Medicaid fraud and waste is a symptom of corruption that is addressed by laws such as the Federal False Claim Act. The False Claims Act became law during the Civil War. It was originally designed to nail horse dealers selling the Union Army ‘worthless nags’.
To control medical fraud, the Federal Government created financial incentives for states to create law that is at least as tough as the federal False Claims Act. One of the most important pillars under this law encompasses that state law contains equivalent qui tam provisions that reward whistleblowers.
Whistle blower protection
Qui tam is Latin and short for ‘Qui tam pro domino rege quam pro seipse.’ Translation: "He who sues for the king as for himself." In general a Qui tam lawsuit is filed by private individuals on behalf of the government in an attempt to prevent abuse of funding and finances.
Is protection under federal and state law really necessary for whistle blowers? Yes, it is. While it might seem like a righteous act to report illegal corporate activities to the government, you might lose everything you have worked through this noble deed.
No one likes to risk his or her financial security by reporting illegal business activities is often the last thing on an employee's mind. The United States government recognizes this and created regulations that 10% of the punitive settlement will go to the person acting on behalf of the government and its citizens.
How does whistle blower protection work against medical fraud and waste?
Losing billions on Medicaid fraud
On June 29, Tenet Healthcare, the second largest hospital chain in the US, made a deal to pay the U.S. government more than $900 million for fraudulent Medicare billings. Tenet might not have been caught if not for a whistle-blower.
A whistle-blower also initiated a $14 million settlement unveiled in mid-August 2006 between the University Hospitals Health System in Cleveland and the federal government. The hospital group admitted no wrongdoing in the Medicare abuse case.
In recent years, the former Columbia/HCA, now Hospital Corp. of America, paid $1.4 billion to settle multiple allegations. The former Vencor, now Kindred Healthcare, paid almost $105 million to settle nine cases.
Qui tam law benefits everyone
These and other actions were launched by private citizens acting on behalf of the federal government. Using the False Claims Act, individuals can sue on behalf of Washington if they have evidence of fraud against a government department.
Investigations will take a long time, sometimes two or three years but typically six to eight. It takes endurances to undertake the process of whistle-blowing as a private citizen.
The idea behind whistle blower protection laws is that corporations consider the risks of qui tam law suits deters Medicaid fraud and waste. Whistle blower protection is an essential ingredient for a healthy medicare system.
Thank you,
Loretta W. Davis