“Whistleblower” is a popular term these days, though it seems to mean different things to different people. For some, the word has a negative connotation—they see whistleblowers as grown-up tattle tales betraying the trust of friends and co-workers. For others, whistleblowers are heroes. Time Magazine, for example, named “the Whistleblowers” (more specifically, Cynthia Cooper of Worldcom, Coleen Rowley of the FBI, and Sherron Watkins of Enron) as its “Persons of the Year” for 2002, after they brought wrongdoing to light.
Count us in the camp that believes whistleblowers deserve enormous credit for their efforts. Whistleblowers take great personal risk to expose fraud and other illegal activities, and America is a better and safer place because of them. But that still leaves the question: what does it mean to actually be a whistleblower?
The short answer is that a whistleblower is someone who comes forward with information on improper conduct that someone else is trying to keep secret. Many different types of people meet this definition: a factory worker reporting on unsafe conditions, for example; or an investment banker reporting stock price manipulation; or a nurse exposing Medicare and Medicaid fraud.
The types of whistleblowers this firm represents are typically those who have information about fraud against a state or the federal government. Abraham Lincoln recognized the importance of these whistleblowers as far back as 1863, when he and Congress enacted a law to reward whistleblowers for sharing information about unscrupulous contractors defrauding the U.S. Army. That law—the federal False Claims Act—remains in effect today, and is still the primary way that the government recognizes and rewards citizen whistleblowers. Under the False Claims Act (“FCA”), a whistleblower who provides information about fraud against the government is generally entitled to anywhere from 15-30% of the money recovered. Just in the past year, the federal government has paid $519 million in rewards to whistleblowers, and has also recouped more than $4.7 billion in fraudulent payments.
As in Lincoln’s day, fraud against the United States and its agencies remains rampant. Medicare with its billions of dollars in annual payments to providers, facilities, vendors, and other contractors is the government program hit hardest by fraud. Health care fraud accounted for more than half of the $4.7 billion the federal government recouped in 2016, and many of the largest judgments and settlements in recent years have been against health care companies. Unfortunately, these recoveries are only a drop in the bucket as some experts estimate that the Medicare and Medicaid programs collectively lose over $70 billion per year in fraud.
Some examples of the types of claims whistleblowers have brought over the years involving the Medicare and Medicaid programs are:
These are but a few examples of the types of fraud that whistleblowers expose on a regular basis. It is by no means a complete list. Many of these schemes are complicated and orchestrated by providers to elude detection. As a result, whistleblowers need competent and experienced lawyers to help crack the case and present the scheme to the government in a comprehensive yet understandable manner.
In short, there are many types of whistleblowers and many different laws that potentially apply them, so if you are thinking about blowing the whistle, the best thing you can do is to consult with an experienced attorney as soon as possible.
To learn more about our Whistleblower & Qui Tam practice, click here. This is the first in our six part series on the ins and outs of exposing fraud against the government. Be on the lookout for next week’s edition discussing what to do if you believe your employer is committing fraud.