Having diligently navigated the process of filing a whistleblower claim, you’re now ready to embark on the next chapter of your journey. The submission of your claim marks a pivotal moment, where integrity meets action against healthcare fraud. But what happens after the claim is filed?
This article will guide you through the subsequent phases of your case, outlining what lies ahead as your whistleblower claim progresses.
What Happens Next?
Once your whistleblower claim is filed, legal teams and governing bodies promptly take charge of your case. The whistleblower’s immediate responsibility is to relax and wait patiently, as your claim is placed under seal. This period requires confidentiality, as your case undergoes the process of a government investigation.
During this time, an interview will be scheduled with the government attorneys. This is an opportunity for you and your legal team to discuss your allegations directly with the government investigative team. However, your primary concern should be maintaining discretion about the details of your case, as discussing it with outsiders could jeopardize its standing.
Healthcare Fraud Investigation Phase
Investigating a federal healthcare fraud case involves careful procedures, ensuring a thorough review and due diligence. Typically, these cases remain confidential throughout the investigative phase, which can span from several months to even a few years, depending on complexity. This phase ensures that your claim is thoroughly assessed by legal professionals who gather and scrutinize evidence, interview witnesses, and construct a solid case. The enforceable confidentiality means discussions are restricted to those directly involved, a crucial rule for maintaining the case’s validity. Sharing information outside this circle risks invalidating your claim.
In the context of the False Claims Act (FCA), once the government completes its investigation, it can choose to officially join—or “intervene in”—the case. From the moment you file it, the case essentially “belongs to the government.” If the government intervenes, it actively assumes charge of the prosecution. On the other hand, the government can decide not to participate further. Procedures in whistleblower reward programs vary depending on the agency.
If the government opts to intervene in an FCA case, it becomes public, and, if not already known, the whistleblower’s identity is likely to be revealed. The case then advances through litigation, trial, or settlement, and the whistleblower might be required to testify. If the government declines to intervene, the whistleblower can proceed independently with the case.
A whistleblower case’s success chances are significantly higher when the government intervenes. In fact, the majority of FCA cases with government involvement resolve favorably through settlement or trial, leading to vindication for the whistleblower and a share of the government’s recovery. However, the period after intervention leading to trial may take considerable time, adding to the earlier confidential investigation phase.
Possible Outcomes from the Whistleblower Case
Navigating through the progression of your case, you’ll encounter multiple potential outcomes. The outcome is heavily dependent on the quality and quantity of evidence presented. Strong evidence can bolster your case, while weak evidence may undermine it. Solid evidence increases the likelihood of a favorable resolution, whether through settlement or judgment.
Understanding these possibilities can help you better prepare and strategize. If the government does choose to intervene in the case, it takes over the prosecution of the case and the case can end in one of several outcomes. Here’s a breakdown:
- Settlement: In this most likely outcome, settling a case often means compromising to avoid the uncertainties and expenses of a trial. It can be a quicker resolution, allowing all parties to move forward without legally admitting fault. You may receive compensation or a resolution agreement, but possibly less than what might be awarded in a trial.
- Trial: While most FCA cases result in settlements and judgments, they can also go to trial. If a case goes to trial, it indicates that negotiations for a settlement may have been unsuccessful. This can be a lengthy process, but also offers the opportunity for complete airing of grievances and evidence. A trial may result in a judgment or verdict either favoring or opposing the plaintiff, potentially awarding damages or imposing penalties.
- Favorable Judgment: Achieving a favorable judgment means that the court has ruled in favor of the whistleblower claim, validating your claims and potentially awarding damages or corrective action. Companies might face substantial fines and penalties to resolve fraud allegations. This can be the most rewarding outcome for whistleblowers, providing complete vindication and potentially significant financial compensation.
Each potential outcome has its own implications, impacting the strategy and expectations for your case. Understanding these can help you make informed decisions as you navigate the legal process.
If the case is successful, it could lead to a potential financial reward for the whistleblower who was first-to-file. Being the first to file a whistleblower claim puts you in a strategic position under the law. This priority status can significantly influence the outcome and potential rewards. You could receive up to 30% of any funds the government recovers, offering substantial financial benefits if the case is successful.
Looking for a Whistleblower Attorney to Win Your Case?
Every year, healthcare fraud causes tens of billions of dollars in losses. Your courageous decision to report healthcare fraud to a whistleblower attorney not only upholds justice, but also fortifies the transparency of our healthcare system. Your contributions are indispensable.
As you pursue this path, remember the DJO Whistleblower Law Group team is committed to providing unwavering support—a testament to our belief in protecting those who act with integrity.
Contact our team for a free and confidential case review. As a contingency-based law firm, commitments come with no upfront costs to you, and payment is only required if we successfully bring your case to a successful resolution.
authored by Christopher J. Piacentile
Director of Investigations DJO Whistleblower Law Group
