Medical kickbacks involve the exchange of anything of value in return for patient referrals or the purchase, lease or order of goods or services reimbursed by federal health care programs. These kickbacks are often disguised as legitimate transactions, which makes them hard to detect unless someone steps forward by filing a report.
The detrimental impact of medical kickbacks extends beyond financial implications. They can lead to overutilization of services, inappropriate medical decision-making and an erosion of trust between patients and health care providers. Ultimately, patient care and the integrity of the health care system are compromised.
Whistleblowers play a crucial role in exposing fraudulent activities, including medical kickbacks, within the health care industry. Whistleblower protections, such as those provided under the False Claims Act, shield individuals who report fraudulent practices from retaliation. These protections encourage individuals with inside knowledge of fraudulent activities to come forward without fear of losing their jobs or facing other adverse consequences.
False Claims Act (FCA) and qui tam lawsuits
The False Claims Act allows private individuals, known as whistleblowers, to file qui tam lawsuits on behalf of the government against entities involved in fraudulent activities, including medical kickbacks.
Whistleblower reports regarding medical kickbacks serve as vital tools in combating health care fraud. These reports trigger investigations into fraudulent practices, hold perpetrators accountable, recover ill-gotten gains and protect taxpayer-funded health care programs from financial losses.
Anyone who takes the time to report illegal medical kickbacks should understand their rights. While retaliation is illegal, some whistleblowers might still face some negative impacts. They may need to work with someone who’s able to help them ensure their rights are protected.