September 13, 2017 - Posts

In the World of Medicare and Medicaid Fraud, Whistleblowers Often Find What Regulators Miss or Ignore

A common criticism of whistleblowers today is that what they do really isn’t necessary.  After all, say the critics, in this regulated world that we live in, government auditors will discover and stop pretty much any fraud sooner or later.


This, unfortunately, just isn’t true.  A great case in point can be found in a recent Wall Street Journal article about the Joint Commission, a non-profit organization responsible for accrediting well over half of America’s hospitals.  As the article noted, the Joint Commission has come under fire for continuing to accredit hospitals with bad patient safety records, including those where poor care has resulted in patient deaths.  State and federal regulators, in turn, often rely on Joint Commission findings, which allows hospitals to continue their dangerous practices with little threat of regulators punishing or even seriously challenging them.


The Joint Commission is admittedly not responsible for investigating potential fraud.  However, as we have previously noted, poor patient care and fraudulent billing often go hand in hand.  That is why it is still important, even in heavily regulated areas like health care, to have whistleblowers who are willing to come forward and share what they know about fraud against the government.  The government and its non-profit proxies have limited resources and cannot always investigate effectively without an insider’s help.  And, as illustrated by the Wall Street Journal Article, even when such organizations do discover compliance issues on their own, they do not always act quickly or aggressively enough, and certainly not as quickly and aggressively as the government can act with the help of a knowledgeable whistleblower.


The full Wall Street Journal Article (which requires a subscription to view) can be found here.


To learn more about our Whistleblower & Qui Tam practice click here.  Our firm is located in Nashville, Tennessee but we represent whistleblowers all around the country.

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