The practice of medicine and other healing arts is a big business.
While the vast majority of medical and dental professionals do their job well and honestly, there are unfortunately always a handful of bad actors who try to game the system in obvious and less obvious ways.
For example, some medical professionals and offices may bill insurers for services they did not actually perform or, perhaps more subtly, for services that were not medically necessary.
Since the federal Medicare program funds a large portion of America’s healthcare system, fraudulent billing often winds up costing the taxpayer.
The government fights this type of fraud in a number of ways. One way it does is so is by allowing private citizens who may have evidence of this fraud to file a qui tam action as a whistleblower.
A person can only file a qui tam when the government has not prosecuted the fraud directly and when no other person has filed a qui tam.
In the name of the government, the person who files can ask a court to impose up to a $10,000 penalty against a medical provider per fraudulent act.
Given that fraudulent billing is often a bad habit of a medical provider, overall penalties can run in the hundreds of thousands of dollars and may exceed $1 million.
A person who pursues a qui tam action may be entitled to a portion of the penalties recovered. In some cases, the government will give 30% of their recovery to the whistleblower who originally filed suit.
Whistleblowers also enjoy other protections under both federal law and the laws of Tennessee, including protection from employment discrimination.