Medical Insurance Fraud And Consumer Fraud Whistleblowers

10 February 2015
 Categories: , Blog


Whistleblowers are conscientious individuals who dedicate themselves to uncovering and reporting different types of fraud or illegal behavior in our society. The types of things that a whistleblower might address range from tax evasion to medical fraud to consumer scams. Two of the most important things that whistleblowers concentrate on are illegal medical insurance activities and consumer-based fraud.

Medical Insurance Fraud

Insurance fraud in the medical industry is the most common venue where whistleblowers operate. Senior citizens, for instance, frequently need post surgical rehabilitative services or require other types of specialized therapy to address age-related medical conditions. These services are designed to assist them in getting back to a more normal lifestyle after stay in the hospital.

Medical insurance providers will hire whistleblowers, both investigative specialists and lawyers, to investigate possible cases of fraud. What will often happen is many home health agencies will hook up with dishonest physicians and falsely declare that the patient needs some type of rehabilitative care.

In these types of situations, whistleblowers will document home visits, plus keep records of outpatient services that are actually provided. The everyday life of a medical insurance fraud whistleblower may seem a lot like that of a private detective. They must be inconspicuous so they don't tip-off their intentions, and they must be very secretive when collecting facts designed to prove a case of fraud exists.

This information is then cross-referenced with what is the normal standard procedure. Whistleblowers look for red flags such as home visits being reported that are not actually kept and procedures that are billed to insurance, which are out of line with what would be considered a normal claim.

Consumer Fraud

Another common area where whistleblowers are valuable is in the area of consumer fraud. Consumer fraud can range from businesses reporting illegal figures for tax purposes to defrauding consumers with false claims of product liability. Large corporations are also guilty of manipulating government contracts to illegally gain an advantage in securing multi-million dollar projects.

Whistleblowers that deal with consumer fraud usually have previous experience in the business world, plus they may have once been an insider involved in some form of unscrupulous behavior themselves. Ralph Nader was one of the most famous consumer advocates in history. He has blown the whistle on big business and government on dozens of occasions.

Whistleblowers can be labeled as grown up tattletales who seem to get a kick out of ratting out other people. But, they are in fact one aspect of our legal system that without their conscientious efforts fraudulent activity would continue unabated. For more information about whistleblowers, contact a whistleblower lawyer.