Healthcare fraud and blowing the whistle
Friday, June 19, 2015
We've all heard the news before; healthcare fraud — especially Medicare and insurance fraud — is more common than we think. Fraud occurs in home health, hospitals, physician offices, and other facilities. Healthcare professionals who find themselves potentially entangled in a fraudulent situation should immediately report the suspected abuse to the appropriate authorities.
Home care fraud goes viral
On June 18, The Dallas Morning News reported in an article that 243 healthcare workers from around the nation were indicted on federal charges of Medicare fraud by The Medicare Fraud Strike Force. Reported as the largest such bust in history, the schemes involved a net profit of more than $700 million for the suspects.
From stolen healthcare information, to patient kickbacks and claims for fictitious care, these fraudulent practices will likely result in enormous legal fees, loss of professional licensure, and prison time for defendants.
We all know that fraud happens, and we also know that, as healthcare providers, we can easily be implicated in fraud if we fail to act or speak out when we witness its occurrence.
If we are clinical providers, we obviously want to focus our attention on patient care. However, many of us do sometimes find ourselves in situations where we gain a certain awareness of the financial and billing aspects of the care that we provide. Meanwhile, others work in positions of management and leadership that allow for intimate knowledge of the inner workings of the healthcare delivery system.
Fraud can occur by design, and sometimes by default or honest error. No matter the cause, if you have awareness of fraud, your silence could be seen as complicity.
As a healthcare provider, your first duty is to protect your patients and seek the best possible clinical outcome on their behalf. Your next priority is your own safety, and keeping yourself safe from financial, legal and professional harm is pertinent and important.
If you are a healthcare professional who is aware that fraud may be occurring in your workplace, begin the process of reporting your concerns by following the chain of command. If you believe that your direct supervisor may be involved, seek counsel from another individual at that same level of management, or go straight up the ladder to other salient parties.
As a potential whistleblower, you could find yourself targeted for harassment, demotion, or firing, and you could very well be in the position of requiring legal counsel in order to protect your livelihood and professional reputation. If you have suspicions that higher levels of your organization are potentially involved in illegal activity, it would behoove you to report your suspicions to an outside agency or entity, preferably under the guidance of an attorney who is skilled in healthcare law.
On Medscape, an article entitled, "Preparing to Blow the Whistle: A Survival Guide for Nurses," offers excellent guidance that is applicable to both nurses and non-nurses alike.
Telling the truth
The American healthcare system is a vastly complicated behemoth, and there will always be individuals and organizations that try to game the system by committing various types of fraud.
As healthcare providers, we swore oaths to protect and care for our patients. Meanwhile, we also have a moral, ethical and legal responsibility to the society at large in terms of reporting abuses that we witness within our industry. Whether it;s improper coding, the theft of private patient information, or other forms of fraud, we are on the front lines in terms of stopping healthcare fraud at its source.
Telling the truth is an act of courage, especially when we may risk our position or professional standing by speaking out. That courage is laudable, and healthcare whistleblowers can put a stop to egregious practices that undermine patient care, erode trust in the healthcare system, and cost taxpayers astronomical amounts of money.
The truth will set us free.
- Best exercises for gluteus medius strengthening
- Pectoralis minor: Far from a minor problem
- The importance of hip internal rotation
- 7 trigger control errors and how to fix them
- The top 5 exercises you should be doing
- The stress of 911 call-takers and emergency dispatchers
- 17 of the most specific, bizarre ICD-10 codes
- Children of the badge: The impact of stress on law enforcement children
- How visitor segmentation can powerfully refocus your digital marketing
- Federal surveillance, track-and-trace technology may be on the way for future COVID-19 outbreaks
- Travel industry steps up with generosity
- Association execs voice pandemic concerns
- Ready to bust some B2B marketing myths?
See your work in future editions
Your content, Your Expertise,
Your Industry Needs YOUR Expert Voice & We've got the platform you needFind Out How