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How can healthcare execs defeat a whistleblower claim?

The federal government has a system in place that encourages current and former healthcare employees to report wrongdoing. This is achieved through qui tam, or whistleblower cases. The government benefits from this system because workers within healthcare organizations often have knowledge of the inner workings of these organizations. They can use this knowledge to file a lawsuit in the event the organization is in violation of federal regulations. If the whistleblower case is successful, the individual who reported the alleged mistake gets a portion of the winnings.

How can healthcare business owners fight these claims?

Although the filing often involves someone with knowledge of the inner workings of the organization, these suits are not always successful. Healthcare exec can fight these allegations.

In a recent case, a worker accused a hospital system of filing false claims for physical therapy services with Medicare. Since the allegedly fraudulent claim involved a government provider, the whistleblower could claim the provider was in violation of the False Claims Act (FCA). The provider beat the claim because the whistleblower did not have sufficient evidence to support the allegations.

Healthcare business owners can takeaway two important lessons from this case:

  1. You can defeat a lawsuit. The allegation of a violation of the FCA is not infallible. If taken seriously, a properly tailored response can defeat the claim.
  2. Records are important. The case also highlights the importance of keeping good records. Had the whistleblower provided evidence, the provider could use their records to fight against the allegations.

These cases can be complex, and the courts often require particularity. A knowledge of these requirements can work in your favor to better ensure a prompt resolution.