Healthcare and pharmaceutical whistleblower cases start with identifying fraud and attempting internal reporting before escalating to external agencies. While whistleblowers may face retaliation and other risks, they’re protected by the law and may receive significant financial rewards if their case is successful.
According to a study by Najar et al., published in the Archives of Public Health, medical fraud and abuse result in financial losses estimated at 3% to 15% of total healthcare expenditures annually. Not only is the sheer amount of money lost horrendous, but these situations often compromise patient safety as well.
So if you’ve noticed wrongdoing in a healthcare setting, then you might want to speak up. However, you might not be sure of the steps, and you’re afraid of potential repercussions, too.
Read on for a healthcare whistleblower guide that’ll walk you through the process.
What Are the Four Steps of Whistleblowing?
The four steps of whistleblowing are:
- Identifying the wrongdoing
- Internal reporting
- External reporting
- Legal protection and case resolution
Essentially, you’ll first recognize the wrongdoing by documenting evidence like emails or billing records. You can then report the concerns within your organization.
But if that doesn’t work, then you can escalate matters to external agencies, such as the Department of Justice (DOJ). From there, you can file a qui tam lawsuit under the False Claims Act.
What Are Five Consequences of Whistleblowing?
Whistleblowing can have both positive and negative outcomes. The five main consequences are:
- Financial rewards
- Organizational changes
- Retaliation risks
- Legal and emotional strain
- Public recognition or stigma
Understanding the False Claims Act in Healthcare
El Ley de reclamaciones falsas (FCA) is the cornerstone of most healthcare and pharmaceutical whistleblower cases. It specifically targets fraud against federal programs, and the law has helped recover billions in healthcare fraud.
In the case of healthcare and pharmaceuticals, the relevant federal programs are:
- Medicare
- Medicaid
- TRICARE
Fraudsters face treble damages and civil penalties, while whistleblowers get a share in the government’s recovery if they’re successful.
Common Types of Healthcare and Pharmaceutical Fraud
One of the most common types of healthcare and pharmaceutical fraud is billing fraud, where the offender charges for services not provided. They may also upcode or double bill.
Another is kickbacks, where illegal payments are made to physicians or pharmacies in exchange for prescribing certain drugs. Offenders may also promote drugs for uses that are not approved by the FDA, or they might artificially inflate prices of essential medications.
Lastly, there’s also clinical trial misconduct. Some people may falsify research data or fail to report adverse effects from a drug.
Protections Available for Whistleblowers
There are several federal laws that safeguard whistleblowers against retaliation, such as:
- Ley de reclamaciones falsas
- Ley de protección de los denunciantes
- Ley Sarbanes-Oxley
- State-level protections
Also, the good news is that you don’t have to prove intent. If you simply provide credible evidence of fraud, then that’s usually enough to trigger an investigation.
In addition, you may be able to get confidentiality protections, although this isn’t very common.
Best Practices Before Blowing the Whistle
First, consider the long-term impact. Understand the potential emotional, financial, and professional consequences before moving forward.
If you feel like blowing the whistle, then make sure to gather strong evidence first. Make sure you get secure copies of:
- Emails
- Contracts
- Billing records
- Reports
Next, consult a whistleblower lawyer. It’s crucial that you receive legal guidance, as healthcare and pharmaceutical cases are usually complex, and they’ll help with navigating whistleblower challenges.
Make sure you don’t share confidential information improperly and keep detailed records if your employer takes adverse actions against you.
Preguntas más frecuentes (FAQ)
How much can a whistleblower earn in a healthcare fraud case?
Under the False Claims Act, whistleblowers can attain rewards ranging from 15-30% of the government’s recovery. But do note that rewards aren’t guaranteed; they depend on the:
- Strength of the case
- Extent of government involvement
- Outcome of litigation
If you consult with a whistleblower attorney and receive healthcare and pharmaceutical whistleblower support, then this increases the likelihood of maximizing recovery.
What should I do if I suspect healthcare fraud but fear retaliation?
You should first document the suspected fraud with as much detail as possible. Then, if you consult with an attorney confidentially, you can fully understand your rights before reporting.
Both federal and state laws prohibit retaliation, so legally, your employer can’t demote, fire, or harass you for whistleblowing. So if retaliation occurs, you can:
- Seek reinstatement
- Back pay
- Daños y perjuicios
Can whistleblowers remain anonymous in pharmaceutical cases?
Initially, they can; when a qui tam case is filed under the False Claims Act, it’s filed “under seal.” During this period, your identity is kept confidential.
However, if the case moves forward or goes to trial, then anonymity is usually lost. In some cases, government agencies may allow limited confidentiality.
How long do whistleblower cases usually take?
Typically, healthcare and pharmaceutical whistleblower cases can take several years to resolve. This is because the cases are complex, especially when investigated by the DOJ, FDA, or OIG. These situations require extensive reviews of:
- Financial records
- Clinical data
- Compliance practices
While some cases settle in a few years, others may take over a decade. So if you want to proceed, you should be prepared for a long process. But often, successful cases result in significant financial recovery and industry reforms, so it’s worthwhile to be patient and follow through.
Healthcare and Pharmaceutical Whistleblower Cases
Now you have a general idea of the legal steps for whistleblowers, as well as how healthcare and pharmaceutical whistleblower cases go.
As you can see, it can be a complicated and long process, and it can be taxing for your emotional and mental health. The best thing you can do is be prepared, and more importantly, have a good whistleblower lawyer on your side. The right legal professional will be your advocate, and they’ll ensure that your case is as strong as possible.
Póngase en contacto con nosotros now to get your free video consultation. RHINO Lawyers has recovered almost $100,000,000 for our injured clients, and we’re here for you 24/7.
