Whistleblowers play a crucial role in alerting law enforcement to fraud and to assisting in bringing the perpetrators to justice. Based upon the information of whistleblowers, the U.S. government has been able to recoup considerable money paid in fraudulent schemes. Yet, whistleblowers bear a substantial risk for coming forward. Fortunately, the laws protect whistleblowers from retaliation for doing the right thing and, in some cases, allow the whistleblower to stake a claim to a portion of the money recouped by the state or U.S. government agencies.
Schneider Wallace Cottrell Konecky Wotkyns LLP advocates for the rights of whistleblowers who report healthcare fraud, kickbacks, Medicare fraud, pharmaceutical fraud and procurement fraud. Our lawyers take decisive, assertive action to ensure the whistleblower is treated fairly and is aptly rewarded for the risks she or he took.
What Are Whistleblower Rights?
Whistleblowers rights are governed by several state and federal laws, but generally include:
- Freedom from retaliation for reporting unlawful activity or for cooperating with an investigation
- Damages resulting from an employer’s retaliatory conduct, such as termination, loss of a promotion or harassment
- A portion of the government’s monetary recovery that relied upon the whistleblower’s information
- Other remedies specific to a particular whistleblower claim
Healthcare fraud costs millions of dollars each year to insurance companies and to the Medicare and Medicaid Services (CMS) program. Potential fraud includes kickbacks, upcoding, unbundling, billing for unnecessary services or products, billing for items that were not provided to the patient, billing unseen or nonexistent patients and stealing the identity of another patient.
Kickback schemes typically involve referring a patient, prescribing a drug or selling certain medical equipment in exchange for cash or in-kind payments. Kickbacks drain money from the Medicaid and Medicare programs as well as interfere with doctor-patient relationship.
Medicare fraud involves billing the CMS for services or products that are unnecessary, not provided to the patient or at a higher price. A whistleblower who reports Medicare fraud and assists with the investigation may be entitled to a percentage of damages under the False Claims Act.
The pharmaceutical industry has been a repeat player in schemes to defraud the government. Common schemes include off-label marketing for purposes not approved by the FDA, violations of good manufacturing practices that rise to the level of fraud, manufacturing of compound drugs that are commercially available, exchanging kickbacks for prescribing certain medications and running pill mills to sell in-demand pharmaceuticals on the black market.
The government awards contracts to vendors based upon a procurement process. Typically, the lowest bid or one that satisfies specific criteria wins the contract for purchases of goods or services. Procurement fraud occurs when bid rigging results in a contract being unfairly awarded, often in exchange for cash or in-kind payout.
Learn More About Whistleblower Rights and Recovery
Learn more about whistleblower claims. Consult with a Schneider Wallace employment lawyer at our Houston, San Francisco or Scottsdale office. Our lawyers regularly appear before state and federal administrative agencies and courts to litigate issues concerning whistleblowers.