The federal False Claims Act gives citizens an incentive for reporting parties who submit false claims or false statements. When the government successfully recovers monies in these cases, whistleblowers are entitled to a percentage, plus attorney fees. The United States Department of Justice recovers billions of dollars in these qui tam cases.
Qui tam lawsuits are filed under seal, meaning whistleblowers must be the first to file the claims and be the original source of information. The government investigates and decides if they will prosecute. These days, health care industry qui tam cases are common, especially when they pertain to Medicare and Medicaid compliance.
Causes for Whistleblowing
Physician whistleblowing is seen in investigations into hospitals, group practices, and billing submissions. Others report illegal kickbacks and prohibited referrals under Stark law. Since physicians are often involved in procedural meetings and have access to information and documentation, they can have the knowledge to help detect industry abuse and fraud. They are thought of as reliable, credible sources. Additional causes for whistleblowing include:
- Stopping practices that are fraudulent or unlawful
- Divulging wrongdoing and misconduct
- Protecting patient safety
- Inappropriate treatment by employers
- Unfair termination, expulsion from joint ventures, and revocation of credentials or staff appointments
- Being excluded from transactions and arrangements that other physicians are benefiting from
- Disputes and conflicts with other health care providers, including threats
Protection for Physician Whistleblowers
Although physicians identified as whistleblowers may be shunned by co-workers, some organizations offer support; there are also laws in place to protect them. The Affordable Care Act’s Section 1558 bans employers from firing or discriminating against an employee’s compensation or any conditions or privileges of their employment for whistleblowing. This includes if the employee participated or assisted in a proceeding, will or already testified, or was unwilling to participate in practices that the employee felt violated the Act.
In addition, the Medical Whistleblower Advocacy Network offers support for physician whistleblowers who take action to protect patients and preserve human rights. Physician lawyers also help physician plaintiffs who make whistleblower claims.
Several whistleblower cases can illustrate how large settlements can be in these disputes. A physician whistleblower who spoke out about a chemotherapy infusion provider recovered over $280,000 in a $3.7 million settlement. The company was charged with unnecessarily extending treatment durations. Another physician blew the whistle on a nonprofit health care organization, who was accused of wrongly providing radiation oncology services. The patients were TRICARE and Medicare beneficiaries who were not properly supervised during the treatments. This physician received over $1 million.
Policies and Practices
All health care providers need to have current whistleblower policies that specify that employees are responsible for reporting concerns about illegal practices, violations, and unethical conduct. They should state that these individuals will not be harassed or subjected to retaliation. The procedures should focus on attorney-client privileges and be compliant with the Affordable Care Act. Health care industry officials should ensure that they are consistently adhering to the guidelines.
Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Support the Rights of Physician Whistleblowers
Effective physician whistleblower cases require trusted legal guidance, and our Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. are here to help. To schedule a free consultation today, contact us online or call us at 215-569-1999. Located in Philadelphia, we serve clients throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.