Typical Healthcare Fraud Whistleblowers
EMPLOYEES: The most common types of qui tam plaintiffs are current and former employees. Detecting fraud is usually very difficult, absent the cooperation of an insider close to the fraudulent activity. Without insiders, proof of fraud can occur by circumstantial evidence at best. It is for this reason that employee whistleblowers are so important — they can provide context for the who, what, where, and when of the alleged fraud.
COMPETITORS AND SUBCONTRACTORS: Competitors or subcontractors of the company committing the fraud do occur but are much less common.
INDUSTRY EXPERTS: Industry experts have successfully brought forth Medicare Fraud qui tam lawsuits. Their understanding of the industry, and special expertise in a given field, helps them to put together facts and documents necessary to appropriately expose the Healthcare Fraud. These cases, while still viable, have become increasingly difficult to bring due to the “public disclosure” and “9(b)” legal issues.
Also see Physicians as Whistleblowers