According to the Department of Justice, in 2017 the government recovered $2.4 Billion dollars from healthcare fraud and abuse. Government officials will tell you that without the courage of whistleblowers in the healthcare industry, most of the fraudulent and abusive billing practices would never have been uncovered. That is why the law incentivizes whistleblowers to reveal illegal activity, by allowing whistleblowers to receive a percentage of any recovery.
Nurses, medical technicians, nursing assistances, medical coders and other medical staff often witness illegal practices. Sometimes they are even asked to participate in the illegal scheme, putting themselves (and the patients they serve) in jeopardy.
Most nurses and medical staff feel that whistleblowing is both an ethical and legal responsibility. Nursing codes of ethics, including the American Nurses Association Code of Ethics for Nurses and many state nurse practice acts require you to report illegal, abusive or unsafe practices.
Some of the most common types of fraud or abuse are:
- Billing for medically unnecessary services
- Up coding, Double-billing, Unbundling
- Billing for services not provided
- Accepting kickbacks
- False price and cost reports
- Beneficiary not eligible for reimbursement
- Inadequate medical documentation
A question that is often asked by many healthcare whistleblowers, “Can I remain anonymous and will I be protected against retaliation?” The federal and North Carolina False Claim Act(s) allow a whistleblower to file a complaint under seal (in secret), and both acts provide protection against retaliation by the wrongdoer. Also, North Carolina General Statute §95-241 prohibits employers from taking any retaliatory action against an employee for filing a claim or providing information related to occupational safety and health.
Before deciding to become a whistleblower and report the illegal activity, nurses and other healthcare workers should consider the following:
- The severity of the problem
- Reporting options
- Legal ramifications
- Who else is aware of the illegal activity
- Nature of proof
If you are considering reporting fraud, abuse or other illegal activity contact Miller Law Group for a free consultation, or call 919-348-4361.