Exposing Healthcare Fraud: How Whistleblowers Protect Patients and the Public

The U.S. healthcare system is supposed to serve patients, not profit from fraud. But every year, billions of dollars are lost to illegal billing schemes, kickbacks, and fake diagnoses. Worse, these actions can put lives at risk.

Healthcare fraud doesn’t just cost the government; it can lead to overprescribed medications, unnecessary procedures, and reduced care for the people who need it most. This kind of fraud is often uncovered only when a whistleblower steps forward to do the right thing.

At Morgan & Morgan, we support whistleblowers who report healthcare fraud. Our attorneys fight to protect their rights and help them seek the compensation and legal protection they deserve.

What Is Healthcare Fraud?

Healthcare fraud occurs when a provider, company, or institution intentionally deceives the healthcare system to receive improper payments. It’s a form of corporate fraud that can involve Medicare, Medicaid, private insurers, or other healthcare programs.

Common forms of healthcare fraud include:

• Upcoding: Billing for more expensive services or procedures than were actually performed
• Phantom billing: Charging for services, tests, or equipment that were never provided
• Unnecessary procedures: Performing  and billing for treatments that aren’t medically needed
• Kickbacks: Offering or receiving incentives for patient referrals, prescriptions, or use of certain products
• Double billing: Charging more than one payer for the same service
• False diagnoses: Misrepresenting a patient’s condition to increase billing or drug prescriptions
• Falsifying records: Manipulating medical charts or billing documentation to support fraudulent claims

These schemes are often hidden under layers of paperwork and bureaucracy, which is why insiders are essential to exposing the truth.

Who Commits Healthcare Fraud?

Healthcare fraud can happen anywhere medical services or equipment are provided. This includes:

• Hospitals and urgent care centers
• Clinics and private practices
• Nursing homes and assisted living facilities
• Home health agencies
• Pharmaceutical companies
• Medical device manufacturers
• Mental health or substance abuse treatment centers

Doctors, executives, billing staff, marketers, or even third-party vendors can commit fraud. Whistleblowers often include employees, former employees, contractors, or healthcare professionals who see something they know isn’t right.

Why Whistleblowers Are So Important

Healthcare fraud is often difficult to detect externally. Government agencies rely on insiders who understand how the system works and recognize when it’s being abused.

Whistleblowers have helped expose some of the largest fraud cases in U.S. history. Their efforts have:

• Recovered billions of taxpayer dollars
• Shut down abusive and dangerous practices
• Protected patients from unnecessary care or financial harm
• Prompted criminal charges and corporate reform

And in many cases, whistleblowers are eligible for a financial reward when the case leads to a recovery.

Legal Protections for Healthcare Fraud Whistleblowers

The False Claims Act allows private citizens to file qui tam lawsuits on behalf of the federal government. These cases involve whistleblowers (known as “relators”) who report fraud against government programs, like Medicare or Medicaid.

A qui tam action, from a Latin phrase meaning “he who sues on behalf of the king as well as himself,” gives individuals the power to help the government recover funds and, in return, share in the recovery. In successful qui tam cases, whistleblowers may receive 15% to 30% of the total amount recovered.

Whistleblowers are also protected from retaliation under federal and state laws. It’s illegal for an employer to fire, demote, harass, or discriminate against you for reporting fraud.

Real-World Examples of Healthcare Fraud

Healthcare fraud can take many forms. Some high-profile examples include:

• A hospital system overbilling Medicare for unnecessary cardiac procedures
• A chain of nursing homes falsifying staffing records and patient care levels
• A lab billing for thousands of COVID-19 tests that were never conducted
• A pharmaceutical company providing kickbacks to doctors to prescribe a specific drug
• A mental health clinic fabricating patient sessions to bill Medicaid

These cases often rely on whistleblower evidence to move forward. Without brave individuals speaking up, many of these schemes would continue unchecked.

What to Do If You Suspect Healthcare Fraud

If you’ve witnessed fraud in a medical or billing setting, take the following steps to protect yourself and your potential case:

• Document what you know: Save emails, invoices, charts, reports, and evidence discreetly and legally.
• Don’t confront the wrongdoer: Reporting internally can trigger retaliation or give others time to destroy evidence. Speak to a lawyer first.
• Avoid using work devices to research or report: Use your personal phone or computer when possible.
• Consult a whistleblower attorney: These cases are time-sensitive and legally complex. If applicable, an attorney can help you file a protected complaint and pursue a reward.

Why You Need an Attorney

Healthcare fraud cases often involve powerful companies and aggressive defense teams. Having an experienced legal team can make the difference between a dismissed claim and a meaningful recovery.

At Morgan & Morgan, our whistleblower attorneys have experience handling complex False Claims Act cases, including those involving hospitals, insurers, pharmaceutical companies, and healthcare providers. We know how to navigate federal procedures, protect your confidentiality, and fight for your rights.

Morgan & Morgan Fights for Healthcare Whistleblowers

You are not alone if you’ve seen fraud in a hospital, clinic, or billing department, or are pressured to participate in it. And you are not powerless.

At Morgan & Morgan, we believe that whistleblowers are heroes. We’re here to protect you, fight for your rights, and pursue the justice you deserve. Whether you’re considering filing a claim or want to explore your options confidentially, our team is ready to help.

Contact us today for a free, confidential case evaluation. You pay nothing unless we win.