Physicians as Whistleblowers
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 employee and/or interact with physicians are honest. Out of the few physicians who are in the position to blow the whistle on fraud, some do not have the moral outrage or personality to step forward, even if a viable reward may be likely. For others, it just isn’t worth it – for many reasons, which is their right.
Even so, those physicians 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 provide context for the who, what, where, and when of the alleged fraud. They also typically provide documents, which may then provide a smoking gun, raise a strong inference of fraud, present circumstantial evidence of wrongdoing, and/or provide important and useful background information.
Physicians are even more in need, as the highly technical and specific nature of the documentation often requires a physician whistleblower explanation. Physicians are also especially valuable whistleblowers as they are generally treated with a great presumption of credibility.