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Whistleblowers Going After United Healthcare

United Healthcare (UH) sales agents brought a whistleblower lawsuit against UH, alleging fraud and kickbacks.

For example, the whisteblowers claim a UH sales agent promised iPads to customers who agreed to sign up and remain on the plan for six months.

Another sales agent allegedly forged signatures on enrollment paperwork – enrolling patients without their knowledge.

Perhaps most seriously, UH kept two sets of books: one with misconduct complaints about UH; and another set of books that concealed the complaints from federal agencies. By hiding complaints, UH artificially boosted its quality ratings, which enabled it to receive $1.4 billion in Medicare bonuses in fiscal year 2016. For example, in March 2016, UH identified 776 complaints, but only reported 257 to CMS.

The whistleblowers also alleged that complaints were met with little investigation and little disciplinary action.

UH’s employees knew of these practices, and, in at least some instances, reported them internally. According to the whistleblowers, when UH did not address these concerns, the sales agents went to the federal government.

Whistleblowers are most often employees or former employees. Are you confident that you are aware of your employees’ concerns? Have employees made complaints? Were they resolved? Do employees know you took their concerns seriously?

The Society of Corporate Compliance & Ethics, and the Health Care Compliance Association recently issued a joint survey: Exit Interviews and the Compliance and Ethics Department (the Survey).The Survey evaluated companies' use of exit interviews as a tool to measure an organization's culture and detect non-compliance.

The Survey found that while 82% of organizations use exit interviews, only 52% use them routinely. While the Survey did not evaluate the effectiveness of these exit interviews, MPA put together a list of pros and cons:

 As part of their OIG compliance programs, health care compliance officers invest a lot of time and effort publicizing the compliance hotline and encouraging internal reporting.