Identifying Healthcare Fraud
Whistleblowers are essential in identifying, reporting, and stopping fraud in government healthcare programs. Whistleblowers are typically employees (or former employees) of a pharmaceutical or healthcare company, with inside information about fraud being committed.
For example, a pharmaceutical sales representative might have information about her company’s off-label promotion of its drugs and payment of kickbacks to physicians. A laboratory technician might learn that his company is performing diagnostic tests that aren’t medically necessary. A healthcare provider might be offered a kickback to prescribe a certain drug, or might learn that her colleagues have been offered kickbacks.
Sometimes, successful whistleblowers don’t have this type of inside information, but they still have reliable knowledge that a company or individual is engaging in fraud.
A whistleblower who files a successful complaint under the False Claims Act is entitled to between 15% and 30% of the amount the government recovers. Healthcare fraud has resulted in some of the largest False Claims Act settlements in history, with whistleblower shares as high as $167.7 million.