Nurses are rightly getting a lot of attention lately for the courageous and essential role they are playing on the front-line during the COVID-19 pandemic.  Whether in hospitals, nursing homes, hospices, or as home health workers, nurses are finally “learning what they are worth,” even as private equity firms seek to profit from nurses’ increased wage-earning power.  As reported by STAT, Congress is now investigating whether travel nursing agencies, controlled by private equity, are exploiting the pandemic-induced staffing crisis at many hospitals.  This would not be the first time that nurses are caught in the middle between corporate entities seeking to turn a profit at the public’s—and individual patients’—expense.  Nurses are frequently taken for granted, or exploited, by those who own and control large institutional providers.  But one method by which nurses can fight back and protect both their own interests and those of their patients is to become a whistleblower.  Many have done so already.  Here are five reasons why nurses—and those with a nursing background—make great False Claims Act whistleblowers.

1. Nurses (and Whistleblowers) Are In The Room Where It Happens

Nurses work directly with patients, the intended beneficiaries of the Medicare, Medicaid, and TRICARE programs, and can observe whether patients are getting medically necessary and appropriate treatments billed by the institution.  As such, nurses are well-positioned to know whether hospitals, nursing homes, or other institutional providers are improperly cutting corners on staffing, performing medically unnecessary surgeries, falsifying medical records to increase MA beneficiary risk scores, or simply not providing the care for which the institution has submitted claims to Medicare or Medicaid for payment.  Nurses who participate in utilization review, coding review, or claims processing are particularly well-situated to identify fraudulent billing.  If they report these problems but are ignored, filing a False Claims Act complaint may be the best way to correct their employer’s fraudulent practices.

2. Nurses (and Whistleblowers) Know Sacrifice and Hard Work

Nursing can involve grueling hours and difficult patients.  It requires incredible dedication and hard work to be a nurse.  Likewise, being a False Claims Act whistleblower requires dedication to a cause, such as more than just a healthcare system.  Being a whistleblower often involves going up against entrenched and well-funded opposition.  False Claims Act cases can last many years.  Getting through the government’s investigation, which occurs when the case is confidential and under federal court seal, and then litigation, often requires patience and perseverance.  Because of their professional training, nurses are well-suited for the challenge.

3. Nurses (and Whistleblowers) Are In It For the Right Reasons

Few people go into nursing to become rich.  Even now, when traveling nurses are earning two to three times their pre-pandemic income due to the desperate need for their services, their salaries pale compared to the physicians and business executives who run hospitals and nursing home chains.  Instead, people go into nursing to make a difference.  Likewise, by and large, whistleblowers don’t file False Claims Act complaints to become rich.  They do it to address injustice.  Very few whistleblowers get fully compensated for the total cost of blowing the whistle to their reputation, lost career opportunities, and time assisting with the government’s investigation.  Nurses make great whistleblowers because they are in it for the right reason.

4. Nurses (and Whistleblowers) Strive For Just Outcomes

Nurses strive to help patients overcome disease or impairment and get well, while treating each individual with dignity.  They want the best outcomes for their patients and work hard to bring all resources to bear to achieve it.  Mary Eliza Mahoney, the first Black nurse trained in America and a member of the American Nurses Association Hall of Fame, as well as the Women’s Hall of Fame, is a case in point.  As reported in a belated obituary by the New York Times, Mahoney, who died in 1926, was described by one of her former professors in the following terms: “This nurse was an outstanding student of her time, an expert and tender practitioner, an exemplary citizen, and an untiring worker in both local and national organizations.  She was a sound builder for the future, a builder of foundations on which others to follow may safely depend.”  Similarly, whistleblowers strive for just outcomes, for wrongs to be righted, and for justice to prevail.  They create a stronger foundation for those who follow.  The best nurses and whistleblowers have a lot in common.

5. Our Healthcare System Can’t Function Without Nurses (or Whistleblowers)

Our healthcare system depends on nurses as direct-care providers, working alongside physicians in the operating room, and bedside to ensure patients’ needs are addressed.  Hospitals and other large institutional providers can’t function without them.  More importantly, patients die if they don’t receive appropriate nursing care:  studies show that mortality rates increase as nurse-patient ratios decrease.  Likewise, the U.S. Department of Justice needs whistleblowers with knowledge of fraudulent billing to help provide appropriate oversight and enforcement of government programs.  In particular, the U.S. healthcare system is simply too large and complex, with too many private actors, for the government to provide this oversight on its own.  The False Claims Act envisioned a public-private partnership to fill the gap.  Nurses, with an inside view of how large institutional providers operate in practice, are critical to ensuring this oversight occurs.

 

If you have information about healthcare fraud, or would like to speak to a member of the Constantine Cannon whistleblower lawyer team, please contact us for a confidential consultation.

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