How Some Hospitals, Healthcare Centers, and Doctors are Cashing in by “Making a Killing”
As a nurse, you’re at the front lines of society’s health care. You are an advocate for patients, showing compassion and support in even the most dire situations.
But what happens when you witness other professionals abusing their authority, putting your patients in danger or benefitting from illegal practices? Undoubtedly this can be a scary position to be in. On one hand, you need to protect yourself and are careful never to put your job at risk. On the other hand, you became a nurse because of your compassion for the patients and desire to be a positive light in an often grim environment.
Where Does Fraud Exist in Your Healthcare Organization?
Outside the obvious moral benefits to reporting fraud, whistleblowers (individuals who report the crime) have put an end to numerous unlawful health care practices. As a result, whistleblowers involved in settled cases have received enormous cash payouts for coming forward and helping putting an end to the organizational crime.
For example, a whistleblower initiated case charged TAP Pharmaceuticals with unlawful kickbacks to doctors for prescribing the high priced prostate cancer drug, Lupron. In the process, the company was also charged for illegally inflating the drug’s prices on Medicare / Medicaid bills, leaving the burden on taxpayers. This case was settled for $875 million in 2001.1
In other cases involving 3 whistleblowers who stepped forward, charges were brought against SmithKline for deliberate blood test overcharging. These cases were settled for a total payout of $325 million.2
In 2013, whistleblowers received $7 million+ in an Illinois-based nursing home case which was heard by jury in a trial that lasted just 9 days. The list of allegations was long, including failure to prescribe medications and therapies, provide food, maintain a sanitary environment, meet the minimum staffing requirements and more.3
These are just a few of the many cases that go to trial every year due to serious fraud in the health care industry. Some of the stories are too heinous to detail here, but include death, severe neurological damage, child deformities, chemotherapy treatment for non-existing cancer — all in the name of higher profits and greed.
Common types of health care fraud include:
- Billing for services not rendered.
- Billing for a non-covered service as a covered service.
- Misrepresenting dates of service.
- Misrepresenting locations of service.
- Misrepresenting provider of service.
- Waiving of deductibles and/or co-payments.
- Incorrect reporting of diagnoses or procedures (includes unbundling).
- Overutilization of services.
- Corruption (kickbacks and bribery).
- False or unnecessary issuance of prescription drugs.
Does This Activity Exist in Your Healthcare Organization?
The law is on your side of protecting whistleblowers, although it is important to be aware of the obligations of an individual who is aware of crime in the workplace. Whistleblowers.org reports, “One major weakness in many statutory whistleblower protection laws is the short statute of limitations for whistleblower cases. Failure to comply with a statute of limitations is one of the favorite defenses in whistleblower case.”
In other words, if you have information about illegal activity, it is best to at the very least have a private, confidential discussion with a whistleblower professional. A quick no-obligation call can provide you with a great deal of background information on whether or not there is a potential case and to learn about the options of coming forward.
Aside from reporting within the appropriate length of time, those with information about these types of crime can be comforted in knowing that there are several laws (federal and state) that restrict employers from retaliating against their employee. The laws are specific for each state but generally protect against any discipline including being fired, suspended, demoted or denied benefits.5
Where You Can Find Out More?
If you are aware of potential illegal activity or health care fraud, we recommend speaking with a whistleblower advocate. This is a person who has been through the process of personally “blowing the whistle” and can share their experience with you, while providing some assistance as to where to go next to get help.
To determine if there is potential fraudulent activity in your workplace, visit WhistblowerJustice.net and complete the form to have a whistleblower advocate discuss what you know privately. Your conversation is 100% confidential.