Reporting Healthcare Kickbacks: Corporate Wrongs and Employee Rights

Federal and state laws protect the rights of whistleblowers to ensure that fraud against the government is brought to light and private sector wrongdoers are brought to justice. As America struggles with the economic challenges of providing health insurance to all, one increasingly important qui tam action involves the anti-kickback provisions of the False Claims Act that govern Medicare and Medicaid fraud actions.

A typical case might involve allegations that sales representatives from an HMO offered payments to physicians in exchange for information about patients who are eligible for a federally funded plan that the company administers. Employees who expose illegal kickbacks involving Medicare or Medicaid are protected from retaliation and harassment, and also eligible for a portion of any civil penalties imposed on the company.

The False Claims Act’s anti-kickback statute forbids any payments – including rebates, bribes or kickbacks – that are intended to induce someone to:

  • refer an individual for any service that is paid for in part or completely by a Federal health care program
  • purchase, lease or order goods, facilities, services or items that are paid for under a Federal health care program

A key legal issue in any whistleblower lawsuit is whether the defendant (known in these cases as the relator) made an actionable false claim. A theory of liability recently recognized in some U.S. Circuit Courts of Appeals looks to whether that claim can be implied by legal circumstances. Implied certification has been recognized by the Third Circuit, which reviews Federal District Court actions that arise in Pennsylvania, Delaware and New Jersey.

Implied certification means that the wrongdoer’s false claim can be recognized in its obligation to comply with federal rules and regulations, even if the defendant did not state something that is factually untrue. In other words, an HMO certifies that it has complied with federal regulations by the very act of seeking payments from a program such as Medicaid.

Financial Rewards for Exposing Medicare and Medicaid Fraud

In addition to anti-kickback provisions, the False Claims Act prohibits several other types of fraudulent actions against federal healthcare programs. Hospitals, nursing homes, physicians and pharmaceutical companies can be held accountable for actions ranging from fraudulent billing and drug diversion to off-label marketing of medicines or medical devices.

Nurses, vendors, pharmacists, hospital employees and others who feel compelled to report healthcare fraud have powerful legal protections on their side. As complex as these cases may be, whistleblower attorneys can explain an employee’s legal options and discuss various laws that provide financial rewards for exposing fraud against the government.

Request an Appointment

Over 115 Years combined experience protecting your rights New Jersey Employment Law Attorneys A Full Service Law Firm Handling Cases Across Pennsylvania and New Jersey

Serving Clients Nationwide

Cherry Hill Office

411 Route 70 East
Cherry Hill, NJ 08034

Telephone: 856.428.6020

Telephone: 856-547-7400

Fax: 856-428-5485