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A Solid Compliance Program Avoids Whistleblowing

Medicare and Medicaid billing fraud scams—upcoding and unbundling schemes, double and triple billing, phantom billing and illegal kickback schemes —cost the United States an estimated $100 billion annually, inflating the size of government, escalating healthcare costs and burdening taxpayers.

To combat the scams, the US government amended the Federal False Claims Act, adding the qui tam provision to encourage more citizens to blow the whistle on Medicare fraud. Originally enacted during the Civil War to deter defense contractors from ripping off the government, the “Lincoln Law” allows whistleblowers who file a suit to not only be free from retaliation, but also entitled to receive a portion of any funds recovered in the case, sometimes up to 30%.

One of the most recent and heinous cases involving whistleblowing is on Farid Fata, MD, a Detroit oncologist sentenced to 45 years in prison on July 10, 2015. Dubbed “Dr. Evil” by the press, Fata not only bilked the government of $91 million, but also administered excessive or unnecessary chemotherapy to hundreds of patients, some of whom died even though they had been cancer-free. Fata’s fate is thanks to a nurse who blew the whistle on him and his appalling “chemo mill.”

To read the full article, visit the American Journal of Managed Care.