Many thousands of medical service providers bill government insurance agencies. While there are many rules in place regarding Medicare and other federal insurance billing practices, it is impossible for the federal government and regulatory agencies to oversee every individual practice billing for government insurance reimbursement.
Given that there simply aren’t enough resources to monitor all transactions and billing attempts, the government relies on the ethical behavior of its citizenry to enforce laws about Medicare fraud. Individuals who work for businesses that provide medical services can potentially act as whistleblowers by calling government attention to inappropriate practices. Doing so could result in a Qui Tam claim.
Why do people submit Qui Tam claims against their employers?
If you noticed that your employer’s policy requires that billing specialists unbundle services to charge higher amounts, if they bill for services not provided or possibly perform unnecessary procedures in order to bill for them, all of those circumstances potentially constitute insurance fraud.
If you are aware of fraud and you take no action, you can wind up implicated as an accessory or as part of a fraud conspiracy. Those who initiate Qui Tam actions essentially initiate civil proceedings on behalf of the government to allege inappropriate behavior on the part of their employer.
This benefits the government because it allows them to take action against those abusing government insurance programs. It also benefits the whistleblower by not just reducing the risk of legal charges but also giving them an opportunity to receive compensation for a portion of the amount recovered while also receiving legal protection against retaliation by their employer because of their whistleblower status. An experienced attorney can help you initiate a Qui Tam action.