A whistleblower lawsuit program that allows individuals to report Medicaid fraud to the government is working, according to a legislative review of Washington state law.

Since the False Claims Act was passed in the state three-years ago, several whistleblower lawsuits have been filed resulting in a 28 percent recovery of Medicaid funds. One qui tam lawsuit filed in Washington settled for more than $3.5 million.

Legislative auditors claim the state law has not encouraged frivolous lawsuits but rather has allowed citizens to file whistleblower lawsuits helping the state to pursue Medicaid fraud. The Washington state False Claims Act expires next summer but auditors have urged lawmakers to renew the law before that time.

Medicaid Fraud Qui Tam Lawsuits

Medicaid is a federal and a state program that helps cover the cost of health care for low-income residents and their families. But some Medicaid providers bill for services that they did not provide or file false claims in an effort to obtain money they are not entitled to.

By allowing citizens to file qui tam lawsuits, the state can pursue civil cases concerning Medicaid fraud that it would otherwise lack authority to pursue. Medicaid recoveries within the state have increased since the False Claims Act was passed in 2012.

What is a Whistleblower Lawsuit?

Whistleblower lawsuits are filed by individuals who have evidence their employer has committed fraud against the government. The most commonly filed qui tam lawsuits accuse companies of committing health insurance fraud, Medicare or Medicaid fraud, and government contractor fraud.

Here are some examples:

• Healthcare insurance fraud takes place when doctors bill for performing tests or x-rays there were never performed
• Medicare fraud occurs when businesses bill the federal government for services or supplies that were never given to Medicare patients
• Government contractor fraud takes place when security, environmental and defense contractors overcharge for performing work or charge for services that were never performed

Those who file a whistleblower lawsuit are protected from being harassed, demoted or fired because they filed the qui tam lawsuit. If any of those actions are taken against them, an employee is entitled to double back pay and reinstatement of their position.

Individuals who can prove that their employer committed fraud against the government can earn up to 30 percent of whatever the whistleblower lawsuit is able to recover.

Filing a Qui Tam Lawsuit

Filing a whistleblower lawsuit can be a complicated process and, often, individuals choose to hire an attorney to help them through the process.

Individuals who choose to hold their employer accountable for government fraud should contact a whistleblower attorney. Their qui tam lawsuit is then reviewed and if it is determined that there is a potential case, the lawsuit is sent to the Justice Department for review.

The federal government generally has about 60 days to decide if it wants to join the qui tam lawsuit. Whistleblower lawsuits are typically more successful if the government joins the complaint, but if they decide not to, the plaintiff can continue pursuing legal action. During the 60-day investigation, the identity of the whistleblower is kept confidential.

Contact a whistleblower lawyer if you have evidence of fraud committed against the federal government.