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Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Posted  June 7, 2019

Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal racketeering conspiracy. The proliferation of kickback schemes, evidenced by the multitude of recent settlements, cost taxpayers millions of dollars and plague the healthcare, pharmaceutical, and medical device fields by clouding physician judgment. The qui tam provisions of the False Claims Act provide one avenue for whistleblowers to bring wrongdoing to light, but other tools could likewise incentivize whistleblowers to come forward.

The Medicare Fraud Hotline and HHS OIG online reporting form are tools that are likely underutilized by potential whistleblowers because they fail to financially incentivize reporting and provide no protection from potential retaliation. Compare this to a qui tam claim or a tip submission under another agency whistleblower program like those of the SEC or CFTC—each provides some combination of reward and protection.

With kickback schemes growing both in number and complexity, healthcare professionals and staff are needed more than ever to bring wrongdoing to light. One solution could be to offer a small reward to those who report wrongdoing to the Medicare Fraud Hotline or HHS OIG when that information results in a successful enforcement action. Certainly any potential award program would need rules and regulations to, among other things, decide criteria for awards, set limits or boundaries on award amounts, and determine whistleblower anonymity and protection. By providing additional tools and incentives to healthcare professionals and staff who may have information on kickback schemes and other fraudulent conduct but who may not want to go down the path of being a qui tam whistleblower, the Federal Government could help itself to combat fraud more effectively by properly incentivizing whistleblowers to come forward.

What do you think? Should the Medicare Fraud Hotline or HHS OIG reward informants?

Should the Medicare Fraud Hotline or HHS OIG reward informants?

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Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Question of the Week, Reporting to Government, Whistleblower Rewards,