When a medical practitioner notices unethical, unsafe or potentially unlawful practices at their workplace, they are bound by medical ethics to do something about it. In most cases, they are mandated to raise the matter internally, and if things fail, then report to regulatory authorities.

However, there are cases where a medical practitioner is empowered to take legal action on behalf of the government. This is specifically when the practitioner notices fraudulent acts being committed against the government. They are empowered to take legal action under the medical whistle blower law.

The medical whistleblower law is actually a section under the False Claims Act. Also known as the Qui Tam provision, this section empowers individuals to take legal action against entities which are involved in defrauding the government.

The fraud covered by the law usually takes one of three forms: falsely billing the government, overcharging the government for services or supplies, and under-valuing obligations which are paid to the government.

In the healthcare field, such frauds are commonly committed by drugs manufacturer/suppliers, providers of services to Medicare or Medicaid patients, and other holders of federal government contracts.

The medical whistle blower law empowers individuals to take legal action against those who commit such frauds on behalf of the government. It spells out the process through which an individual can take such action, as well as benefits and protections which can accrue to them.

A Basic Whistle Blower’s Process

A whistleblower can file a lawsuit in any US District Court against any person or organisation it suspects of defrauding the government. When the suit is filed, the whistleblower isn’t the plaintiff. Rather, it is the government which is the plaintiff. The whistleblower is referred to as a “relator”.

Any lawsuit brought by a relator is filed “under seal”. This means that the only parties who know about it are the relator and the government. The reason why it is filed under seal is to protect the identity of the relator.

After the suit has been filed, the Department of Justice (DOJ) is supposed to investigate the claim within 60 days. Such an investigation is usually carried out in conjunction with District Attorney of the jurisdiction in which the case was filed.

The goal of the investigation is for the DOJ to determine whether the matter is worth pursuing. If they judge the matter worth pursuing, then they go ahead and begin legal proceedings against the defendant.

In case the DOJ wins the case, then the relator is entitled to between 15% and 25% of any finances recovered from the defendant. Financial recovery is almost always guaranteed for any case won, since restitution is part and parcel of fraud cases.

In case the DOJ decides not to pursue the matter, the relator is empowered initiate legal proceedings on their own. If they win the case, then they are entitled to up to 30% of the monies recovered from penalties levied on the defendant.

Protection Against Retaliation

It is common for whistleblowers to face retaliation for exposing fraudulent (or any other unlawful) acts. This is true especially if the whistleblowers are employees in the organisation against which they have blown the whistle. The medical whistleblower law offers protection against retaliation in two ways.

First of all, it hides the identity of the whistleblower. This is why the lawsuits are filed under seal. This is also why the DOJ investigates the claims before bringing charges against the defendant. It is also why it is the government, rather than the whistleblower which is the plaintiff. All these contribute towards protecting the identity of the whistleblower.

Secondly, in case a whistleblower is indentified, the law makes it illegal for employers to carry out retaliatory actions against them. Such retaliations are almost inevitable if the defendant is the whistleblower’s employee. They typically include threats, demotions, withdrawal of privileges and even termination of employment.

Any employer who takes retaliatory action against a whistleblower can be sued. In case they are found guilty, they can face a number of punitive sanctions. The bottom line is that the law protects whistleblowers against blowbacks and retaliations.

Famous Cases Brought Under The Law

The most famous (or is it infamous) lawsuit brought under the medical whistleblower law is the one which led to the $2.3 billion settlement by Pfizer in 2009. The suit which was initiated by a whistleblower alleged that the drug giant was marketing to Medicare and Medicaid patients drugs which weren’t covered by the federal healthcare programs. Pfizer agreed to pay the settlement, and the whistleblowers earned $104 million for their efforts. Click to read more.

Another famous case involved the drug giant GlaxoSmithKline (GSK). This suit was brought by a former employee who alleged that GSK was selling substandard drugs. The whistleblower claimed to have raised the matter internally, but instead of resolving it, she was fired. She initiated a lawsuit under the medical whistle blower law, which culminated in GSK being slapped with penalties totaling $750 million. The whistleblower was given $96 million. Click here to read more.

It isn’t just medical workers who have brought cases under this law. In 2003, Richard West, a 56 year-old patient brought a lawsuit against Maxim Healthcare – a leading provider of healthcare services. Mr. West had noticed that Maxim had billed the Medicaid for 735 hours of nursing care he’d never received.

Having reported the matter to New Jersey officials, a social worker and even Medicaid without anything getting done, West brought a lawsuit against Maxim. Thanks to Maxim’s financial muscle, the case dragged for seven years, before being resolved in 2011. Maxim was fined $150 million, and Richard West received 14.8 million. Click here to read more.

In Summary

The medical whistle blower law empowers individuals to initiate legal proceedings against healthcare provides who defraud the government. It offers whistleblowers protection against retaliatory actions. In case the cases lead to financial settlements, it entitles whistleblowers to a proportion of the settlements.

Therefore, in case you notice any medical fraud being committed against the government, then it is your duty to do something about it. If you are an employee, your first course of action may be attempting to resolve the matter internally. If you are a patient, then your first course of action may be contacting the authorities in your area.

Incase these options fail, then you can begin legal proceedings under the medical whistle blower law. You will not only make the country a better place, you may earn some money for your efforts.