Like most of you, I'm highly addicted to podcasts. Serial, in particular, has been interesting this season. For those of you who do not know, Serial covers a singular story through a number of episodes, and in the process, conducts interviews, separates facts from fanfare, and manages to sift through the broken pieces of a story to find some meaning and truth. All of those things are subjective, but it's probably as close to investigative journalism as we'll experience in our lifetimes. It's a free podcast. If you have some time, it's worth a listen.
This season, the focus has been primarily on Bowe Bergdahl. For those of you unfamiliar with the story, it's about a Sergeant in the Army who abandons his post and is captured by the Taliban.
From his wiki:
Robert Bowdrie "Bowe" Bergdahl (born March 28, 1986) is a United States Army soldier who was held captive by the Taliban-aligned Haqqani network in Afghanistan from June 2009 until his release in May 2014.[3][4][5][6] The circumstances under which Bergdahl went missing and how he was captured by the Taliban have since become subjects of intense media scrutiny.
Bergdahl was released on May 31, 2014, as part of a prisoner exchange for five Taliban members who were being held at the detention center at Guantanamo Bay. This exchange and the ceremony announcing it, held in the White House Rose Garden, generated controversy in the United States. On December 14, 2015, the U.S. Army announced that Bergdahl would be tried by general court-martial on charges of desertion and misbehavior before the enemy.[7]
While there is a ton of political discourse as to the authenticity of his actions, I want to focus on a small piece of the story that no one seems to be discussing. Bowe continually states he pulled this stunt as a whistleblower effort to uncover the poor leadership and conditions he served under. On multiple occasions, he states he did not know of any other ways to draw attention to their deteriorating situation, and in retrospect, is a bit remorseful that he didn't follow proper channels to air these grievances. While the merits of his actions are debatable, and I'm taking no sides, it is utterly devastating to hear someone say their command is bereft of upwards communication.
This lesson is not lost on healthcare. In both Medicaid and Medicare, whistle-blowing is a positive behavior. Remember, all of our tax dollars are funding the cost of care for MCare/Caid recipients, so anything we can do to curb those costs without limiting access is a boon for all parties involved. Each of us are stakeholders in public health, whether we think about it or not.
Another important point to illustrate is the different between fraud and waste. Fraud has a criminal intent. Waste could be inadvertent. The determination between he two is made outside of our reporting. What I mean by this is, if you work for a provider and suspect mis-billing or wrong doing, you can report it without the mental burden of trying to determine which category the act falls into.
However, some see this as a deterrent to report at all. What if you discover an accidental coding issue that's been ongoing for some time, resulting in an overpayment? Self-reporting is not admission of fraud. It's the identification of overpayments. And typically, if no fraud is found, those overpayments are recouped through various methods.
Billing agents and physicians should never be deterred from reporting suspected fraud, waste, abuse. HHS's website has a number of outlets to report Medicaid or Medicare fraud:
Anyone suspecting Medicaid fraud, waste, or abuse is encouraged to report it. The first touch point should be the Program Integrity contact in the State Medicaid Agency for your individual state. The State By State Fraud and Abuse Reporting Contacts document was last updated October 2014, and includes the contact information for the State Medicaid Agencies (SMA), and the Medicaid Fraud Control Units (MFCU). Another reporting option is to visit CMS' State Contacts Database which requires entering the State, Contact Type, and Organization Type. Lastly, the Office of Inspector General's (OIG) National Fraud Hotline is:
Dial: 1-800-HHS-TIPS
(1-800-447-8477)
Or visit their website at: Office of Inspector General - Report Fraud
Medicare does offer financial incentives to whistleblowers, up to $1,000. While they did try to increase this to 15% of the amount recovered, up to ~$10million, that provision was retracted by CMS after a negative public reception. However, the $1,000 bonus does remain in effect. Additionally, the Office of the Inspector General (link above) has an anonymous form (or hotline) to report fraud.
Thank you for reading, and if you have any comments, please be sure to add them below. Also, re-share this to anyone on LinkedIn, Facebook, or Twitter as you see necessary!