Define Whistleblower

The Whistleblower Protection Act of 1989 (WPA) is a law to protect government employees in the US from being punished for voluntarily disclosing information regarding dishonest or illegal activities that occur within a government entity.

Regulations prohibits a federal agency from taking action, or threatening to take action for this, against a worker or applicant for sharing information about someone that violated legislation, regulation or any other rule. The information may possibly include reports of mismanagement, unwisely using government money, abusing authority, or risking the public’s well being. The U.S. Office of Special Counsel controls all allegations of retaliation and investigates every complaint that is received.

During 2009, Senator Daniel Akaka (D-Hawaii) developed and enforced the Whistleblower Protection Enhancement Act (WPEA) to boost the legislation. It officially went into effect in November 2012.

Whistleblowers are also known as tattle-tales but the reality is, their work can safeguard a lot of American citizens. Whenever they pull back the curtains on hidden illegal activity, they provide a helpful service. They are alerting the Justice Department about various types of Medicare fraud or revealing questions of safety of nuclear plants in the 1980s, whistleblowers can be thanked for taking care of ordinary people.

Define Whistleblower Protection Act

Today, reports that are filed under the U.S. False Claims Act, also known as the Whistleblower Act, are being used by the Department of Justice to pursue investigations of prescription medication manufacturers accused of safety violations. This effort may help guarantee the safety of prescription drugs which are often challenging for the U.S. FDA to observe since eighty percent of the ingredients are made outside the US. By teaming with the Department of Justice, the FDA can be a great deal more effective and pharmaceutical makers located domestically and internationally will likely be discouraged from strategies that go against health and safety.

Whistleblowers using the False Claims Act will hold an integral role if his or her lawsuits come to be investigated by the Justice Department, that has vowed to take an especially hard look at all drug manufacturing facilities. Americans can rest a little easier understanding that the drugs they take are under heavy scrutiny by two government departments as well as other caring people taking steps to blow the whistle on unscrupulous business practices.

According to the Whistleblower law, the government departments are not exempt from claims that are processed under the False Claims Act. A fairly recent case involved a staff member at the Office of Safety and Health Administration. The person came forward and exposed evidence the incriminated OSHA, showing the agency allowed companies to get away with failing to properly report workplace injuries. This whistleblower was subsequently fired from his position as record keeper, but won $820,000 in their lawsuit that the person filed for unlawful firing.

Whoever has intimate knowledge and evidence of significant fraud from the government is qualified as being a whistleblower. If their case is productive, they may even obtain a part of the money recovered. If you think you may have cause to file a case, the ultimate way to begin is usually to speak to an attorney or lawyer who specializes in whistleblower cases. They’ll tell you your rights and what you need to do, and they can help with the entire process of filing False Claims Act lawsuits. These lawsuits may be complicated, so ensure that the firm you decide on has experience in this area. If you are successful, you may be able to recover huge amounts of money on the part of taxpayers and protecting your fellow Americans.

Medicare and Medicaid Fraud

Violations of legislation governing the two programs may also qualify as violations of Federal level and State level Whistleblower Acts. Hospitals, nursing facilities, physicians, home medical care agencies, pharmaceutical related businesses, and labs that seek and receive reimbursement for Medicare and Medicaid total funds are government contractors that must comply with the legislation. If anyone receives money from TRICARE, the military’s health insurance program; the rules in the act also apply. Additionally, wrongful conduct that takes away state dollars reserved to insure public employees may be considered a violation of whistleblower laws.

Healthcare workers, elderly care facilities and hospital patients need to be aware of the help provided. Not only can this help the healthcare of patients and family members, it ensures that public funds are properly utilized according to the law and proper medical practice.

Billing any type of services that were not done or completed, misrepresenting offered services or goods provided, or misrepresenting the character in the patient’s illness can possibly hold you liable for fraud under the False Claims Act. Likewise, being unable to provide correct data from a hospital or an elderly care facility may constitute violations of federal qui tam laws set by the state and federal governments. Furthermore, hospitals and convalescent homes that offer substandard care might also violate the enforced legislation.

The next varieties of conduct should trigger a red flag:

  • Incomplete prescription filling, but charging the full cost just as if an entire prescription was provided
  • Providing kickbacks with a medical provider so that you can induce the company to prescribe specific drugs or use specific products to boost sales
  • Prescribing medications, drugs, or treatments which are not medically necessary for a patient
  • Falsely diagnosing a far more severe illness as opposed to one the individual actually has, known as upcoding an analysis, thereby falsely justifying a far more expensive prescription treatment or any other treatment
  • Improper and unnecessary modifications in a patients’ prescriptions and providing an alternative due to kickbacks and for other reasons that are illegal
  • Providing false information to the government regarding drug research related to a grant that was given by the government
  • Changing an analysis or treatment code to find a higher amount reimbursement coming from a government program

False Claim Whistleblower Cases

Already, in the current year 2013, the Office of the Inspector General has successfully settled several Medicare fraud cases prosecuted under the false claims act, and recovered large dollar amounts for the government and U.S. taxpayers and whistleblower awards for blowing the whistle on medical care fraud. Beyond these settlements with Emory, OIG has announced the following Medicare fraud qui tam settlements in the month of August 2013 alone:

The Whistleblower act has recovered over $3,570,000 million from Imagimed LLC for their false claims associated with magnetic resonance imaging (MRI) equipment.

Another $388,000 was collected from a Long Island doctor who overbilled Medicare for noninvasive spine treatments and surgeries.

$26 million was recovered from Shands Healthcare because the medical facility billed outpatient procedures as inpatient procedures.

The federal government also collected $750,000 from Maryland General Hospital for overbilling a patients cardiac testing.

Medicare fraud continues to occur in communities across the USA, costing taxpayers substantial amounts of money, filling the wallets of men, women and businesses who have not honestly earned the sales or funds. In a short time of only 30 days in 2013, the government recovered over $30 million that unscrupulous companies tried to generate through Medicare dollars.

Whistleblowers that come forward with information about Medicare fraud are without a doubt key to the continued efforts to stop these unfair billings that give rise to sky-rocketing healthcare costs for all.

Protection after Blowing the Whistle

The False Claims Act also prohibits “getting revenge” for taking a stand those who commit Medicaid fraud. This means that on account of speaking up on a fraudulent billing scheme you:

  • Can’t lose your job by being terminated or fired
  • Can’t lose your rank in any company
  • Do not need to suffer a cut in pay or hours scheduled
  • Can’t be discriminated against just because you blew the whistle on Medicaid fraud
  • Can’t experience punishment for refusing to take part in the fraud scheme

In the event you experience any type of retaliation for participating in protected activity, you could have an outside claim to recover damages caused by your employer, including reinstatement, back pay and attorney’s fees.