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3 types of medical professionals who may become whistleblowers

On Behalf of | Oct 8, 2024 | Uncategorized

Professionals don’t take positions with companies assuming that they’ll have to act as whistleblowers. Most professionals look for positions at reputable companies where their employment should remain stable for the duration of their time at the company.

Unfortunately, professionals in the healthcare sector sometimes realize that their employers may have violated the law. Specifically, they may notice concerning signs of inappropriate billing practices, which might include billing for appointments that didn’t exist, upcharging by billing for a different procedure than the one performed and any other billing activity intended to manipulate the system for financial gain. As such, numerous professionals may find themselves in the uncomfortable position of needing to report employer misconduct.

Billers and coders

Coding professionals play an important role in any medical business. They take information about a patient’s diagnosis or treatment and convert it into a specialized universal code. Billers, on the other hand, take treatment information and appropriate codes and submit them to insurance companies or government insurance programs for reimbursement. These financial specialists in the medical field may notice trends that indicate fraudulent activity. They may need to take legal action when the company’s conduct clearly violates the False Claims Act.

Receptionists

Those working in the front office and interacting with patients may field complaints about billing issues. They may also notice inconsistencies in internal records, such as signs of the company billing for appointments that they know the patient canceled or did not attend. In scenarios where the medical practice or facility consistently engages in such questionable practices, those handling the scheduling or patient communications may eventually feel the need to speak up about their concerns. They may even need to file a qui tam lawsuit if the organization doesn’t address their concerns.

Licensed medical professionals

Registered nurses, physician’s assistants and other professionals actively providing medical care may be the ones who recognize unusual notes in the practice’s record-keeping system. They may notice upcoding where the billing requests submitted do not align with the services provided. They might also notice unbundling or an attempt to separate out services that are usually billed as a group at a discounted rate. Any professionals who become aware that a medical practice has violated the False Claims Act may need to speak up about their concerns.

Acting as a whistleblower and potentially filing a qui tam lawsuit can lead to a change in company practices. A professional serving as a whistleblower has the right to protection from retaliation and may even receive financial compensation if their lawsuit is successful.