Healthcare Whistleblower Qui Tam Lawsuits

A Practical Guide for Medical Professionals, Healthcare Company Employees, and Pharmaceutical Industry Insiders About Exposing Medicare and Florida Medicaid Fraud

Chapter One

Introduction

Every year, Medicare and Medicaid pay billions of dollars to doctors, hospitals, pharmacies, and other healthcare providers. Most people involved in the healthcare industry are honest professionals who work hard every day to care for their patients. Unfortunately, most doesn’t mean all.

We’ve all heard the stories and read the headlines about healthcare providers throughout the United States who have made millions and millions of dollars by submitting false claims to the government. These false claims are based on a wide range of improper conduct, including making payment of illegal kickbacks for patient referrals, billing for services that were never performed, performing medically unnecessary procedures, manipulating billing codes to increase reimbursement amounts, and violating any of the many other laws regulating the healthcare industry. 

To combat fraud against the U.S. government, Congress enacted the False Claims Act during the Civil War. One of its central provisions allows private individuals with knowledge of fraud to bring lawsuits on behalf of the United States. These lawsuits are commonly known as qui tam actions. 

Similarly, many state governments have enacted their own version of the False Claims Act to combat fraud that impacts the state. In Florida, we have the Florida False Claims Act.

Nowadays, the most common qui tam cases involve allegations of healthcare fraud.

To give you some idea of the extent of healthcare fraud across the country, the Department of Justice reported $6.8 billion in False Claims Act settlements and judgments in fiscal year 2025, with over $5.7 billion related to matters that involved the healthcare industry. 

Whistleblowers who successfully expose fraud via qui tam actions may be entitled to receive a portion of the government's recovery. Depending upon the circumstances, those awards can amount to hundreds of thousands, and sometimes millions, of dollars.

Before taking any significant action, consult an attorney

In my experience as a trial lawyer, some of the most important decisions in a case are made long before the first document is ever filed with the court. 

One of the most common mistakes people make, at least as far as legal matters are concerned, is automatically assuming they know what they should do. And if they don’t know what to do, they just run an AI search and think that all their questions will be answered. People often like to believe that ChatGPT is a substitute for talking with a lawyer. In reality, as good as they are at many things, AI programs just aren’t an adequate substitute for sound legal advice. More often than you might imagine, AI programs will lead people in the wrong direction and result in them doing unnecessary harm to their case at the outset. 

The same thing frequently happens in cases involving potential healthcare fraud. Before speaking to a lawyer, people just go ahead and decide upon a course of action. They may decide to confront their employer, discuss their concerns with coworkers, resign from their job, or copy confidential documents. In some situations, those decisions are appropriate. In others, they may seriously jeopardize the case.

The simple fact is there is no universal roadmap that applies to every whistleblower case.

Every situation is different. Like most things in life, the details matter. 

Broward Healthcare Whistleblower Lawyer

If you suspect that you’ve discovered healthcare fraud being committed at a doctor’s office, hospital, or by any other healthcare provider in Florida, give us a call if you’d like to discuss your options and whether you may potentially have a whistleblower case worth pursuing. Our office is located in Coral Springs, and we represent clients throughout Broward, Palm Beach, and the rest of Florida.  You can reach us at (954) 833-1440to schedule a free consultation to discuss your case.

Legal Notice

This guide is provided for general educational purposes only. This guide is not legal advice. This guide does not create an attorney-client relationship. It is designed to help healthcare professionals understand how whistleblower cases generally work. Every whistleblower matter is unique. The appropriate course of action depends upon the specific facts, applicable federal and state law, employment circumstances, and many other factors.

Before taking any action, you should consult an experienced attorney.

Chapter Two

Who Can Become a Healthcare Fraud Whistleblower?

Basically, any person with personal knowledge of fraud against the government can bring a qui tam lawsuit. You don’t have to be the boss or the president or the CEO of the company. In many successful qui tam cases, the whistleblower is a lower-level employee who simply recognizes that something is wrong.

Physicians

Physicians are often in a good position to recognize improper billing practices at hospitals and medical clinics. Physicians may learn of other doctors performing medically unnecessary procedures, the hospital or medical practice having illegal financial arrangements or paying kickbacks for referrals, or other fraudulent activity taking place.

Nurses

Registered nurses, nurse practitioners, licensed practical nurses, and other nursing professionals frequently observe patient care firsthand. They may discover that services billed to Medicare were never provided, that patient records have been altered, or that unnecessary procedures are being performed solely to increase reimbursement amounts.

Billing Personnel 

Many healthcare fraud investigations begin because an employee who handles billing for the company notices claims being submitted with incorrect billing codes, inflated reimbursement requests, or duplicate billings. Employees responsible for billing often recognize fraudulent patterns long before anyone outside the company discovers the problem.

Compliance Officers and Internal Auditors

In the course of reviewing or auditing a hospital’s practices or a medical clinic’s operations, compliance officers and auditors may come across evidence of improper billing or other unlawful practices at the company.

Pharmacists

Pharmacists might learn of fraudulent prescription practices, billing for medications that were never dispensed, or other improper conduct relating to prescription medications.

Hospital Employees

Hospitals employ people in many different departments. Respiratory therapists, radiology technicians, physical therapists, financial personnel, admissions and discharge planners, and any number of other hospital employees may potentially discover fraudulent practices at the hospital. 

Former Employees

Former employees can be whistleblowers just the same as current employees. Simply because you are no longer working at the company doesn’t mean you can’t possess valuable information regarding fraudulent conduct you observed during your employment. 

Chapter Three

When Is It Fraud, And When Is It Simply a Mistake?

One of the most important things to keep in mind is the difference between an honest mistake and conduct that may violate the False Claims Act.

Not every billing error is fraud. Not every violation of a government regulation can be the basis for a whistleblower lawsuit.

Healthcare is one of the most heavily regulated industries in the United States. Physicians, hospitals, surgery centers, nursing homes, home health agencies, pharmacies, laboratories, durable medical equipment suppliers, and other healthcare providers are subject to an ever-changing regulatory landscape. Because those rules are so complex, honest mistakes happen every day. Sometimes people make a coding error or some other isolated billing mistake. Sometimes people simply misunderstand Medicare regulations and submit claims with insufficient or incorrect information as a result. Those situations may require some form of remediation. But those errors alone don’t constitute healthcare fraud.

Fraud Requires More Than A Mistake

There are various ways that a person or company can violate the federal False Claims Act or its Florida equivalent. But speaking generally, successful Federal and Florida qui tam lawsuits most often entail situations where the defendant knowingly submitted or caused to be submitted false or fraudulent claims to the government or participated in a scheme that involved knowingly submitting false or fraudulent claims.

Some examples of conduct that could constitute healthcare fraud include:

• Billing the government for services that were never performed.
• Performing medically unnecessary procedures to increase reimbursement.
• Billing for unnecessary laboratory testing.
• Paying illegal kickbacks for patient referrals.
• Falsifying patient records to make it appear as if services were provided in compliance with government regulations.
• Submitting claims while falsely certifying compliance with material Medicare requirements.
• Upcoding, which typically involves billing a CPT code that represents a more expensive service than what was actually provided.

These are just a few examples to give you a broad conception of how healthcare fraud is often perpetrated. Of course, whether particular conduct actually violates the federal or Florida False Claims Act depends on the specific circumstances.

Ask Yourself These Questions

If you suspect fraud, whether it’s based on one of the examples above or something else entirely, consider the following questions:

• Did this conduct happen once, or does it happen routinely?
• Was the conduct corrected after a supervisor or manager learned about it?
• Did any supervisors or managers instruct any employees to continue doing the same thing even after somebody brought up that it may be improper or illegal?
• Are any documents regularly being altered to make it seem as if different services are being provided than the services that are actually being provided?
• Has anyone tried to explain away what’s going on by saying that "everyone does it" or "this is just how we've always done business"?
  • Office visits that never occurred.

These are just a few of the questions you may want to ask yourself when you are uncertain whether fraud is actually taking place. With that said, even if the answers to some of these questions are yes, that doesn’t necessarily mean there’s fraud going on. Again, this is one of those things where if you want to gain a more definitive sense of whether you may have discovered healthcare fraud, your best bet is to get in touch with an attorney who can give you guidance on this issue.

Trust But Verify

Many successful whistleblower cases begin with one simple thought: "Something about this doesn't seem right."

If you start thinking that, don’t ignore your instincts. But at the same time, don’t automatically assume it's fraud. Right when you start thinking it might be fraud is probably the best time to consider speaking with an attorney. The attorney will hopefully be able to give you some insight into whether your suspicions about fraud are correct and be able to guide you on the appropriate steps to take next.

You don’t have to possess incontrovertible proof that fraud is taking place before you can speak with an attorney. If you have legitimate suspicions about fraud on Medicare or Medicaid, seek legal advice before taking any further action.

Dan Cytryn's Practice Pointer

One of the first questions I ask a client when they come to me with an allegation of any type of fraud is: "Was it an isolated event, or was it part of a pattern?"

The more frequently the potentially illegal conduct occurs, the more likely it is actual fraud rather than just an honest mistake.

Chapter Four

Common Mistakes Whistleblowers Make

Over the last 40+ years practicing as a lawyer in Florida, I’ve learned that many lawsuits can be won or lost long before the lawsuit itself is ever filed. Healthcare whistleblower cases are no exception.

Always keep in mind that every situation is different. Nonetheless, the following are some of the most common mistakes prospective whistleblowers might make:

Mistake No. 1: Confronting Your Boss or Supervisor Without Considering Whether They Are Involved in the Fraud

In some circumstances, internally reporting the fraud may be the appropriate course of action. In other situations, it might not be. Sometimes it makes sense to confront your boss about what’s going on. Sometimes your boss may not even know that fraud is taking place and may be receptive to the information you provide. 

Other times, your boss or supervisor might be in on the fraud. Or even if they are not part of the scheme, their boss or supervisor might be. When this is the case, you raise the risk of your employer firing you because of your reporting of the fraud. (Both the federal and Florida False Claims Act have anti-retaliation provisions, but those provisions don’t prevent you from getting fired; instead, they just give you recourse to bring a lawsuit under limited circumstances if you are fired in retaliation for reporting fraud.) 

If you get fired, you’ll likely lose any ability to collect documents that may be needed to prove a False Claims Act case. Once that happens, it oftentimes becomes much more difficult for you to successfully prosecute a false claims case. 

Mistake No. 2: Discussing the Matter with Coworkers, Friends, or Family

One of the hardest things for many people is keeping silent. You might want advice from a trusted coworker. You might want to confide in a close friend. You might simply need someone to talk to. The problem, as the saying goes, is that people talk. Even well-meaning friends could inadvertently repeat what you told them to the wrong people.

As a very general rule, when you believe you’ve discovered healthcare fraud, avoid discussing your concerns with anyone other than your attorney.

Mistake No. 3: Posting Anything on Social Media

Don’t ever do this. This is even worse than talking to friends and family about the fraud. Even seemingly innocent comments can create unnecessary complications. If you believe you have a whistleblower claim, don’t say anything about it on Facebook or Instagram or Twitter or anywhere else online.

Mistake No. 4: Copying or Disclosing Documents 

This is an area where many well-intentioned people make serious mistakes. You need to be careful when copying and disclosing documents, especially when the documents may contain confidential or HIPAA-protected information.

HIPAA does have provisions allowing whistleblowers to share protected health information in certain circumstances, including when disclosing information to an attorney retained for the purpose of determining your legal options. But those provisions are very limited, and you always need to be careful when disclosing health information.

Even if you have lawful access to certain information as part of your job, that doesn’t mean you should feel like you have carte blanche to copy or disclose that information. The law in this area is fairly complex. Don’t just assume you can copy and disclose something simply because you have access to the documents themselves. This is one of those times when you really want to speak with an attorney before doing anything rash. 

Mistake No. 5: Assuming Someone Else Has Already Reported the Fraud

Many people convince themselves that government investigators must already know what is happening. Sometimes they do; oftentimes they don’t. The reality is that healthcare fraud in this country is so widespread that the government cannot possibly discover every instance of fraud. Even if the suspected fraud has been going on for years, don’t assume that somebody else must have at least reported it. In many instances, the fraud is able to go on for so long, in part, because nobody reported it.

Mistake No. 6: Conducting Your Own Investigation

You don’t need to interview witnesses. You don’t need to question your coworkers. You don’t need to search through company files looking for additional evidence.

Listen, you’re not Sherlock Holmes. You’re not some great detective or investigator on the hunt for fraud. The truth is, you may not even know what, exactly, that you should be looking for when you suspect fraud is occurring. And that’s OK.

Prospective whistleblowers sometimes believe that they need to prove the entire case before contacting an attorney. That’s not how this works. One of the important things an attorney can do is explain to you what documents you should be on the lookout for. The attorney can tell you what they need to pursue the case, and then you can act accordingly.

Mistake No. 7: Waiting Too Long to Contact an Attorney

This can be one of the biggest mistakes you make.

The federal and Florida False Claims Act give priority to the first whistleblower to file a qui tam claim. This can get a little complicated in practice, but the basic idea is that if somebody else has already filed a qui tam lawsuit based on the same facts underlying your case, then you can’t proceed with your case.

Dan Cytryn's Practice Pointer

One lesson I have learned from over four decades of litigation is this:

People often believe the most important question is, "Do I have a case?"

That’s not really the right thing to ask. 

The question should be: "What should I do next?"

Those are two very different questions.

A strong whistleblower case can become far more difficult if important decisions are made without legal advice. If you suspect you’ve discovered Medicare or Medicaid fraud, resist the urge to act impulsively. 

Chapter Five

How a Healthcare Fraud Whistleblower Lawsuit Works

Filing the Complaint Under Seal

When you file a qui tam case under the federal or Florida False Claims Act, the lawsuit is filed under seal. This means that, at least initially, the lawsuit is not public and is not served on the defendant.

Under the federal False Claims Act, in addition to filing the case under seal, the plaintiff must serve a copy of the complaint on the United States Attorney for the district where the case is filed and to the United States Attorney General. The plaintiff must additionally serve them with a written disclosure statement discussing the material evidence and information supporting the allegations.

The case remains under seal for 60 days in order to give the government an opportunity to investigate the allegations before the defendant is notified of the lawsuit. In many instances, the government needs more than 60 days, so they ask the court to extend the time for which the case remains under seal. 

Similarly for claims under the Florida False Claims Act, the case is filed under seal and not initially served on the defendant. A whistleblower (also known as a relator) filing a civil qui tam action on behalf of the state under the Florida False Claims Act must file the complaint in the Second Judicial Circuit in Leon County, Florida. The plaintiff must also serve a copy of the complaint and a written disclosure statement on the Florida Attorney General and the Florida Chief Financial Officer, as head of the Department of Financial Services. 

The Government's Investigation

Once the complaint and the written disclosure statement is served on the government, the government will then have a chance to begin evaluating the allegations and conducting its own investigation. Depending upon a whole range of circumstances that are oftentimes unpredictable, the investigation may take anywhere from a few weeks to a few months and, in some instances, a whole lot longer. There are some cases where a relator filed a qui tam action, and it then took the federal government years to finish conducting the investigation.

In the course of the investigation, the government’s attorneys and investigators are going to try to figure out whether there is an actual false claims case that they can prove. As part of the investigation, they typically will:

• Evaluate the legal merits of the allegations – in other words, determine whether the allegations, if proven true, even make out a false claims act case.
• Review documents provided by the relator.
• Obtain additional records through subpoenas, civil investigative demands, and other methods.
• Interview witnesses who might have relevant information about the alleged fraud.

These things take time. Many people are surprised to learn how long these investigations often take. Unfortunately, there’s no shortcut. When the government is conducting their investigation, you’re on their timetable.

The Government Decides Whether to Intervene

At some point during its investigation, the government will decide whether it will intervene in the case. In determining whether to intervene, the government will typically look at a number of different factors, including whether there’s a strong false claims case to be made, whether the fraud is large enough that the government feels it’s worth pursuing (they’ll look to how long the fraud been going on and how much money the government paid out because of the fraud), whether the government might actually be able to recover any money from the defendant who committed the fraud, etc.

If the government decides to intervene, it assumes primary responsibility for prosecuting the case. When this occurs, the government’s attorneys essentially take over the entire case. This doesn’t mean that the whistleblower and the whistleblower’s attorneys have no involvement whatsoever in the case, but they very decidedly take a back seat to the government’s attorneys.

If the government declines to intervene, the whistleblower can proceed with the lawsuit on their own. In that situation, the whistleblower’s attorney would be the person handling the case. Just because the government doesn’t intervene doesn’t mean that the case lacks merit. In a lot of cases, the government might think that there’s fraud, but they don’t believe the case is big enough to warrant their direct involvement. 

After the government makes its decision on whether to intervene, the complaint is usually unsealed and the plaintiff (or the government, if it intervenes) then proceeds with serving the complaint on the defendant.

Litigation

Like any other complex civil litigation, healthcare whistleblower cases rarely proceed on a predictable track. There are ups and downs in just about any case. 

But in very general terms, after the government decides on whether to intervene, the next step is serving the complaint and moving forward with the litigation. 

In most cases, after the defendant is served with the complaint, they will file a motion to dismiss the complaint. This is a pretty standard tactic in False Claims Act cases. Because of the somewhat onerous requirements for pleading fraud in false claims cases, a good amount of these motions to dismiss are granted. But even if the motion to dismiss is granted, the courts often allow the plaintiff an opportunity to amend their complaint. At that point, the plaintiff has to go back and determine whether they can revise their complaint in a way that will get them past a future motion to dismiss. Sometimes, plaintiffs will amend their complaint multiple times in response to defense motions to dismiss.

If you get past the motion to dismiss stage, then the case proceeds in a manner relatively similar to any other civil case – discovery (requests to produce, interrogatories, etc.), depositions, mediation, etc. 

In part because of the very substantial fines and penalties (discussed below) that can be imposed under the False Claims Act, a good number of cases will settle relatively quickly. Some defendants realize that they are better off coming to terms and settling the case rather than risking a trial. Although some cases are resolved quickly, others are litigated for years. 

It’s impossible to know ahead of time whether your case is going to be one that resolves swiftly or drags on for years. It sounds cliché, but every case is different. When it comes to False Claims Act cases, there really is no reliable timetable that will apply to each and every case.

Fines and Penalties

Under the Federal False Claims Act, a defendant is liable for three times the government’s actual damages, plus a civil penalty for each violation. In some limited circumstances, the damages can be reduced from treble damages down to double damages. The civil penalty is adjusted for inflation, but as of summer 2026, the minimum amount is $14,308 per violation, and the maximum is $28,619 per violation. Each false claim is its own violation. So, you are dealing with hundreds or thousands of claims, these numbers can add up real fast.

The penalties are a little different under the Florida False Claims Act. A defendant is liable to the state for a civil penalty of not less than $5,500 and not more than $11,000 and for treble the amount of damages the state sustains due to the fraud. As with the federal law, in some limited circumstances, the damages can be reduced from treble damages to double damages.

Whistleblower Award

If the case results in a successful recovery for the government, the whistleblower may be entitled to receive a percentage of that recovery.

The amount depends upon a variety of factors, including whether the government intervened and the extent of the whistleblower's contribution to the successful resolution of the case.

Federal False Claims Act:

If the U.S. government intervenes, the relator can receive 15 – 25% of the recovery.

If the U.S. government declines to intervene and the relator prosecutes the case, the relator can receive 25 – 30% of the recovery. The relator is also entitled to receive an amount for reasonable expenses that were necessarily incurred, plus reasonable attorney fees and costs. The expenses, fees, and costs shall be awarded against the defendant.

Florida False Claims Act:

If the Florida government intervenes, the relator can receive 15 – 25% of the recovery.

If the government declines to intervene and the relator prosecutes the case, the relator can receive 25 – 30% of the recovery. The relator is also entitled to receive an amount for reasonable expenses that were necessarily incurred, plus reasonable attorney fees and costs. The expenses, fees, and costs shall be awarded against the defendant.

Dan Cytryn's Practice Pointer

Clients often ask me how long their case will take. My answer is ordinarily the same: "As long as it takes to do it right."

Healthcare whistleblower cases are no exception. These cases move at their own pace. You need to have some patience. This type of case is extremely complex and requires a substantial amount of work to do things the right way. There aren’t any shortcuts.

Chapter Six

Common Types of Medicare and Medicaid Fraud

If you’ve watched the local news lately, especially if you live in Miami or Broward, you know how common health care fraud is in this state. It’s nothing to brag about, but South Florida is the Medicare fraud capital of the world.

The following are some of the most common types of healthcare fraud that give rise to whistleblower lawsuits.

Billing for Services Never Performed

One of the most common examples of healthcare fraud occurs when Medicare or Medicaid is billed for services that were never provided. This includes:

• Diagnostic tests that weren’t performed.
• Therapy sessions that didn’t take place.
• Medical equipment that was never delivered.
• Home health visits that never happened.

Upcoding

Upcoding by knowingly billing for a more expensive service than the one actually provided.

Medically Unnecessary Procedures

Medicare and Medicaid generally pay only for services that are medically necessary and reasonable. When medically unnecessary procedures, surgeries, laboratory tests, imaging studies, or other services are performed primarily to increase reimbursement rather than because they are medically indicated, that may be fraud.

Illegal Kickbacks

Federal law generally prohibits paying or receiving remuneration in exchange for patient referrals involving federally funded healthcare programs. Illicit kickbacks can come in many different forms, including:

• Cash payments.
• Sham consulting agreements.
• Gifts or other financial incentives.

Laboratory Fraud

This type of fraud might involve:

• Performing medically unnecessary lab tests.
• Billing for tests never performed.

Medical Device Fraud

Medical device fraud is becoming more and more common. Examples include:

• Illegal payments to physicians in exchange for ordering medical devices for patients.
• Improper consulting agreements that are used as a cover to illegally pay doctors for using certain medical devices.
• Providing doctors illegal incentives designed to influence medical device purchasing decisions.

Chapter Seven

Real-Life Whistleblower Cases: Lessons from Actual Recoveries

As we’ve said before, every whistleblower case is unique. Different facts, different legal issues, and different evidence produce different results. Nevertheless, real-life examples can show how people working in the healthcare industry have helped expose fraud against government healthcare programs.

The following examples are intended just to give you some idea about the types of cases that have resulted in significant recoveries in recent years. 

Broward Health (Florida)

Dr. Michael Reilly filed a qui tam case alleging that the North Broward Hospital District (which operates hospitals and health care facilities in Broward County, Florida) entered into improper financial relationships with referring physicians that violated the False Claims Act.

The government intervened and prosecuted the case. Ultimately, the case resulted in a settlement wherein North Broward agreed to pay the United States a $69.5 million settlement. Dr. Reilly received more than $12 million as the whistleblower's share.

Freedom Health (Florida)

A former employee of Freedom Health brought a qui tam claim alleging that Freedom Health (a provider of managed care services) violated the False Claims Act by submitting unsupported diagnosis codes to CMS, resulting in increased reimbursement payments from CMS to a few of Freedom Health’s Medicare Advantage plans.

Freedom Health agreed to pay the government $31,695,593 to resolve allegations that it violated the False Claims Act.

Arthrex (Florida)

Florida-based medical device manufacturer Arthrex agreed to pay the United States $16 million to settle claims that it allegedly paid kickbacks to an orthopedic surgeon in exchange for the surgeon using and recommending their products. The whistleblower who initially filed the case received $2.5 million as his share of the recovery.

Chapter Eight

Can My Employer Fire Me? Understanding Whistleblower Retaliation

Nobody wants to lose their job. The potential for retaliation causes many potential whistleblowers to remain silent, even when they may believe they have witnessed extensive fraud at their company. 

The good news is that the federal False Claims Act provides meaningful anti-retaliatory protections for whistleblowers. The bad news is, for the law to have any impact for you, you’ll need to prove that you were retaliated against because of some action you took in connection with the False Claims Act, such as investigating potential fraud committed by your employer. The same is generally true for the Florida False Claims Act.

What Is Retaliation?

Retaliation can take many forms.

Termination from your employment is the most obvious example. But retaliation could also include being:

• Discharged
• Demoted
• Suspended
• Threatened
• Harassed
• Discriminated against in the terms and conditions of employment

Remedies for Retaliation

The anti-retaliation provisions don’t actually prevent you from being fired or retaliated against. What the provisions do is provide you with a set of remedies that you can pursue if you were improperly fired or otherwise retaliated against due to protected activity related to the False Claims Act.

For example, federal law provides that your remedies can include: 

• Reinstatement with the same seniority status that you would have had but for the discrimination.
• 2 times the amount of back pay.
• Interest on the back pay.
• Compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys’ fees. 
  • When you first noticed the fraudulent conduct.

Dan Cytryn's Practice Pointer

One of the most important things I tell clients is this: “Do not let fear make your decisions for you.”

Fear can cause people to act too quickly and make poor decisions. It can also cause people to do nothing at all when they otherwise should have taken action. The prudent course, before you do anything else, is to call an attorney to discuss what you should do and how you can protect yourself from potential retaliation.

Chapter Nine

Preparing for Your First Meeting with the Attorney

You don’t need to know all the details about Medicare rules and the specific False Claims Act provisions. Nobody expects you to be anything close to an expert on these things. You can leave that to the lawyer. 

What you should do is organize the information you already have and put it into an accessible format for the lawyer to review.

Start with a Timeline

Prepare a chronological summary of the events you personally observed or know about. Your timeline does not have to be perfect; just try to organize your thoughts into a coherent timeline including as much of the ‘who, what, where, when, and why’ as you can. Include information such as:

• What exactly you observed.
• Who was involved (names, job titles, and other important identifying information) and what did each of them do.
• When and where important meetings occurred, and who said what.
• Whether the conduct continued to happen over and over again.

Be Honest 

There’s that old saying, “Don’t lie to your doctor or your lawyer.” All things considered, that’s pretty good advice. Especially when dealing with a false claims case, you need to tell your attorney the truth. If you participated in the fraud, make sure to let the attorney know that at the outset. If you signed documents that you shouldn’t have signed, let the attorney know. There’s no sense in running from the truth. In these types of cases, the investigation (whether the government’s investigation or your attorney’s investigation) will often reveal what your role, if any, was in the fraud. It’s better for the attorney to know this information at the beginning rather than being surprised by it later.

One of the worst things you can do is make your attorney think you had nothing to do with any fraudulent conduct. When you lie to your attorney about your own role, this can cause problems in your case that may be hard (or impossible) to fix later on.

Dan Cytryn's Practice Pointer

During my 40+ years as a trial lawyer, I have learned that credibility is key. A whistleblower who is honest, careful, accurate, and professional is far more persuasive than someone who lies, exaggerates, or speculates about things that they cannot prove. If you don’t know the answer to a question, just say so. As we’ve said before, nobody expects you to have all the answers.

One of the best clients I can represent is someone who comes to me with an open mind and is upfront with me about everything. 

Even if you’ve made some mistakes. Even if you’ve played some role in the fraud. That doesn’t necessarily mean that you don’t have a case. That doesn’t always mean that you are going to be personally held accountable for your involvement. It just means that I, as your attorney, will have to figure out how to handle that issue, how to acknowledge and explain your role in the fraud, how to disclose your role to the government, etc. But that’s part of my job. I don’t get frustrated when clients tell me the truth, even if it’s something bad; what does get frustrating is when I can’t trust what my client is telling me.

Chapter Ten

Frequently Asked Questions About Healthcare Whistleblower Lawsuits

How do I know whether what I have observed is actually fraud?

You may not know for sure.

A lot of people end up contacting an attorney because they aren’t sure whether the conduct they have observed violates the False Claims Act. An initial consultation is often the best way to determine whether your suspicions warrant further investigation.

Do I need to have every document before speaking with a lawyer?

No.

You aren’t expected to have every single useful document at your disposal. If you have the documents in hand, that’s great, and we can take a look at what you have. If not, we can discuss what type of documents we need and come up with a plan on how you can lawfully gather them.

What if I am only suspicious?

A lot of whistleblower cases begin with a reasonable suspicion. Obviously, if you just have a “bad feeling” about something, then maybe that’s not worth pursuing. But if you have actual, firsthand knowledge of something that you have a reason to believe is fraudulent, you should call an attorney to discuss whether you might be on to something.

What if I participated in the fraud?

Like we say above, this doesn’t mean you don’t have a case. If you participated in the fraud, let your attorney know exactly what you did. The attorney can then figure out what the best next step is going to be.

Can I remain anonymous?

Generally, no. Qui tam actions are filed under seal, meaning the complaint is initially not available for public viewing and is not served on the defendant. But at some point, the complaint is likely going to be unsealed and served on the defendant. At that point, the cat’s out of the bag regarding your identity.

What if the government decides not to intervene?

That does not necessarily end the case. The government often declines to pursue viable cases for a variety of reasons. But if there’s a viable case, you should continue with the case even if the government declines to intervene.

Will my case go to trial?

Hard to say. Many healthcare whistleblower cases are resolved without a trial, while other times the defendants keep fighting up until the very end (including through appeal). There’s just no way to tell what will happen with some of these cases.

Should I report the matter to my employer first?

There is no universal answer to that question. In some situations, internal reporting may be appropriate. In others, it may not. The best thing you can do is, before making a decision on this, speak with a lawyer and see what makes the most sense in your circumstances.

Conclusion

To sum things up for anybody who just skipped straight through to the end of this guide (and considering its length, we wouldn’t blame you), healthcare whistleblower cases are complicated. 

At this point we’re sounding like a broken record, but we cannot stress this enough: Do not make any important decisions until you have talked to a lawyer.

Who knows what you’ll learn from speaking to an attorney. Maybe you’ll hear that you have a potentially strong case; maybe you’ll hear that a lot more investigation is needed before we have any idea if there’s a viable case; or maybe you’ll hear that you are barking up the wrong tree and that there is no fraud going on. Whatever the case may be, your best bet is to speak with an attorney and get an honest, knowledgeable opinion about your situation.

Believe it or not, the purpose of this guide isn’t to encourage qui tam lawsuits. Instead, we’re trying to help you understand the importance of making informed decisions. When it comes to claims involving healthcare fraud, the best decisions a potential whistleblower can make are made based on accurate information, carefully and thoughtfully weighing your options, and sound legal advice (though as we’ve said before, this guide itself is not legal advice).

If you suspect that you have discovered healthcare fraud, call our office today at (954) 833-1440 to schedule a free consultation.