All too often, the medical care providers that we depend on to take care of us and keep us healthy take advantage of their circumstances and act fraudulently, either toward patients or toward the government.
Depending on the details of the fraud that you observe, you may feel an obligation to report fraud, which puts you at risk yourself. The government understands how difficult it is to report fraudulent behavior by your own employer and offers protections to those who do report fraud in the workplace.
However, before you pull the trigger and report fraudulent practices in a health care workplace, it is wise to assess exactly what you observe and to document it as much as you can. A carefully constructed case will protect your rights and your interests while ensuring that the government has the information it needs to stop protect consumers.
Where is the fraud?
Although it may seem as though fraudulent behavior is self-evident, in order for claim to incur liability for a health care provider, it must show unethical actions by the health care provider, typically involving appropriate billing or recommending necessary treatment for financial gain.
For instance, if a health care provider recommends a course of treatment that does not necessarily help a client, this does not mean that fraud occurs. Medical care is not always efficient, and many factors may play into a medical care provider’s choices. In order for a fraud claim to hold water, it must demonstrate that the accused party:
- Has specific knowledge of a false action or claim
- Maintains intentional ignorance of a false claim
- Exhibits disregard towards the integrity of the practice and the truth of claims made on patients and government partners
Protect yourself first
Before you take the step of reporting fraudulent behavior by your employer, make sure that you fully understand the tools you have available to protect yourself against retaliation. In many cases, choosing to report unfair practices in the workplace can add up to career suicide, at least in the short term. A strong legal strategy can keep your rights and financial security protected both before you blow the whistle and after, giving you the freedom to shine a light on unfair, fraudulent practices and help keep health care fair and efficient for all people.
