According to the government, over 10 percent of all of the funds it spends is lost due to fraud! This means over $300 million a year. Fraud is rampant and is not being controlled by audits. Now, Congress has revamped a number of laws and ordered that the U.S. Department of Justice upgrade and enhance its whistleblower rewards program and to pay up to 30 percent of what it recovers based on whistleblower information.
Here are some common types of whistleblower cases;
1. Over charging for goods and services or collecting on goods and services not provided at all;
2. Submitting false cost and pricing data to the government as part of contract bidding or negotiation;
3. Billing federal health programs for tests and services not performed;
4. Performing and billing for medical tests not requested by a physician;
5. “Upcoding” or inflating bills by using diagnosis codes for patients not receiving the services stated;
6. Tax fraud. New regulations allow the whistleblower to obtain up to 30 percent of what the IRS gets back.
How to know if you have a claim?
For a person to have a viable whistleblower claim under the Federal False Claims Act, they need to show;
a. That the company or person who committed fraud presented or caused someone to present a claim for payment by The United States;
b. The claim presented to the U.S. for payment must be fraudulent;
c. The person or company must know the claims are false or be reckless in their actions.
Who can bring a case?
Anyone can bring a case if they are the original source of the information (not previously disclosed); they have direct and independent knowledge of the misconduct.
The law specifically prohibits retaliation by harassment or threatening an employee for blowing the whistle. In addition, the claims must be handled in a particular fashion by experienced counsel. FCA claims, for example, must be filed under seal.