Qui Tam Relators Are Not The Only “Whistleblowers” To Lead To Investigation

HHS OIG issued its Semi-Annual Report for the first half of Fiscal Year (FY) 2016 (October-March). The Report summarizes significant accomplishments, deficiencies, abuses, and investigative outcomes relating to the administration of HHS programs and operations disclosed during the reporting period. Additionally, the Report addresses a variety of cases successfully investigated by the OIG. A very significant percentage of cases were the result of “Whistleblower” complaints. Although many of the complainants filed qui tam actions under the False Claims Act, numerous other complaints were simply reports filed directly with the OIG. The OIG maintains a hotline that accepts tips and complaints about potential fraud, waste, abuse, and mismanagement in HHS programs from all sources. All information is reviewed by a professional OIG staff member.

The statistics provided by the OIG reveal the significance of the hotline resource. Between October 1, 2015, and March 31, 2016, there were a total of 75,050 hotline calls received; 59,191 phone tips evaluated; and 11,456 tips via phone referral. In addition, there were 4,905 tips received via internet and another 2,021 tips received via letters and facsimile. What this really means is quite a lot of people are reporting suspected wrongdoing without using the “Whistleblower” statute that provides rewards. None of the tips that resulted in successful action provided any reward to the “Whistleblower.”

Carrie Kusserow, a health care compliance consultant who has worked with over 100 hotline operations over the last 20 years, notes: “The OIG Semi-Annual Report tells us that there are tens of thousands of employees who do not believe they can report suspected wrongdoing through internal compliance channels and thereby become Whistleblowers, either under the qui tam provisions of the False Claims Act, or directly to the OIG or other government agencies. This speaks to a failure of many health care organizations to adequately develop or promote their hotlines. First and foremost, I believe that very few internally operated and managed hotlines are effective. It is simply not practical to staff a hotline around the clock, seven days a week, to provide live operator services. Without having someone available to debrief callers, the quality of the process is seriously compromised; and no matter what representations there are for confidentiality or anonymity, employees as a rule distrust making a call to another employee of the organization. The answer is to outsource the hotline to a qualified vendor that provides 24/7 live operators to debrief callers, and permits filing report submissions through the internet. In any case, this alone is far from being adequate to channel complaints internally. The hotline must be actively and consistently promoted with posters prominently displayed in work areas, along with ongoing compliance training to reinforce the fact the Compliance Officer and management will take calls seriously. Failing to take these measures just creates an incentive for employees to report externally to government agencies, attorneys, and the media. None of these channels would bode well for any organization.”