Whistleblower Rewards in Healthcare

What is the reward for a  healthcare whistleblower who reports Medicare or health insurance fraud?

"A whistleblower is typically entitled to a share of the financial recovery, which is typically between 15% and 30%.  A whistleblower is called the “relator” and if they are not an employee at the time of filing the case, it is then called a qui tam case.  In order to receive an award that the whistleblower must have: 1) Specific personal knowledge about the violations, 2) Cannot (or minimally) have participated in the violation, and preferably protested on record about the violations, 3) Have evidence in hand, such as emails, texts, contracts, specific transactions, with names, dates, numbers, that would lead the U.S. Department of Justice investigators to start their investigations.  Some of the larger awards given to healthcare whistleblowers are well above $100 million, it will depend on the case at hand; and many of them include healthcare providers, insurance companies, and pharmaceuticals.

A reward sends a clear message to potential healthcare whistleblowers that their information is valuable and can mitigate the risks of retaliation for the government.

The Medicare fraud whistleblower rewards under the False Claims Act are calculated as follows:

1) Actual Damages to the government - the amount of overpayment received, plus

2) Treble Damages - three time the amount of the actual damages, plus

3) For example as of 2021, Federal Penalties on the low side are $11,803 per claim filed, and on the high side are $23,607 per claim filed; hence supposing a 100 false claims could result in penalties ranging from $1,180,300 to $2,360,700.  Obviously this would be significantly different if there were 10,000 claims, hence the amount would be $118,030,000 to $236,070,000 in penalties, plus

4) Florida FCA Penalties are not less than $5,500 and not more than $11,000 per claim, plus treble damages for the claim submitted.  Other states have similar penalties.

Plus there are other penalties and fines that will likely apply. 

Under the False Claims Act, the penalties are often much higher than the actual or treble damages.  The healthcare whistleblower would then be entitled to essentially a bounty fee equal a portion of that recovery between 15% and 30%.

How Much Reward a Healthcare Whistleblower Will Get Depends on the following:

  • Did the healthcare whistleblower and their attorney help the with the investigation and litigation?
  • How widespread and extensive is the fraud?
  • How much effort the government had to put in to the case?
  • Did the government already know about the fraud before the healthcare whistleblower reported it?
  • Did the healthcare whistleblower participate in the wrongful conduct?
  • How big was the settlement?
  • Did the healthcare whistleblower get adversely affected as a result of the whistleblower lawsuit.

Remember you cannot win an Award unless you file a Lawsuit.

If you think you have a situation that you would like to discuss with an attorney in confidence, do not hesitate to contact me directly Ben A. S. Mirza, Cell/Text 954-445-5503 or email me at [email protected].  We are a team of lawyers ready and standing by to correct the wrong, and we will do our best to earn you an award.  We only make money if you get an award from the government. The right team of attorneys can make all the difference.  We stand by to earn your business.

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