Health care fraud occurs in all facets of the industry, including home health, hospitals, physician offices, nursing homes and other facilities. Most fraud cases revolve around Medicare and insurance fraud. If you see fraud in the workplace, report illegal actions immediately to the appropriate authorities. It is your duty to protect the health of patients while maintaining your own protection.
Health care fraud costs the United States approximately $80 billion per year. If caught, people who participate in fraud face jail time, fines and permanent loss of licensure. Due to the lucrative nature of the health care industry, whistleblower protection needs to become a priority in cases of fraud.
People benefit from these illegal actions through stolen health care information, patient kickbacks and claims for fictitious care. Perpetrators also file duplicate claims for the same service, alter medications to make it seem like someone needs more medicine, alter descriptions of medical services to something more expensive or even prescribe unnecessary treatments. Potential criminals then pocket the extra money paid by insurance companies for services that only existed on paper. Health care fraud has become so rampant that up to 10 percent of every taxpayer dollar spent on health care goes towards paying fraudulent claims. Fraud reporting helps reduce wasteful spending in an overburdened system.
Although patient care remains a priority, you may run across the patient billing process and other financial aspects of providing medical care as an entry-level employee observing managers. Upper-level administrators typically have intimate knowledge of medical billing, health insurance law, financial regulations and accounting practices within the health care industry. You may observe fraud at any of these levels of management. Even if you are an innocent bystander, courts may implicate you if you witness health care fraud and then fail to act on it.
Whistleblower protection surrounding fraud takes many forms. Your first actions should be to report to your own supervisor. If you feel that your supervisor may have a role in health care fraud, consider talking to another supervisor on the same level as your boss. Follow the normal chain of command. If you find the upper echelon of your company may participate in fraud, inform an outside agency of the possibility.
Unfortunately, you may find yourself the target of harassment, reduced hours, firing or demotion for your potential whistleblowing activities. Keep detailed records of anything that happens to your status at work. Discuss your situation with an experienced health care attorney who may take your case. Most lawyers offer one free consultation before agreeing to take on your case.
The most important aspect of whistleblowing includes telling the truth, even though it takes courage to do so. Health care fraud is illegal, even if someone participates unknowingly. Courts may grant leniency to whistleblowers in exchange for information. If you see criminal activity, do the right thing and report what you have seen.
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