The state relies on the truthful submission of information to oversee an efficient and effective healthcare system. Sadly, both patients and providers commit acts of fraud that cheat the state out of money as well as violate the law.
Ordinary citizens have the ability to report abuses to the South Carolina Department of Health and Environmental Control (DHEC) as whistleblowers. Serving in this role is not only a person’s civic duty, but it can also result in the receipt of a reward.
A Charleston healthcare fraud lawyer can help individuals looking to report fraud involving the healthcare system. This can involve assisting with filing an initial report with the relevant governmental agency, requesting a reward through a writ of Qui Tam, and protecting people if their reports result in retaliation.
The receipt of healthcare comes with the acknowledgment that some party will pay for the services. In many situations, this is a combination of private insurance and patient funds. However, many people receive healthcare subsidies from the state government. Here, the government has a profound interest in ensuring that fraud does not cheat it out of money.
Committing healthcare fraud is always illegal. According to South Carolina Code § 8-27-10, it is a crime to commit any act that cheats or attempts to cheat the government out of money. The statute further describes this concept as the intentional abuse, misuse, destruction, or loss of public funds.
One role that a Charleston healthcare fraud attorney can plan is to perform a more in-depth investigation into this activity and determine if it meets the state’s criteria for fraud.
There are many reasons to consider being a whistleblower. Under state law, parties filing a whistleblower complaint can include a writ of Qui Tam. This notifies the government that a party is demanding a reward if their information results in a conviction. These rewards can be as significant as 25 percent of the funds that the state recovers from a healthcare fraud case.
It is also important to feel safe concerning one’s coming forward as a whistleblower. In many situations, an individual is an employee or is otherwise subservient to the party committing the fraud. The threat of retaliation is real.
Not only is this activity illegal on its own, but it may entitle an individual to demand compensation. S.C. Code § 8-27-10 says that any person who experiences retaliation in the workplace as the result of serving as a whistleblower has a cause of action to demand a remedy in civil court. These remedies can include:
A Charleston healthcare fraud lawyer could help to pursue these lawsuits in the event of retaliation as well as to demand appropriate rewards from the government.
Healthcare fraud is a persistent problem in Charleston and throughout the state. State healthcare programs rely on honesty from patients as well as accurate reporting from providers to know when to issue benefits and payments. A party that intentionally misleads the government commits healthcare fraud.
The state often relies on reports from private citizens to uncover instances of healthcare fraud. We call these people whistleblowers. If you believe that you have observed healthcare fraud, you can submit a report to the state and demand a reward for your information. A Charleston healthcare fraud lawyer could help you to submit these claims. They may also be able to take the lead in pursuing civil lawsuits if your serving as a whistleblower has resulted in workplace retaliation. Call today to discuss your options.