Understanding the Threat of Whistleblowers to Your Practice

What is a whistleblower, and how can you shield your practice from the risks they pose?

Woman doing medical coding

When it comes to preventing fraud or other misconduct at your practice, you want your employees to be like Achilles — mighty warriors at your side as you navigate the complex world of healthcare regulation. Unfortunately, employees can quickly become your Achilles heel when they report potential wrongdoing to authorities. 

We get it. Tackling potential fraud and other regulatory issues can feel like joining the Trojan War without a shield. So, let’s dig into the realm of whistleblowers in American healthcare and discuss how you can “build your army” to keep you feeling protected. 

Whistleblowers in Healthcare: The Basics

A whistleblower is someone who reports a suspected violation of state or federal law to the authorities. Typically, the whistleblower consults an attorney, who represents them in their dealings with the government and law enforcement. Because fraud, waste, and abuse hurt patients and taxpayers, the government actively encourages citizens to report questionable activities. 

The False Claims Act (FCA) makes it illegal for providers to submit fraudulent claims to the Centers for Medicare & Medicaid Services. It also allows whistleblowers to sue those who submit fraudulent claims on the government’s behalf. Whistleblowers who bring legal actions may receive a portion of the government’s recovery — a powerful incentive for anyone who witnesses fraud to come forward. As of June 2023, the largest whistleblower reward was over $250 million. 

Meanwhile, the Whistleblower Protection Act protects “any disclosure of information” by federal government employees that they believe violates the law or constitutes gross mismanagement of funds, abuse of authority, or a substantial danger to public safety. 

Who Becomes a Whistleblower?

The biggest threat of government intervention often comes from within — a worker who believes their employer is doing something illegal and decides to blow the whistle. Their actions may be guided by their ethics or a sense of responsibility to protect patients. Alternatively, they may feel mistreated or marginalized and seek to harm the practice as retribution. Either way, firsthand knowledge or access to internal information will lend weight to their reports of wrongdoing.

Preventing Whistleblower Complaints

To reduce the risk posed by whistleblowers, start by addressing the root of the issue. Build an organized and efficient practice that handles finances and patients ethically and complies with federal and state laws.

Practice culture matters, too. Aim to create an environment where employees and staff members understand compliant procedures and know what to do if they suspect wrongdoing. 

Address fraud, waste, and abuse through written policies. 

Create a written fraud, waste, and abuse policy for your practice. Merely drafting a policy isn’t enough; you must consistently enforce it and emphasize its importance to your employees. Designate a central contact person within your practice or lab to handle any questions or concerns related to the policy.

Train employees on compliance.

Ensure new employees know relevant state and federal laws, such as FCA, the Anti-Kickback Statute, the Stark Law, and other insurance-related policies at your practice. Training should also cover the employees’ and practice’s legal obligations and the potential consequences of violations.

Establish a process for evaluating employee complaints. 

Creating a process shows your commitment to preventing fraud and other criminal actions. This policy should specify which supervisor is responsible for handling concerns. It should also set a timeline to address all complaints promptly. Emphasize the importance of documenting all complaints and maintaining whistleblowers’ confidentiality. 

How to Respond to Whistleblowers

As a practice owner, it’s vital not to view whistleblowers as nuisances trying to undermine your operations. Do not terminate, reduce hours, withhold perks, or take any other adverse action in response to someone who alleges misconduct publicly or privately. Such retaliation may lead to additional violations of state or federal law and worsen the situation. 

Instead of perceiving those who speak up as threats to your healthcare practice, consider them catalysts for growth and development. By addressing their concerns and implementing necessary changes, you not only protect your practice from legal troubles but also contribute to an ethical work environment. This approach encourages transparency and accountability, which, in turn, fosters trust and cooperation among employees. Remember, a thriving healthcare practice is built on a strong foundation of trust, integrity, and open communication.

Get Legal Help

It’s important to create a workplace where your employees stand shoulder-to-shoulder with you in the fight to maintain legal compliance. Experienced healthcare attorneys can create written policies that serve as a battle plan to help prevent fraud. They can also help you confront incoming fire if a whistleblower brings a claim. If you operate in any of the states where we have licensed attorneys, schedule a complimentary consultation to learn how we can support you.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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