Medicare Compliance & Reimbursement

Tip: Take all employees’ concerns into account.

If you feel overwhelmed by Medicare’s steady stream of policy upheavals, claims review updates, and regulatory reforms, you’re not alone. Plus, when you add law enforcement scrutiny to your daily list of worries, keeping your practice compliant is really no mean feat. 

You probably consider your employees to be the front line of your office compliance — the guardians of your practice secrets and policies. But, accidents happen, worries are overlooked, and staff are sometimes sidelined. That’s when yesterday’s star employee turns into tomorrow’s qui tam relator.

You might shrug whistleblower worries off, but no practice is immune to disgruntled employees and insider threats. That’s why it’s essential to make staff feel valued and heard while cultivating compliance.

Facts: According to the Department of Justice (DOJ), “the number of lawsuits filed under the qui tam provisions of the [False Claims] Act has grown significantly since 1986, with 633 qui tam suits filed this past year — an average of more than 12 new cases every week,” notes DOJ in a release on FCA recoveries for 2019.

Who Will Blow the Whistle?

There aren’t many published commonalities among whistleblowers, other than the fact that they encounter someone who they think is breaking the law and report it to the government or other entity. Unfortunately, most employers don’t think their staff would ever blow the whistle, but many whistleblowers have collected millions of dollars in their portion of settlement money after a successful qui tam lawsuit.

“Violations of the Anti-Kickback Statute may be brought under the False Claims Act, which statute is unique in that it financially incentivizes individual citizen whistleblowers [qui tam relators] to bring suit against offenders, by permitting qui tam relators to share in a portion of the government’s recovery when their actions are successful,” advise attorneys Kendra E. Pannitti and John E. Morrone with Frier Levitt Attorneys at Law in the regional firm’s Healthcare Blog.

Consider this: Of the total $3 billion recovered by DOJ last year from FCA recoveries, including healthcare and other areas of federal fraud, $2.1 billion came from qui tam provisions, indicates a DOJ release. In fact, the government paid $265 million of those recoveries to whistleblowers, DOJ says.

“Frequently, qui tam relators are disgruntled employees, contractors or competitors that have knowledge of suspect arrangements,” warn Pannitti and Morrone.

Caution: While some merely think a qui tam whistleblower suit is going to be their payday, others feel ignored after reporting fraud within their practices. These employees instigate a suit because they feel that they have nowhere else to turn. If a member of your staff comes to you and says, “We aren’t doing this properly — this is not the legal way,” listen to them. They have probably researched the issue extensively before approaching you.

Bottom line: If your employee complains and after investigating you find that they’re wrong, then go back and talk to them about why they might have a misconception — but don’t ignore their concerns.