Whistleblower

Think back to your first PE class in elementary school or your proudest moment in high school and the winning goal for that state championship game. Then, there is that dreaded whistle from the referee.  Suddenly, everything stops for the man in the stripped uniform and the power to stop everything in its tracks (the whistle). What will happen? What did he/she see that commanded a stop of the game?

Ok, now that I have your attention (and maybe that cloud nine moment in time), that whistle sometimes is not bad and signals a chance to check on a key play or issue.  This blog will address two points on whistleblowing in healthcare: (1) How to develop a safe environment for self disclosure and (2) the impact of a whistleblower action on your organization.

A safe environment is tantamount for self disclosure 

When your staff is trained to know where and how to self disclose a possible issue or an insight that could expose a larger fraud issue, then the organization can effectively and timely deal with the issue.  This will enable the organization to investigate, react and if necessary, correct the issue.  If it is serious enough, the organization will have the opportunity to self disclose to the OIG or DOJ.

This can be done through a hotline or with knowledge and comfort that they know who to contact in managment or compliance and most importantly that there will be no retribution for doing so.  If the employee does not feel safe or has fear of retribution, then two things are evident:  You have not done a good job creating a safe enviroment and your organization is likely to find itself on the other end of the whistleblower claim.

The impact on your organization of a whistleblower claim

A whistleblower is a person that has a safe harbor in order to report suspected fraud. A whistleblower allows an individual to file on behalf of the US Government.  Such a person will be provided protection under the law from retribution and will also share in the proceeds if the action results in a monetary award.

False Claims Act lawsuits (FCA) continue to produce billions of dollars in recovery for the DOJ.  $35,000,000,000 to be exact in fiscal year ending Sept 30, 2015. A significant number of cases and dollars were brought to the DOJ through whistleblower claims ($28,000,000,000).  Under FCA laws, if the government prevails in its action, the whistleblower obtains up to 40% of the recovery.

Summary:

Now, back to the PE class-  so when you were playing four sqaure and someone cheated, did you talk it through as team mates, if not resolved, then did you go to the teacher OR did you go straight to the principal and try to fire the teacher?  Although working in healthcare is no game and not the same as PE class, it is serious business and requires an open and safe environment where your staff feels comfortable reporting internally potential fraud.  Otherwise, look for the an expensive and public problem- all from your very own.