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how to report healthcare fraud

how to report healthcare fraudIf you’re wondering how to report healthcare fraud, you’re probably already in an uncomfortable position. Someone you work for (or with) is doing something illegal to defraud the government and the healthcare system it supports. You’ve found out, and now you think you need to do something about it.

Here are the steps you should follow if you ever think you need to file a report:

How to Report Healthcare Fraud:  Gather Evidence

When reporting any fraud or misconduct, you need more than just hearsay. Ideally, you’ll have a paper trail consisting of invoices, vouchers, emails, database records, and any other physical items that paint the picture about what exactly is going on.

Once you have everything in order, do not talk to anyone about it yet. Not a friend, not your company, and not the press. This is important because the instant you disclose certain information, you lose options. You also potentially implicate yourself in contractual and non-disclosure violations.

Simply gather the information for now, and keep it in a safe place.

How to Report Fraud:  Understand Your Options

You have three main options when it comes to reporting suspected fraud:

  1. Notify the agency being harmed. Each agency has its own Inspector General, responsible for investigating any fraud relating to their department.
  2. Notify the FBI. You can always report fraud anonymously through the FBI tip hotline, or by contacting your local FBI office.
  3. File a qui tam lawsuit under the federal False Claims Act. Under the FCA, individuals can file a civil lawsuit on behalf of the U.S. government.

The first two options above are fairly straightforward, and are certainly good choices in specific and simple scenarios. However, the third option is potentially the most lucrative of the three.

How to Report Fraud:  Consult a Qui Tam Lawyer

In the event you need help making the best choice, or you’ve already decided to file a qui tam lawsuit, it’s time to consult a lawyer. Your lawyer can review the evidence you’ve provided, and help you determine if it’s enough to bring a lawsuit. What your lawyer is looking for is the strength of the evidence, and the size of the fraud in question; both factors will determine your likelihood of success

After reviewing the evidence, your attorney will likely advise on which of the three options is in your best interest given the facts of the case. In the event you decide to proceed with a lawsuit, you can expect them to do the following:

  • File a complaint with the U.S. District court under seal. The term “under seal” means only the government and you are aware a suit has been filed. It gives them time to conduct their own investigation
  • Work with the government to help determine if they want to join your case
  • Carry your case, working with the government (in cases where they intervene), on your behalf

Anything Else You Need to Know about Healthcare Fraud Reporting?

Still have questions about how to report healthcare fraud? Click here to contact the Bothwell Law Group online.

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