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Speaking Up – Whistleblowers Help Avert Healthcare Fraud

Whistleblowers have played a vital role in weeding out illegal practices in the private sector, abuse of authority, waste, fraud and gross mismanagement in government agencies, and improper activities in international institutions. As we have seen time and time again, whistleblowers have also played a vital role in the healthcare sector, be it in the private sector or the government.

Reporting Illegal and Unethical Conduct

Whistleblowers helped bring to light the scandal at the Veterans Administration, where it was discovered that multiple hospitals and care facilities run by the VA across the country kept patients waiting for visits and treatment for months at a time. Such neglect hastened their illnesses and injuries, and led to untimely deaths for many. To make things worse, the VA furthermore covered up these horrible issues. Whistleblowers have also been valuable in ferreting out fraud when it comes to Medicare and Medicaid programs. Where an individual blows the whistle on fraud under the False Claims Act, he or she can reap a bounty payment for their efforts if the government recovers. This also depends on other circumstances, such as the size of the recovery. As with any false claims case, such false claims stand to defraud the government as well as the taxpayers.

In Alabama, a nurse will be earning a substantial bounty of $15 million for her whistleblowing on her former employer, a national home healthcare company. The company, called Amedisys Inc., is based in Baton Rouge, Louisiana and has facilities in 37 states. It just settled with the United States Department of Justice, specifically through the U.S. Attorney for the Northern District of Alabama, for approximately $150 million, $15 million of which will go to the whistleblowing nurse. As with many settlements, the company has not admitted guilt or wrongdoing as pertains to the charges that it made false claims for Medicare reimbursement as well as reimbursement from other government healthcare insurance programs. These submissions related specifically to home healthcare, and the nurse was instructed to bill for services that she did not actually perform for patients, or for services that were not actually necessary. Even services that are performed can be considered the basis of fraudulent claims if they were not necessary for the medical care of the patient. Unfortunately, some healthcare providers will order certain services or procedures to simply “run up the bill.” On top of this, the settlement also contemplated allegations of bribery and kickbacks provided by the healthcare company to referring physicians, which is also against the law.

As is the case with many whistleblowers, this brave nurse had her employment terminated after she objected to the false claims. Thus it is extra fitting and she is very much deserving of her bounty after putting her employment and livelihood on the line to do what was right. Other brave whistleblowers involved in this case will split an additional $9 million for their help. This case demonstrates the importance of whistleblowers in the nursing home and broader healthcare industry, and furthermore shows the need for vigilance when it comes to potential false claims submitted by greedy healthcare providers.

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