Healthcare fraud whistleblowers play an important role in exposing providers and other entities in the healthcare sector that improperly bill the government under Medicare, Medicaid, and other programs. Estimates put the cost of healthcare fraud at more than $100 billion per year, and the federal government relies on whistleblowers to report healthcare billing fraud so that it can take legal action when warranted.

In healthcare fraud cases, it is important for whistleblowers to have experienced legal representation. While hiring an experienced whistleblower attorney is not legally required, if you are thinking about coming forward, there are several important reasons to talk to an experienced attorney before doing so.

“The federal government relies on healthcare providers to accurately bill for services and items provided to Medicare and Medicaid patients. Unfortunately, far too often, this reliance is misplaced. As a result, the federal government also relies on whistleblowers within the healthcare industry to expose violations of the law.” – Dr. Nick Oberheiden, Founding Attorney of Oberheiden P.C.

In many cases, serving as a healthcare fraud whistleblower involves filing a qui tam lawsuit under the False Claims Act. The False Claims Act prohibits fraudulent billings under Medicare, Medicaid, and other programs, and filing a qui tam lawsuit can help the government recover fraudulent billings from unscrupulous healthcare providers and other entities in court. But, there are other options as well. With this in mind, one of the first—and most important—reasons to contact a healthcare whistleblower law firm is to ensure that you make an informed decision about how to come forward.

10 Key Considerations for Choosing a Healthcare Whistleblower Lawyer

Here are 10 key considerations for choosing a whistleblower lawyer if you are thinking about reporting fraudulent billings to the federal government:

1. Is the Lawyer Familiar with the Laws Governing Medicare Fraud and Other Forms of Healthcare Billing Fraud?

While Medicare fraud and other forms of healthcare billing fraud are clear violations of federal law, the laws governing federal reimbursement of patients’ medical expenses are extremely complex. As a result, it is important to choose a lawyer who is intimately familiar with all applicable laws and regulations. A lawyer who has a clear understanding of when billing fraud allegations are warranted will be able to help you make an informed decision about whether to pursue a False Claims Act case or provide a protected whistleblower disclosure through other means.

2. Is the Lawyer Familiar with the Procedures for Filing Whistleblower Complaints Under the False Claims Act?

As mentioned above, reporting healthcare fraud to the federal government often involves filing a complaint under the False Claims Act. These qui tam complaints are subject to strict substantive and procedural requirements. If it makes sense for you to file a qui tam complaint under the false claims act, any prospective attorney you contact should have extensive experience handling False Claims Act litigation.

Not only will a lawyer who has successfully represented clients in False Claims Act litigation be able to help you file your complaint correctly, but he or she will be able to effectively represent you throughout the process as well. In False Claims Act cases, the U.S. Department of Justice (DOJ) investigates whistleblowers’ allegations before deciding whether to intervene. An experienced lawyer will be able to communicate with the DOJ on your behalf during this process—and will be able to work with the DOJ to secure your whistleblower reward should you become entitled to one.

3. Is the Lawyer Familiar with the Procedures for Filing Complaints Under Other Federal Whistleblower Laws?

While reporting healthcare fraud to the federal government often involves filing a complaint under the False Claims Act, there are other options as well. A lawyer who has experience representing whistleblowers in healthcare fraud cases will be able to help you make an informed decision about how best to proceed (if you decide to come forward). For example, in some cases, rather than filing a qui tam complaint in federal court, it will make sense for healthcare fraud whistleblowers to file a complaint with the U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG) or another government agency.

4. Does the Lawyer Have Extensive Experience and a Proven Track Record of Helping Healthcare Personnel Blow the Whistle?

Beyond familiarity with the relevant whistleblowing procedures, it is also important to choose a lawyer who has extensive experience helping healthcare personnel blow the whistle on billing fraud. Hiring a lawyer who has a proven track record of helping whistleblowers report billings for medically unnecessary services, billings for services provided to ineligible patients, and other forms of financial fraud can make all the difference in your case. With this in mind, during your free, confidential consultation, you should feel free to ask about the lawyer’s experience representing whistleblower clients in the past.

5. Is the Lawyer Affiliated with a Law Firm that Handles Federal Healthcare Whistleblower Cases Nationwide?

Due to the complexity of federal healthcare fraud whistleblower cases, only a small percentage of law firms help courageous clients come forward with information about fraud under government healthcare programs. With this in mind, it is important to choose a lawyer who is affiliated with a law firm that handles federal healthcare whistleblower cases nationwide. In these types of cases, it is much more important to choose a lawyer based on experience than to choose a particular lawyer simply because his or her offices are located near your home or office.

6. Will You Have Access to the Law Firm’s Entire Legal Team During Your Healthcare Whistleblower Case?

Because federal healthcare whistleblower fraud cases are so complex, it is important to choose not just a lawyer, but an experienced legal team. While you should have one lawyer who is your primary point of contact, you should have access to the law firm’s other counsel on an as-needed basis as well. This will help ensure that your case proceeds as efficiently as possible and that you have the best chance of helping the federal government achieve justice.

7. Will the Lawyer Help You Make an Informed Decision About Reporting Fraud Without Pressuring You to Come Forward?

When it comes to how to choose a healthcare whistleblower attorney, another key factor is whether you will feel pressured to come forward. If you are thinking about blowing the whistle, you have a big decision to make, and it is important that you have the opportunity to make this decision on your own terms. An experienced and reputable healthcare whistleblower attorney will not pressure you to hire him or her to blow the whistle on your behalf, but instead will focus on making sure you have all of the information you need to make an informed and confident decision.

8. Does the Lawyer (or Do Any of the Firm’s Other Lawyers) Have Prior Experience at the U.S. Department of Justice (DOJ)?

Since reporting healthcare fraud involves working with government attorneys and government agents, it can be helpful to have a lawyer on your side who has prior experience at the DOJ. A lawyer who has worked at the DOJ will be familiar with the department’s procedures for evaluating and investigating healthcare fraud complaints from whistleblowers. These can be valuable insights when deciding whether to come forward and when working with the DOJ (or other federal authorities) if you decide to file.

9. Can You Schedule a Free and Confidential Consultation Promptly?

Timing can be important in federal whistleblower cases, so it is important that you are able to schedule a free and confidential consultation promptly. As a prospective whistleblower, you should not have to pay any attorney fees out-of-pocket. Whistleblower lawyers generally represent employees and other individuals on a contingency-fee basis, which means that their legal fees (if any) are calculated as a percentage of any financial rewards they help their clients recover. In some cases, whistleblowers can seek to recover their fees separately from their clients’ financial rewards as well.

10. Do You Feel Confident in the Lawyer’s Ability to Handle Your Federal Healthcare Whistleblower Case Effectively?

Finally, when choosing a lawyer to represent you, it is critical that you feel confident in the lawyer’s ability to handle your whistleblower case effectively. If you speak with a lawyer and you are not confident in his or her abilities, you should not hesitate to schedule another free consultation with a different whistleblower lawyer. You have the right to make an informed decision about your legal representation; and, again, under no circumstances should you feel pressured to hire a lawyer to file a whistleblower complaint on your behalf.

In the end, the lawyer you choose should be able to help you work with the government to seek accountability for fraud, secure the legal protections afforded to federal whistleblowers, and collect your whistleblower reward if you become eligible to receive one. Your choice of legal representation matters for lots of reasons, and it will be well worth putting in the effort to ensure that you feel confident in your decision.