07/21/2025
Whistleblowers don’t just happen in the government. If a healthcare employee reports an issue to management of a health system, the system deals with any Federal $$$ (e.g. Medicare/Medicaid), and the system fails to address the issue, the employee could become a whistleblower. This can occur for a variety of reasons but these cases often evolve from billing fraud (e.g. intentionally upcoding, billing for services not rendered) or other avenues to separate the government from its $$$ like paying for referrals, incentivizing unnecessary care. Whistleblowers pop up in large pharma companies, hospitals/health systems, and even private practices. Clinicians should ensure coding/documentation are appropriate and accurate via the occasional chart review and/or coding education.