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Whistleblowing: Don't blow it!

Medicaid patients sometimes pass through many different medical organizations, including ambulance companies, emergency services, doctors' offices and specialists. If you work in the health care industry, you likely understand the amount of paperwork and record-keeping necessary for each patient. Many times, the patient is not able to keep up with the claims procedures or understand the codes and terminology included on the forms.

More often than you would like to admit, the opportunity arises for someone in your organization to take advantage of the complicated nature of a Medicaid claim. In fact, you may be witnessing this kind of fraud going on in your office, and you aren't sure what to do about it.

Successfully reporting fraud

Because of the fortune that is lost each year through fraudulent Medicaid practices, the government often offers substantial rewards to whistleblowers to encourage people in Michigan and elsewhere not to cover up misconduct in their organizations. However, in order to claim the reward, you have to be the first person to report the fraud. This is why Medicaid officials suggest you do not talk to anyone about your suspicions of misconduct. Potential whistleblowers who unburden themselves to friends or co-workers often find themselves watching someone else claim the reward.

Medicaid officials recommend other precautions, such as the following:

  • Document anything that proves intent to defraud.
  • Use personal email and phone to correspond with authorities about the alleged fraud.
  • Avoid alerting IT, which may happen if you send many documents through company computers or email.
  • Refrain from taking documents from the workplace without advice from counsel.
  • Continue your duties as a model employee.

If others learn or suspect that you are a whistleblower, your supervisor may transfer you to some department where you will not have access to the information you need to support your claim of fraud. Additionally, you do not want to give your employer cause to enact disciplinary measures or to have security monitor your every move.

Seeking guidance and protection

From the moment you determine to report Medicaid misconduct in your organization, you may feel isolated and scrutinized. You may be afraid of making a mistake or of retaliation. Having legal counsel may help reduce the stress.

Following the advice of your lawyer will improve your chances of having a successful case. Since you may not understand every legal aspect of a fraud claim, you will benefit from the advice of someone who successfully deals with such cases regularly. Your attorney will instruct you on what to do to make your case strong and to protect your rights moving forward.

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