Most physicians never get the opportunity to file Medicare Fraud qui tam lawsuits because they simply are not in a position to do so; most healthcare providers that physicians are employed by or come into contact with, are honest. Out of the minority of physicians who are in an opportune position, many of those simply do not have the moral outrage or personality to step forward, even if a lot of money is at the end of the path. For others, it just isn’t worth it – for many reasons. And that is their right.
Even so, those that do step forward are valued and, in the right circumstances, handsomely rewarded. Guile and concealment are at the heart of most cases of healthcare fraud. Without insiders, evidence of fraud will almost always be available only by circumstantial evidence. It is this reason why whistleblowers are so important. Whistleblowers can explain the who, what, where, and when of the alleged fraud. They also typically provide documents, and the documents may provide a smoking gun, raise a strong inference of fraud, present circumstantial evidence of wrongdoing, and/or provide important and useful background information. Often, the highly technical, or keen and specific nature of the documentation requires a physician whistleblower explanation. Physicians are also especially valuable whistleblowers as they are typically intelligent, have otherwise successful careers, and are generally treated with a great presumption of credibility.