Doctors often blow whistle on financial improprieties

Most physicians make pretty good livings compared to most other Americans, but they can really strike it rich playing another role in healthcare: That of whistleblower, JD Supra has reported.

That's in part because some healthcare financial wrongdoing and fraud cases are settled with the federal government for tens if not hundreds of millions of dollars, and parties who blow the whistle can share in up to 15 percent of the settlement. 

Moreover, healthcare is the nexus of large financial fraud settlements in the United States. In 2013, the U.S. Justice Department recovered more than $3.8 billion under the False Claims Act, according to the JD Supra article. Of that sum, nearly $3 billion was the result of actions taken by whistleblowers. And of the $3.8 billion that was recovered, $2.6 billion came from healthcare entities.

In recent months, there have been 67 healthcare-related lawsuits unsealed, the National Law Review has reported.

"Whistleblower claims in the healthcare industry have become commonplace, particularly in matters relating to Medicare or Medicaid compliance. These claims can involve a range of practices, such as billing, coding and claims submissions by hospitals, surgery centers, medical device manufacturers, medical group practices, nursing homes or others," said the article, written by Michael Joseph and Ron Shinn of the McAfee & Taft law firm in Oklahoma City. "They can also arise based on prohibited referrals under the Stark law and illegal kickback arrangements involving healthcare providers, physicians or others. Unexpectedly, a number of qui tam plaintiffs have been physicians."

Physicians may be more knowledgable of fraudulent procedures than other individuals in a healthcare organization, and are often considered trustworthy authority figures, according to the article. 

The Affordable Care Act (ACA) expanded individuals' ability to bring a whistleblower, or qui tam, lawsuit. Joseph and Shinn also noted that whistleblowers enjoy additional protections regarding employer retaliation under the ACA.

And those doctors are reaping the benefits. In one case involving fraudulent billing among hospitals in Kentucky, three cardiologists shared in $2.46 million. In another case involving false claims at a Southwest hospital operator, a physician received more than $1 million.

But non-physician employees can also reap benefits from whistleblowing. Norma Rivera, an employee with Baptist Health Systems in San Antonio, received $661,500 when it settled a false claims suit two years ago.

To learn more:
- read the JD Supra article 
- check out the National Law Review article