Colorado Healthcare Fraud Whistleblower Lawyer | Qui Tam False Claims Act Cases

Healthcare fraud is a serious crime, and it happens all too often in Colorado and across the U.S. Information from the national Department of Health and Human Services indicates that in a single recent month, federal agents charged 345 defendants with offenses totaling more than $6 billion in fraudulent charges.

Some people see fraud as a “victimless” crime, but these offenses make healthcare more expensive for everyone. In many cases, the fraudulent activity is only exposed by a whistleblower.

If you have information about healthcare fraud and wish to file a whistleblower lawsuit or qui tam case, The Wilhite Law Firm wants help to help you. Our Colorado healthcare fraud whistleblower lawyers can help you file your claim and guide you through the process.

We can also help you pursue potentially significant compensation for reporting healthcare fraud. The federal Whistleblower Protection Act and other laws allow whistleblowers to receive a portion of whatever the government recovers from stopping the fraudulent activity.

For more information on healthcare fraud whistleblower and qui tam cases in Colorado, contact us for a free and completely confidential consultation today.

What Is a Whistleblower

A whistleblower, is someone who reports fraud, corruption, waste, abuse or dangers to public safety to someone who can fix the harm. Whistleblowers are typically people within an organization where the wrongdoing is taking place or even within an organization connected to the wrongdoing organization. However, a whistleblower does not have to be within an organization. Anyone with knowledge of the harm could be a whistleblower

What Healthcare Whistleblower Laws Apply in Colorado?

The most important whistleblower law that applies in Colorado is the federal Whistleblower Protection Act (WPA). Originally passed as part of the Civil Service Reform Act of 1978, the WPA protects federal employees from retaliation if they report misconduct by a federal government agency. That includes instances of healthcare fraud, as Medicare and Medicaid are both federal programs and are two of the programs in which fraud is most rampant.

In addition, two state laws protect whistleblowers in Colorado. The first is Section 24-50.5-103 of the Colorado Revised Statutes (CRS), which protects public employees from retaliation in most circumstances if an employee reports fraud. The employee must file a written complaint within 30 days of the alleged instance of fraud, and they can file a lawsuit only if the initial complaint is denied. However, this law does not apply to:

• Employees who disclose false information or disclose information with reckless disregard for the truth
• Employees who disclose information from public records that have been sealed
• Employees who disclose confidential information

The other Colorado law protecting whistleblowers is CRS Section 24-114-102, which applies to private sector workers. This law states that private employees are protected from retaliation under similar circumstances as public workers. However, one additional requirement for private-sector workers is that they must make an effort to report the alleged fraud to their supervisor or another internal authority before they report the fraud to an outside source.

One advantage private-sector workers have over public employees in Colorado is that private-sector employees can file a wrongful termination lawsuit without having to go through a formal complaint process first.

What Is a Qui Tam Case?

A qui tam case is a type of whistleblower claim brought under the federal False Claims Act. Under the False Claims Act, the government can pursue criminal and civil legal action against those who defraud or attempt to defraud government agencies. However, since individual employees uncover many acts of fraud before federal authorities can investigate them, the False Claims Act also allows individuals to file lawsuits on behalf of the government against those who’ve committed fraud.

This type of claim is known as a qui tam lawsuit, and individuals who file successful qui tam claims can receive a portion of whatever money the government recovers. Thus, qui tam claims provide an incentive for people to report fraud committed by their employers, co-workers, and so on.

What Types of Healthcare Fraud Often Result in Whistleblower Cases?

Many different types of healthcare fraud can lead to a whistleblower lawsuit. Some of the more common cases include:

• Services not performed – If a Medicare or Medicaid provider bills the government for services that were never actually performed, that constitutes fraud.
• Worthless services – If a healthcare provider performed services that aren’t medically necessary, did nothing to improve the patient’s condition, or ended up causing additional harm to the patient, that could be considered fraudulent activity.
• Neglect – Sometimes, providers at nursing homes, assisting living homes, and similar facilities will bill Medicare or Medicaid for healthcare services, but they never actually see a patient, or the level of care is so poor that it amounts to fraud.
• Overly aggressive treatments – Many healthcare fraud cases involve providers performing unnecessary procedures, ordering tests that aren’t needed, and providing other overly aggressive treatment that can harm patients. If the services provided aren’t helpful or aren’t medically necessary, these actions can constitute fraud.
• Misrepresenting credentials – If a facility or provider submits a claim for services and misrepresents the credentials of whoever performed those services, that is considered fraud, as only qualified medical providers should treat patients.
• Improper coding of services – When providers provide healthcare services and submit a claim for reimbursement, the services they provide correspond to specific numerical codes, and these codes are included as part of the claim. One widespread form of healthcare fraud is providers improperly coding claims to bill for more expensive services than what they actually provided. That and similar examples of improper coding are considered fraud.
• “Unbundling” services – In many cases of healthcare fraud, a provider submits a claim where they bundle the services they provided to receive reimbursement, then submits a second claim where those services are unbundled for additional reimbursement.

Can I Get Compensation for Whistleblowing?

Under the federal False Claims Act, whistleblowers can potentially receive a portion of whatever the government collects as part of the fraud claim. To do so, the whistleblower will need to file a qui tam suit and prevail in that claim.

The exact amount you can recover for filing a whistleblower claim will depend on the amount of fraud that’s allegedly occurred and whether your claim is successful. A whistleblower lawyer can assist you with your case to give you the best possible chance of recovering compensation.

Our Attorneys Also Investigate and Pursue Claims Of Improper Billing Practices.

Our attorneys are actively pursuing claims against medical providers for seeking money from injured individuals they are not allowed to pursue. For example, hospitals that file liens against injured people settlements and judgments without first billing their primary medical payers of benefits violate Colorado law. Other hospitals may seek reimbursement from settlements and judgments in amounts greater than they are allowed to seek under state and federal law. Additionally, some medical providers may unreasonably and illegally set prices for treatment in collusion with other companies. These are all situations The Wilhite Law Firm attorneys investigate and pursue as claims.

How Can a Denver Healthcare Fraud Whistleblower Lawyer Help Me?

Healthcare fraud whistleblower cases can be highly complex, and there’s a significant risk of retaliation by your employer or other parties. However, it’s important to expose fraud when it happens, and a whistleblower lawyer can help you with your case and protect your rights.

The Wilhite Law Firm stands ready to examine the facts of your case to determine whether fraud has been committed and what you might be able to recover through a qui tam claim. From there, we can help you file your claim and develop a case to help show that your employer committed fraud.

If you want to know more about how The Wilhite Law Firm can help with your case, contact us now for a free and completely confidential consultation.