Whistleblowers play a critical role in our society. Without checks and balances in government and the private sector, fraud would run rampant.

1. What It MeansTo Be A Whistleblower
DefiningWhistleblowers andTheir Role in Our Country
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2. What is a
Whistleblower?
A whistleblower is someone
with evidence of fraud or other
wrongdoing who then reports
that misconduct to the
company, the government or
both.

3. Who Can Be a
Whistleblower?
Anyone who has evidence of fraud or
wrongdoing inside a company can be a
whistleblower.While most
whistleblowers are current or former
employees, it is not a requirement. It is
also not required that you witnessed the
fraud or misconduct firsthand.

4. The False Claims Act
The False Claims Act (sometimes referred to
as the “Lincoln Law”) was passed in 1863 and
allows ordinary citizens to bring
whistleblower cases on behalf of the
government.These set of laws are most often
used by whistleblowers to report fraud or
wrongdoing against the federal government.
It also awards them 15-30 percent of the
amount that is recovered by the government.
One of the most important provisions in the
False Claims Act is the QuiTam provision.

5. What is the QuiTam
Provision?
The False Claims Act includes a “qui tam”
provision. “Qui tam” is a Latin phrase that
roughly means “he who sues for the king as
well as for himself.” In practice, this means that
a qui tam suit is one in which you sue the
wrongdoer on behalf of the U.S. government.
Those who do so are referred to as “relators.” It
is up to the government to decide whether or
not they will take part in a qui tam suit.

6. What is the statute of
limitations for
whistleblowing?
It is essential that a whistleblower report fraud or wrongdoing as
soon as possible. Each whistleblower law has its own statute of
limitations, delineating the amount of time by which claims
must be filed. If such time limits are not met, the whistleblower’s
claim may no longer be legally actionable.
Under the FCA, the filing limitations for qui tam suits are as
follows:
• A suit must be filed within six years from the date of the fraud
• OR three years after which the government knew (or should
have known) about the fraud.
• AND no later than ten years after the fraud.

7. Types of Fraud
• Defense Contractor Fraud
• QuiTam Damages and Awards
• Healthcare Fraud
• Medicare Fraud
• Securities and Commodities Fraud
• Mortgage Fraud
• Tax Fraud Reporting

8. Medicare Fraud
& Upcoding
Let’s take a deeper look at one of the more costly and
rampant forms of fraud to gain a deeper understanding on
the importance of whistleblowers.
• One of the most common forms of Medicare fraud is called
upcoding.
• The Center for Public Integrity says that Medicare fraud could
amount to over $11 billion from 2001 to 2010 alone, and that much
of this fraud comes from upcoding.
• Upcoding occurs when a provider performs a service for Medicare
and then bills Medicare for a higher paying service than was
performed.
• This process of fraudulent billing to Medicare ends costing the
government significant amounts of money and can affect
projections over future costs and health care spending.
• The same 2012 report from the CPI stated that abuse seemed to
have occurred most frequently in hospital emergency rooms.

9. Examples of Medicare
Whistleblower Cases
Unfortunately, a lot of Medicare fraud has occurred in
our state and in our nation. Here are just a few recent
cases:
• In 2015, a California man was sent to prison for Medicare
fraud. He established a “ghost” medical clinic in South
Carolina that billed Medicare over $1.1 million. Medicare
paid roughly $350,000 in claims.
• Also in 2015, qui tam suits alleging Medicare fraud that
were filed by former employees of Nason Medical in
Charleston were settled with the federal government for
over one million dollars.
• One more this year:Two labs (VA and CA) that tested for
heart disease settled for $48.5 million due to three
whistleblower actions. Admirably, a Hilton Head doctor
was one of the whistleblowers.

10. Securities Fraud
Under the Dodd-Frank Wall Street Reform and Consumer Protection Act
of 2010, the Office of theWhistleblower was established for the
Securities Exchange Commission (SEC) to encourage those who have
information about securities and commodities laws violations to notify
the authorities.
The SEC entitles whistleblowers to an award if their evidence meets
the criteria required to bring a case.The information must:
• Be voluntary.Your submission of information to the SEC must occur
before it is requested by the SEC, by Congress, or by some other
regulatory or enforcement agency, such as FINRA.
• Be original. Original information comes from a whistleblower’s
independent knowledge or analysis that is not already known by the
SEC and is not a product of publicly available sources.
• Lead to success. If the SEC opens a new investigation, re-opens a
previous one, or pursues a new line of investigation, and a successful
action is brought based at least partially on your information, then it
has led to success. Additionally, the information must lead to
monetary sanctions of more than $1 million (called the “covered
action”).
• Have been first submitted after July 21, 2010, when Dodd-Frank was
enacted. Submissions before that date are not eligible for an award.
However, the date of the illegal conduct reported can have occurred
before that date.

11. Consequences of
Whistleblowing
Unfortunately, taking a stand can also come with the risk of retaliation
by employers. Whistleblowers can often file for reinstatement, back
pay and other damages. The following actions taken by an employer
against a whistleblowing employee are prohibited:
• Blacklisting, making you unable to secure future employment in
your field
• Demotion
• Denying a promotion or overtime
• Denying benefits
• Disciplining
• Issuing a policy that conflicts with whistleblower protections
• Firing, laying off, or suspension
• Reassignment to a position that adversely affects your future
prospects
• Reduction of pay or hours
• Threats and intimidation.

12. More About Protection for
Whistleblowers
From the U.S. Department of Housing and Urban
Development:
“TheWhistleblower Protection Act of 1989 prohibits
retaliation.This means it is unlawful for agencies to take or
threaten to take a personnel action against an employee
because he or she disclosed wrongdoing. Personnel actions
can include poor performance review, demotion, suspension
or termination. In addition, the law prohibits retaliation for
filing an appeal, complaint, or grievance; helping someone
else file or testifying on their behalf; or cooperating with or
disclosing information to the OIG (Office of Inspector
General).”
https://www.hudoig.gov/fraud-prevention/whistleblower-protection

13. The Importance of
Representation
The laws covering whistleblowing activity are
extremely complex, requiring you to file a number of
forms that may not be clear in what they ask you to
do and supply in the way of evidence. Although you
could go it alone, having a skilled and experienced
whistleblower attorney will go a long way towards
giving you peace of mind.Your legal team can help
you make the best case possible, ensure that your
legal protections are observed, and help get the
government interested in taking part in your suit.

14. DoYou Want to Speak Out About
Fraud or Wrongdoing?
Time is of the essence.The Louthian Law Firm can assist you in
evaluating your case and deciding the best course of action for your
particular circumstance.
Visit our website to learn more about how we can help you
or give us a call to talk to us directly at 855-573-6264.
http://www.louthianlaw.com