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The Compliance Whistleblower: Friend or Foe?

Posted by Margaret Scavotto, JD, CHC on 8/10/12 1:00 PM

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Some of the biggest Federal penalties for false claims begin with a call from a whistleblower. Employees who feel you are not addressing their concerns, or that you don't care about compliance, often turn to the government. By creating a culture of compliance and encouraging internal reporting, you can address problems without government intervention.

Whistleblowers are rewarded handsomely for reporting you

  • A chain of urgent care facilities agreed to pay $10 Million to resolve allegations that it submitted false claims by billing for unnecessary allergy, H1N1 virus, and respiratory panel testing, and for upcoding services. The lawsuit was filed by a former employee, who received $1.6 Million of the settlement as her reward. 
  • Since 2008, 40 hospitals have agreed to pay a total of $39 Million to resolve allegations that they submitted false claims by overcharging Medicare when they performed the outpatient kyphoplasty spinal procedure on an inpatient basis. All of these lawsuits originated with two whistleblowers: former employees of a company that sold kyphoplasty equipment to the hospitals. These employees will receive $2.1 Million of the settlement funds as their reward.

As you can see, your current and former employees and your contractors are incentivized to report you to the government.

Internal whistleblowing is in your best interest

Encouraging employees to report potential fraud and false claims to your management has many advantages:

  • You will be able to root out compliance issues in your facility and stop them as soon as possible
  • By self-reporting non-compliance to the government, your penalties may be reduced
  • When you foster a culture of compliance and encourage internal reporting, you elevate the integrity of your organization and the satisfaction of your employees and residents

MPA TIPS: promote internal whistleblowing

  • Provide an anonymous way for employees, residents and contractors to report non-compliance (for example, a toll-free hotline)--and make it known
  • Create a strict non-retaliation policy for compliance reports--and make it known
  • Investigate all complaints promptly, and follow up with the complainant when possible
  • Use employee exit interviews as an opportunity to identify compliance concerns or violations  

Learn more

Do Compliance Hotlines  Help or Hurt Whistleblowing?

Would your employees report to you, or the government?


Topics: Penalties and Enforcement, Hotline, Whistleblowers, Culture of Compliance

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