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Speaking up in health care: Beyond the False Claims Act (FCA)

On Behalf of | Oct 21, 2024 | Uncategorized

The False Claims Act (FCA), mainly known for combating fraud against the government, has been a strong tool for whistleblowers in the health care industry, especially in cases involving Medicare and Medicaid fraud. But aside from the FCA, there are other laws that offer crucial protections for those who expose misconduct in the industry.

The Affordable Care Act (ACA)

This law aims to make health insurance more accessible and affordable. It also protects employees who speak up about or refuse to take part in ACA violations such as:

  • Refusing to provide coverage for people with pre-existing conditions
  • Putting limits on how much coverage a person can get in a year or lifetime
  • Treating people unfairly because of their health status or medical history

The law encourages honesty and fairness in the health insurance system by protecting employees who report these issues.

Emergency Medical Treatment and Active Labor Act (EMTALA)

Known as the “anti-dumping” law, it requires hospitals to provide emergency medical treatment to anyone who needs it, even if they cannot pay. It has a specific provision that prohibits hospitals from taking any negative action against a physician or hospital employee who reports a violation under this law, such as:

  • Refusing to screen a patient for an emergency medical condition
  • Not stabilizing a patient with an emergency medical condition before transfer
  • Moving a patient with an unstable emergency condition without proper procedures

These protections allow health care workers to speak up when hospitals deny patients necessary emergency care.

New York’s whistleblower law

New York Labor Law Section 740 protects employees who speak up about or refuse to take part in illegal or unsafe workplace activities. This protection extends to former employees and independent contractors as well.

If a court finds that an employer retaliated against a worker for protected actions, it may order several remedies:

  • Requiring the employer to give the worker their job back, with the same pay and benefits
  • Awarding compensation for lost wages, benefits and any legal fees incurred
  • Imposing fines on the employer to discourage future violations

Workers have a two-year period from the date of the employer’s retaliatory action to file a claim. This gives employees time to gather evidence and seek legal advice if needed.

You are protected for doing the right thing

If you are planning to report workplace violations or believe you are facing retaliation for speaking up, know that legal help and support are available.