The 10-Step Guide To Blowing the Whistle on Medicaid Fraud

If you have knowledge of activity occurring within your organization attempting to benefit financially from defrauding Medicaid, you'll face some difficult decisions. This 10-Step Guide to Whistleblowing outlines the essential steps necessary to maximizing your cash reward, ensuring your protection from retaliation and making certain your whistleblower claim is successful from the very start.

  • Step 1: Call Our Medicaid Fraud Hotline Immediately

    Delay is the number one fatal flaw in filing a successful Medicaid fraud whistleblower claim. You may have the strongest case in years, worth millions to both the government and yourself, but if you don’t file on time, it’s worth nothing. If another employee or government agent reports concerns before you, you can definitely lose all rights to a whistleblower cash reward and conceivably diminish any retaliation claim you might have.

    Do not contact another entity prior to reporting your concerns to our State Medicaid Fraud Hotline. This is vital to protecting your rights to a retaliation claim and solidifying your role as whistleblower. The process of filing a whistleblower claim must be followed to the letter in order to ensure your eligibility for a whistleblower reward. Any holes or skipped steps and the case can unravel early on.

  • Step 2: Keep Quiet

    There are several reasons you shouldn’t discuss your case until the time is right. Most whistleblower awards are based on first-to-file. Share your intentions with others and they may file a claim before you, eliminating your chances for a whistleblower claim. Because of the potential for a lucrative cash reward, this happens surprisingly often.

    Some whistleblower statutes include a public disclosure bar (this means your information must not already be public knowledge or the like), in which case telling anyone could threaten your claim and award eligibility. In addition, depending on the type of claim, many courts have a judge-issued sealing order, for which you could be sanctioned (conceivably jailed, fined or other penalty) and your claim dismissed for confidentiality breach.

    Though some state laws require employees to bring the fraudulent activity to the attention of a supervisor and give the employer reasonable opportunity to correct the activity, there are many instances when this disclosure is not required, such as when the employee reasonably believes that the activity is known to a supervisor or when the employee fears physical harm as a result of the disclosure. Your State Medicaid Fraud counsel will advise you on when and with whom you should discuss your claim to best ensure the safety and eligibility of the claim.

  • Step 3: Maintain Your Privacy

    We suggest you contact our State Medicaid Fraud Hotline from a personal phone or email account. Work computers, company telephones and employee email accounts may offer little privacy or legal protection of that privacy.

    In collecting evidence, we don’t recommend emailing yourself large numbers of documents using company computers or email accounts. Many companies have IT programs in place that look for potential whistleblower activity by examining outgoing emails and attachments. Our State Medicaid Fraud counsel can advise you on how to gather evidence legally and protect your rights.

  • Step 4: Prepare To Prove Your Case

    In order to file a successful whistleblower claim and prove your case, you must be able to prove motive and pretext. Valuable information can include a documented timeline of events, evidence of intent to defraud Medicaid (that the fraud was done intentionally and knowingly in an attempt to benefit financially), and a general idea on possible State Medicaid monetary damages as a result of the medical provider’s or employer’s actions.

    Whistleblower cases must be based on facts. Speculation and rumor are not enough to file a claim. Keep a detailed record of the details and insights involved. Quietly gather names and phone numbers of prospective witnesses. Identify supporting digital and hard copy documents.

    It isn’t unusual for organizations to suspect a potential whistleblower. Though you may not be fired, you may be escorted to a different position or sent on paid leave and lose access to your computer, email account and records. Keep claim-related documents and notes in a personal location. For non-classified information, make a set of digital or hard copies for yourself. If possible, keep backup copies in a separate location.

  • Step 5: Follow the Rules

    If the court ascertains that you have violated the law in order to collect evidence, the case may be dismissed, your rights may be lost, and criminal prosecution can result. In some states, taking documents from the workplace is illegal. Speak with your counsel about any evidence you have already gathered and always ask if you have any question regarding what may or may not be okay. Your lawyer will help you determine what you can and cannot take according to the law..

    In addition, don’t aggravate your employer. Follow workplace rules and continue with your work to the best of your ability. As a potential whistleblower, be mindful that support staff may be asked to observe you or security police may be used to investigate you. Act as a model employee to prevent cause for disciplinary measure. The less likely there are obstacles and distractions, the safer you will be and the greater your chances of success.

  • Step 6: Listen to Counsel

    The job of counsel is to protect your rights as a whistleblower and ensure that your case is successful. You and your lawyer are becoming partners in a process that can potentially take years. Often, your lawyer will need to ask tough questions or give advice you may not immediately understand. It can be easy to get offended or take the process to heart, however your lawyer must find and correct weaknesses in your case and needs to know the facts. Always ask questions if you don’t understand a procedure and follow your counsel’s expert advice as closely as possible to ensure the process is positive and successful.

  • Step 7: Prepare For Your Whistleblower Identity to Become Known

    Depending on the type whistleblower case, your position may remain completely confidential throughout the entire process. However, it’s important to prepare for the likelihood that your whistleblower status will become known, with or without warning.

    At this point, you may get media interview requests, friends and coworkers may treat you differently, and you could be exposed to harassment, demotion or firing. Your lawyer can discuss these scenarios with you well in advance and prepare you for the appropriate responses. Appreciate the serious nature of whistleblowing and the potential impact it can have on your career and family. Follow the required steps your lawyer recommends to protect yourself and others.

  • Step 8: Do Not Sign Anything without Counsel

    Your company or coworkers may become aware of your whistleblower status at any moment, with or without your knowledge. Once you have decided to file a claim, it is important to seek the advice of counsel before signing any contract revisions or other documents that could have an effect on your eligibility to collect a reward.

    Some unscrupulous corporations add severance plan language that can exclude employees from whistleblower award eligibility. An employer can’t prevent you from filing a claim, but it may be able to stop you from collecting whistleblower benefits. It is essential to speak to legal counsel before signing any documents through the process to ensure your rights are kept safe.

  • Step 9: Avoid Bribes and Pay Offs

    Do not respond to offers by your employer to take “hush money” or to be bought off. Though such offers may be tempting, accepting them can destroy your chances for a much more lucrative cash whistleblower reward and can damage your rights to career and future protections. It is important to make note of any such offers and report them to your legal counsel as soon as they occur.

  • Step 10: Don’t Spend Your Cash Award Before You Receive It

    Cases with potential for great success can unravel due to technicalities. If a defendant files for bankruptcy because they have wasted their finances on a promise of an anticipated whistleblower reward, it can cause irreparable damage to the case. The case isn’t over until the check is deposited into your bank account. Act responsibly and let the case be seen successfully through to the end.

    Perhaps the most important advice… stay positive! You are making a choice to report wrongdoing and recover valuable taxpayer dollars for your state. The government appreciates this and, in turn, offers a well-deserved reward. The process won’t be easy, but with the skilled and knowledgeable expertise of your legal counsel backing you up there’s no need to worry. Have confidence and move forward. Reporting fraud is the right thing to do!

If you have knowledge of fraudulent billing by an employer, medical provider or company against Medicaid, act now to protect yourself and ensure your role as whistleblower. Call our Medicaid Hotline at 888.742.7248.

Medicaid Fraud Hotline: 888.742.7248 or Report Online