Is it dangerous to be a Medicare whistleblower?

The benefits of being a Medicare whistleblower are tempting, but do they outweigh the risks? Most people want to do the right thing, but when they are under pressure to provide information, office staff, healthcare providers, doctors and others caught up in fraudulent schemes sometimes say they were afraid to speak out. For others, the lure of securing a major payout is their major motivation. Find out how to make a complaint to enjoy the most protection.

Medicare Fraud Does Not Happen by Accident

The Association of American Physicians and Surgeons recently did a survey of their members on the topic of Medicare fraud. What they found was shocking. Over 80 percent of doctors fear an investigation. The majority weren’t defrauding anyone. They’ve just bought into the idea that complicated billing codes are the root of recent fraud cases — and the sizeable financial ramifications.

Nearly a quarter of practices no longer accept Medicare patients for the same reason. They don’t want to deal with the risks. A look at actual cases involved Medicare fraud show these fears are unnecessary. Medicare fraud doesn’t happen by accident.

Take, for instance, the case of Williston Rescue Squad, Inc., in South Carolina. The ambulance service had a year’s long history of transporting patients by ambulance when it wasn’t necessary and falsifying documents to meet Medicare transfer requirements. Finally, a clinical social worker who worked at a local hospital turned in the business.

Remember, Medicare rarely pays all your medical bills. So as the government was being defrauded, so were the patients!  The company replaced three top executives and agreed to pay the government $800,000. Because the social worker raised the complaint by suing the company in a qui tam lawsuit, she received $160,000 of the settlement. The False Claims Act has revolutionized many industries by motivating change from within organizations. The protections involved are as important as the potential benefits, but they aren’t always what they appear.

Surprisingly, the lawsuit listed the name of the whistleblower and her association with the Williston Rescue. The company, her employer and the general public knew she spoke out. Her name is Sandra McKee. She still lives in Augusta, Georgia, and still works for U.S. Renal Care, Inc.

Protection for Whistleblowers Depend on How You Complain

Whistleblowing does not always guarantee your anonymity, though working with an experienced legal team can help safeguard your privacy. There are many ways to legally protect yourself from the backlash. For instance, federal law prevents:

• Firing
• Demoting
• Harassment
• Industry blacklisting
• Unreasonable transfers

A common, new trend is employees getting into trouble for venting their concerns over social media. While these individuals believe they are doing the right thing, this doesn’t constitute “whistleblowing.” By airing grievances in the public eye, you open yourself up to ramifications at work, as well as potential legal problems. Your employer could fire you and sue for defamation. Courts are finding in favor of businesses in these situations. Employees fired for public complaints have also gone without unemployment.

That said, most employers cannot fire you for complaining directly to management. One whistleblower who remained anonymous not only successfully sued her employer for firing her in retaliation for complaints, she went on to sue the government for accepting too small of a settlement. And she won.

False Claims Cases Are Not Get-Rich-Quick Schemes

Consider the case of James Swoben, a former employee of a Medicare Advantage Organization doing business with DaVita Medical Holdings LLC. Swoben alleged the Medical Services Organization instructed their healthcare providers to use the wrong coding information to receive higher rates of reimbursement.

DaVita settled in October for $270 million, of which, Swoben received just over $10 million. However, he first filed the case and saw it dismissed in 2013. An appeal in 2016 revived the case. In addition, one of the original defendants – SCAN Health – settled early on by paying $322 million. Swoben didn’t receive any portion of that payment and had to fight for his right to compensation.

There have been so many qui tam lawsuits raised in the last three years, some courts are raising the stakes for what constitutes fraud. Others are limiting the scope of “retaliation.” One former employee found this out the hard way when she sued based on anti-retaliation protection after she resigned.

Handled differently, the employee could have been a source for positive change while benefiting financially. Finding the right lawyer to walk you through the process makes all the difference.

Click to find out more about Medicare whistleblower protection by contacting Bothwell Law Group online.