How to Report a Clinic for Healthcare Fraud

The state and federal governments pay hundreds of billions of dollars each year for pharmaceutical drugs, medical devices, hospital care, outpatient services, physician visits, and nursing home care. In making payments for these services, the government relies on clinics, companies, and individuals to abide by the law and submit accurate reimbursement requests. Unfortunately, experience has shown that many clinics, companies, and individuals violate this “honor system” and submit false or fraudulent requests for payment. Indeed, whistleblower lawsuits in the healthcare fraud area have resulted in billions of dollars in recoveries.

Reporting Your Clinic’s Fraud Internally

If you work for a healthcare clinic and discover that another employee is committing healthcare fraud, one option is to contact your clinic’s compliance officer, human resources manager, supervisor, or (if your company has one) your hotline to report the fraud internally. As common sense dictates, there are risks inherent in reporting (and not reporting) suspicions of fraud internally. If and how to report fraud depends on your clinic and your clinic’s policies and directives.

Reporting a Clinic for Healthcare Fraud Through Government Avenues

Depending on the type of healthcare fraud, another option could be to contact the government directly through websites and phone numbers. For example, to report a clinic for Medicaid fraud, an individual may contact one of the agencies listed on the Centers for Medicare & Medicaid Services website.

Reporting a Clinic’s Healthcare Fraud Using the False Claims Acts

The federal False Claims Act is codified at 31 U.S.C. 3729, et seq.  The District of Columbia and numerous states have passed False Claims Acts. These laws encourage private individuals to help the government fight fraud by providing whistleblowers with a financial reward if the suit is successful. The reward to the whistleblower is normally between 15% — 25% of the amount recovered, plus attorney’s fees. There are various types of fraud which can be pursued under these federal and state statutes, including healthcare (Medicare and Medicaid) fraud.

Selecting an Attorney to Report Fraud Using the False Claims Acts

In order to report fraud by utilizing the False Claims Acts, it is important to first contact an experienced False Claims Act attorney to guide your though the process of investigating and filing a complaint.  Things to look for in a False Claims Act attorney include:

1. the ability to efficiently evaluate a case,
2. whether that attorney has litigated False Claims Act cases before,
3. the attorney’s relationship with government prosecutors,
4. the attorney’s skills/abilities- including the ability to present your case, and most importantly,
5. whether you trust and respect the attorney.