Whistleblower protections and risks in healthcare fraud cases

False claims act contain 'qui tam' or whistleblower provisions. This work will discuss the pros and cons of being a whistleblower and to ask the question of if one were aware of the fraudulent issues in the healthcare organization why would they not report the issues?

In 1975, in the case (NLRB vs. Weingarten, Inc. 420 U.S. 251, 88 LRRM 2689 the U.S. Supreme Court established the rights of employees to have a union representative at an investigatory interview and this rights are known as Weingarten Rights. The investigation interview happens when a supervisor questions the employee for the purpose of obtaining information that could be used in a discipline or conduct complaint against the employee. In the event the employee believes that they result negative outcomes from what they have to say the employee under the Weingarten Rights has the right to request union representation at the hearing. Once the employee has made the request for a union representative to be present management, can either: (1) stop questioning until the representative is present; (2) call of the interview; or (3) inform the employee that the interview will be called off unless the employee agrees to give up their rights (voluntarily) to the representative from the union being present. (UC Davis Human Resources, 2012)

First Student Response

Whistleblowing is defined as "disclosure of illegal, immoral, or illegitimate practices that are under employer control by either former or current organization members to person or organizations that are able to effect action" according to Angus, et al. (nd) Whistleblowing occurs in all types of professions. There are various considerations for whistleblowing including one should have investigated the incident well and make sure that the facts are completely understood. As well, one should make sure that the whistleblowing will result in more good than harm to clients and that the client will not be on the receiving end of retaliation. As well, one should understand the serious nature of whistleblowing and assume responsibility for such actions. There is a duty to take such actions when there is serious and great harm to the public involved and one has reported the incident to the immediate supervisor with no action and all possible and available channels have been exhausted for correcting the issue within the organization. There should be evidence that is documented and the capacity to convince a party who is impartial and a good reason to believe that going public with the information will result in the necessary changes. There are however, reasons to consider whether one should take this course of action. For example, in 2002 90% of whistleblowers lost their jobs or were demoted and 27% had lawsuits filed against them. 26% of whistleblowers in 2002 had psychiatric or medical referrals and 17% lost their homes and another 8% went bankrupt. (Angus, nd) One example of such is that of Jeffrey Wigand, former vice president of Brown and Williamson Tobacco Company who assisted the FDA in gathering evidence that cigarettes were "drug delivery devices." (Angus, nd) Wigand lost his $300,000 per year job and will never be hired as a high-level researcher again. Wigand's marriage ended and he is now teaching science in high school making $30,000 per year. Should one decide to blow the whistle it is advised that they: (1) Stay strong and confide in an attorney as well as consulting a mental health professional; (2) Stay safe, through selecting others they can trust; (3) gather all possible evidence to support the issue; (4) think ahead and make an escape plan to remove oneself from the situation quickly and safely; (5) seize the initiative through carefully choosing the time and place to announce the information; (6) maintain the high ground and do not act too soon. (Angus, nd)

Second Student Response

Whistleblowing is a serious issue and one that should be given due consideration prior to acting. The pros of whistleblowing include a clear conscience and personal integrity since one has taken the better choice of action rather than looking the other way. However, due to the disadvantages of whistleblowing it is important that one carefully consider that action prior to blowing the whistle. When one blows the whistle they should remember that while there are those who will admire them for having had the courage there are others who will be angry and retaliate. Individuals have lost their lives, their homes, their jobs and at the very least suffered a great deal of intimidation. Before one takes such actions they should ensure that they have documented the situation carefully and thoroughly and that they have sought the support of others. One should never consider whistleblowing unless they are absolutely sure that they are correct in their assumptions and that their knowledge of the situation is based purely upon facts. The whistleblower should ensure that their family members know what is transpiring so that they can watch their backs. The field of healthcare is one in which the whistleblower has a chance to assist in avoiding loss of life if there is a serious issue that needs to be revealed to the public or to authorities.

Summary and Conclusion

Whistleblowing is a serious issue and one that should be given careful consideration. The whistleblower should carefully document any evidence and ensure they have reported through the appropriate channels prior to any whistleblowing actions. Learned during this study is that in 1975, in the case (NLRB vs. Weingarten, Inc. 420 U.S. 251, 88 LRRM 2689 the U.S. Supreme Court established the rights of employees to have a union representative at an investigatory interview and this rights are known as Weingarten Rights.

It has been learned that the investigation interview happens when a supervisor questions the employee for the purpose of obtaining information that could be used in a discipline or conduct complaint against the employee. In the event the employee believes that they result negative outcomes from what they have to say the employee under the Weingarten Rights has the right to request union representation at the hearing.

Also learned is that once the employee has made the request for a union representative to be present management can either: (1) stop questioning until the representative is present; (2) call of the interview; or (3) inform the employee that the interview will be called off unless the employee agrees to give up their rights (voluntarily) to the representative from the union being present. (UC Davis Human Resources, 2012)

Also learned is that the penalties one may receive for whistleblowing are varied and may include loss of income, and ultimately the loss of one's home and even one's family. However, it is necessary at times to reveal information that protects the public interest and public good whether it be regarding the environment, banking processes or other such factors that affect the good and welfare of the public.

It is a personal choice whether to make the decision to blow the whistle on unethical or illegal practices however, in cases where a union is present in a company, the individual does have some protection available to them for whistleblowing.