Acute Care Whistleblower Reward

Learn How to Seek an Acute Care Whistleblower Reward from Our Former Healthcare Fraud Prosecutors

Acute care fraud costs taxpayers tens of millions of dollars per year. It also has significant costs for Medicare patients greater in number and need, and for their families—both in terms of copays and deductibles and in terms of reduced quality of care. Whistleblowers play a critical role in uncovering acute care fraud; and, in many cases, they are eligible to receive acute care whistleblower rewards.

Acute care whistleblower rewards are paid to eligible individuals under the False Claims Act—and these rewards can be substantial. As discussed in greater detail below, rewards under the False Claims Act are generally between 10% and 30% of the amount the government recovers. This means that if a whistleblower helps the federal government uncover a multi-million-dollar acute care fraud scheme, the whistleblower could easily be entitled to a six-figure—or even a seven-figure—financial reward.

Acute Care Whistleblower Rewards Under the False Claims Act

The False Claims Act is a federal statute that broadly prohibits the submission of “false” and “fraudulent” claims for reimbursement to the federal government. This includes fraudulent payment requests under Medicare’s prospective payment system, for Medicaid-reimbursed services, and under other federal healthcare benefit programs. While the False Claims Act is a powerful tool in the government’s ongoing fight against fraud, waste, and abuse, it is the statutory source of authority for one of the most well-known whistleblower reward programs.This is where the False Claims Act’s qui tam provisions (and, specifically, its whistleblower reward provisions) come into play.

Under the False Claims Act, individuals who come forward by filing a qui tam complaint in federal court are entitled to protected whistleblower status. This has three critical implications:

• Whistleblowers are entitled to confidentiality;
• Whistleblowers are entitled to protection against retaliation; and, 
• Whistleblowers are entitled to financial rewards if they help the government recover fraudulent reimbursements. 

Whistleblowers are eligible to receive rewards when the information they provide leads to successful enforcement actions—whether the government settles claims or wins verdicts in federal court. In all cases, the amount of an acute care whistleblower reward is determined based on several factors. First, whistleblower rewards under the False Claims Act broadly fall into one of three categories:

• 10 Percent to 15 Percent – Most qui tam whistleblower rewards in acute care fraud cases fall in the 15 percent to 25 percent range. However, whistleblower rewards can be reduced to 10 percent in certain circumstances. This is most often the case when the whistleblower participated in the fraud but is still eligible to receive a reward. 
• 15 Percent to 25 Percent – As we just mentioned, most qui tam whistleblower rewards will fall within this range. These are the “standard’ percentages for acute care whistleblower rewards when the government successfully pursues an enforcement action and requires the defendant to repay Medicare for improper reimbursements. 
• 25 Percent to 30 Percent – In some cases, the government may decline to pursue an enforcement action in response to a whistleblower’s complaint. When this happens, the whistleblower has the option of taking legal action directly to resolve claims on behalf of the government—and, if this legal action is successful, the whistleblower can receive up to 30 percent of the amount recovered. 

Then, within each of these three categories, the specific percentage of a reward is determined based on a variety of case-specific factors. These factors include (but are not limited to):

• The materiality (or importance) of the information contained in the whistleblower’s qui tam complaint;
• The amount and materiality of any additional information the whistleblower provides during the government’s investigation; and, 
• The extent to which the whistleblower provides other assistance with the government’s investigation. 

Generally, the more information and assistance a whistleblower provides, the larger the reward. If you are interested in seeking an acute care whistleblower reward, our attorneys can assist you with seeking the largest reward possible. We can work with you to prepare a robust and comprehensive qui tam complaint, and then we can communicate with the government’s attorneys and agents throughout the investigative process on your behalf.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

How To Seek an Acute Care Whistleblower Reward

Let’s say you have access to non-public information about acute care fraud under Medicare, Medicaid, or another government healthcare program, such as situations where administrators purposefully delay patient care for financial benefit. What do you need to do to seek a whistleblower reward? Here are some of the first steps in the process:

1. Keep the Information to Yourself

To qualify for a whistleblower reward under the False Claims Act, you generally need to be the first person to come forward with the information you have in your possession. You also need to come forward through the appropriate means—by filing a qui tam lawsuit in federal court. With this in mind, at this stage, you should not share your information with anyone but your lawyer.

2. Be Careful About Accessing Additional Information

You should be careful about accessing additional information at this stage as well. If you are thinking about blowing the whistle on your employer, you need to make sure you do not do anything that could unnecessarily jeopardize your employment–such as improperly attempting to access records used to discharge patients–before you secure protected whistleblower status. If you need additional information to qualify as a whistleblower, our attorneys can advise you regarding the appropriate steps to take.

3. Talk to an Acute Care Whistleblower Attorney

An experienced acute care whistleblower attorney will be able to assist you in a variety of ways. To protect yourself—and to help maximize your chances of securing an acute care whistleblower reward—you should schedule a consultation as soon as possible. At Oberheiden P.C., we provide completely free and confidential consultations, and we do not charge our whistleblower clients any legal fees or costs out of pocket.

4. Work With Your Attorney to Make Informed Decisions

Once you hire an attorney, you will want to work with your attorney to make informed decisions. There are various complicated aspects to serving as a federal whistleblower, and it is imperative that you make informed decisions throughout the process.

5. Assist Your Attorney with Fully Disclosing What You Know

If you decide to file a qui tam complaint and seek an acute care whistleblower reward, you will need to assist your attorney with fully disclosing what you know. Your attorney can only disclose the information you provide. The closer you work with your attorney—and the more information and assistance you provide to the government—the more likely you are to receive a whistleblower reward at (or near) the top of the applicable range.

FAQs: Whistleblower Rewards for Reporting Acute Care Fraud