Healthcare Qui Tam: An Industry Where Whistleblowers Can Make a Difference

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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The healthcare industry has grown considerably over the past few years and it is an industry where whistleblowers – those who expose fraudulent activity against the government – can truly make a difference.

What is a whistleblower lawsuit?

A whistleblower lawsuit exposes a company’s fraudulent activity against the government. Also called a Qui Tam lawsuit, whistleblowers tend to be everyday employees who discover that their employer is somehow cheating the government. The whistleblower seeks the advice of an attorney and a lawsuit is filed in camera – which means that it is not made public until the government has a chance to review the allegations and decide whether they have merit.

The government can choose to join the lawsuit, abstain from joining the lawsuit or dismiss the lawsuit altogether. If one of the first two occurs, an investigation is done. If monies are recovered, then the whistleblower averages between 15 and 25 percent of the total recovery. Most whistleblower lawsuits are multi-million dollar cases.

Why healthcare?

Whistleblower lawsuits were commonly filed against military contractors many years ago. We’ve all heard of the contractor who charged thousands of dollars for a toilet seat several years back; and while military contractors are still suspect, it is the healthcare industry that has seen the greatest jump in whistleblower lawsuits in the past few years.

According to reports, the healthcare industry often markets drugs for uses that have not been approved by the U.S. Food and Drug Administration. In addition, while drug companies are required to provide the government’s Medicaid program with the “best price” available, they often inflate those prices in the hopes of it not being detected – and it often adds up to millions of dollars. In fact, in 2006, $920 million was recovered through a whistleblower lawsuit from Tenet Healthcare. Analysts say that we will continue to see more whistleblower lawsuits in the healthcare industry in the years to come.

What to do if you discover fraud

If you work for a healthcare company and discover fraudulent activity against the government, contact an attorney immediately. Exposing the fraud to your employer may result in a subtle adverse employment action which may be hard to prove in court. An experienced Qui Tam attorney can guide you through the process. To contact an attorney to discuss your situation, please click here. Consultations are strictly confidential and are free of charge and without any obligation.

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