Can I Report My Employer For Fraudulent Billing?

Can I report my employer for fraudulent billing?

Yes. A whistleblower can report their employer for fraudulent billing, especially when it involves government money (such as when a hospital accepts Medicare). In those circumstances, federal law protects whistleblowers from retaliation and offers them financial rewards to report fraudulent billing. Filing a qui tam case through an attorney is one of the best ways to ensure that a report of fraud complies with federal law.

Common Signs of Fraudulent Billing

Signs indicating a fraudulent billing practice often manifest in subtle patterns. Employees may become suspicious when they notice irregularities in Medicare billing procedures, discrepancies in government contractor documentation, lack of transparency in response to questions or feedback, or pressure to code procedures in a certain way to maximize reimbursement.

Some employers also maintain a culture of disregard for compliance with billing regulations. When management prioritizes revenue generation over ethical billing practices, employees may feel pressured to engage in fraudulent activities or look the other way. This pressure can be subtle, conveyed through performance metrics or implicit directives to meet financial targets.

When fraud is occurring at a company, it’s often considered “profitable.” Accordingly, internal reports of suspected fraudulent billing may go unaddressed or be dismissed by supervisors or administrators, fostering a sense of futility among employees attempting to raise concerns. Many whistleblowers opt to contact an outside attorney to protect themselves from potential retaliation and navigate the complex legal process involved in reporting fraud through a qui tam lawsuit.


Common Whistleblower Traits

According to a CNBC report, whistleblowers tend to:

  • have a personal identity that isn’t caught up in their job title or performance metrics
  • have worked their way into a position of trust
  • be motivated by a larger ideal, such as their faith, or by a background of service, such as their military service.

None of those things are essential, of course–whistleblowers come from all kinds of backgrounds and have all kinds of reasons for reporting fraud.

Benefits of Reporting Billing Fraud

Whistleblowers are important for finding and stopping bad actors, especially in places like hospitals. By speaking out, whistleblowers help keep healthcare honest and make sure taxpayer money goes to helping sick people, not to crooks. When a whistleblower helps the government enforce the law, it often means that companies have to pay back what the money that they cheated the government out of–and even pay the whistleblower who did the right thing.