’s whistleblower provisions.
6. Law Firm Size, Capabilities, Resources, Practice Focus, and Reach
Due to the complexity of healthcare fraud cases under the False Claims Act and the amount of work involved in successfully pursuing a qui tam lawsuit, you will want to look for a law firm that has a team of attorneys who are prepared to get to work on your behalf. When comparing law firms, some key considerations include:
- Size – You will want to choose a law firm with a legal team that is large enough to pursue your healthcare whistleblower case efficiently.
- Capabilities – You will want to choose a law firm that has the capabilities, in terms of personnel and technological resources, to handle the nature and volume of work involved in your case.
- Resources – You will want to choose a law firm that has the resources required to thoroughly investigate the fraud at issue and work effectively with the DOJ on your behalf.
- Practice Focus – You will want to choose a law firm that focuses on helping whistleblowers report misconduct and representing clients in other federal healthcare fraud matters.
- Reach – You will want to choose a law firm that has the reach to work with you locally no matter where you live.
These are just examples. As discussed below, you will ultimately want to choose a law firm that gives you confidence and that you feel you can trust without reservation.
7. Level of Experience with Private Insurance Fraud and Other Related Matters
Along with experience representing whistleblowers in federal healthcare fraud matters, you may want to choose an attorney who has experience with private insurance fraud and other related matters as well. An attorney who can evaluate all of the potential legal issues implicated in your case will be able to help ensure that you are making a fully informed decision about whether to file a qui tam complaint and help the federal government seek to recover funds for fraudulent program billings, improper referral fees, or other matters covered under the False Claims Act (FCA).
8. Availability to Begin Advising and Representing You Immediately
If you need to speak with an attorney about filing a qui tam complaint under the False Claims Act, you should be able to schedule a free consultation today. Time is often of the essence in these cases, and your ability to secure protected whistleblower status should not be jeopardized by unnecessary delays.
9. Preparedness to Fully Pursue a Qui Tam Lawsuit on Your Behalf
Along with being prepared to assist you immediately, the attorney (or law firm) you choose should also be prepared to fully pursue a qui tam lawsuit on your behalf. As discussed above, these are complicated cases that involve working with the DOJ to prove fraud, waste, or abuse. While healthcare whistleblowers must file lawsuits under the FCA to initiate the process, this is truly just the first step. As a result, the attorney (or law firm) you choose should be prepared to effectively handle your case every step of the way.
10. Your Level of Comfort and Confidence in the Healthcare Whistleblower Attorney’s Ability to Represent you Effectively
While a proven track record and deep experience helping whistleblowers expose fraud in connection with designated health services are relevant considerations, ultimately, you should make your decision based on how you feel. Do you feel comfortable and confident in the attorney’s (or law firm’s) ability to represent you? Or, do you feel like you should speak with someone else before moving forward? If you do not feel like a particular attorney (or law firm) is the right choice for you, you should not hesitate to schedule another free initial consultation.
