Can an employer fire an employee for reporting Medicare or insurance fraud?
Warning - Do not call the government, without speaking to us first.
As a whistleblower, they ride a fine line between HIPAA violations and gathering of trade secrets. However, the government provides whistleblowers protection from getting fired if they report Medicare fraud.
"By definition a whistleblower is a person who informs the government, when a person or an organization is engaged in illegal activity. A whistleblower is someone who reports waste, fraud, abuse, corruption, or dangers to the public and safety. A whistleblower is a person, often an employee, who reveals information about activity withing a private or public organization that is deemed illegal. This includes activities that the employee sees an employer doing some type of wrongdoing. Whistleblowers perform an important service for the public and the Department of Justice when they report evidence of wrongdoing, which is driven by their professional conscience, personal integrity, and moral values. Click here to see the OIG's Whistleblower Protection Information. https://oig.hhs.gov/documents/root/362/ocig-whistleblower-2021.pdf
A honest healthcare whistleblower has the opportunity and a moral duty to do the right thing. In healthcare, whistleblowers play an important role in stopping healthcare fraud, by bringing forward a case under the federal False Claims Act, or the Stark Law or physician self-referrals, or the Antikickback statute. This often entails Medicare Fraud, Medicaid fraud, and other healthcare fraud that costs the government money. The fraud is committed in order to gain certain financial benefit, or to out-gun the competition, or outright mistreatment, maltreatment or misrepresenting something to either or the patient or the government or related insurance companies. In healthcare this means a medical provider - a pharmacy, pharmaceutical company, a hospital, a clinic, a nursing home, a home health provider, doctor, dentist, podiatrist, chiropractor, a network, an insurance company and insurance brokers.
Healthcare Whistleblowers have certain protections that laws and the government provide them. A healthcare employer cannot retaliate against the employee for exercising the employees rights under the Department of Labor's whistleblower protection laws. Under the Whistleblower Protection Act (5 U.S.C. Section 2302(b)(8)) (WPA) an employee is protected from demotions, pay cuts, or dismissals for blowing the whistle. There is also the Whistleblower Protection Enhancement Act of 2012 that strengthened the protection for Federal employees, and the Department of Health and Human Services, Office of Inspector General, established a Whistleblower Ombudsman in the OIG to educate Department employees about prohibitions on retaliation for whistleblowing, as well as employees' rights and remedies if anyone retaliates against them for making a protected disclosure (i.e., ""Whistleblowing""). The name of the Ombudsman was changed to the ""Whistleblower Protection Coordinator"" under the Whistleblower Protection Coordination Act of 2018 to better reflect the roles and responsibilities of the position."
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