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Risk managers might find themselves in difficult situations if they think fraud is not being corrected, particularly if they are also the compliance officers at their facilities, notes John Banja, PhD, medical ethicist at the Center for Ethics at Emory University in Atlanta.
Unlike some other hospital employees, however, the risk manager has to meet a higher ethical standard when it comes to whistleblowing, he says. Because the risk manager is at least partly responsible for preventing and detecting fraud, he or she cannot look the other way and and say solving the problem is someone else’s job, Banja says.
"Assuming he or she has done due diligence and has genuine reason to be concerned about a problematic billing behavior, an absolutely fundamental ethical obligation of a patient-centered hospital is to take the next step in addressing that problem, which could mean reporting it to authorities," Banja says. "Virtually every code of ethics says that when a healthcare professional notices something that violates practice standards or the law, they have to do something about it."
Having an employee resort to whistleblowing is a failure of the system for an employer, Banja says. A hospital’s leaders should have a culture that encourages employees to report their concerns internally and a determination to follow through on investigating the issue and taking any necessary remedial actions, he says. If an employee’s concerns are handled so ineffectively that they are taken public and proven to have merit, the employers have no one to blame but themselves, he says.
"If the ethics concerns don’t grab you, then what should grab you is the fact that the people who conduct the investigations for the feds are depending on your guilt for their livelihood," Banja says. "The monies they recover in these fraud lawsuits, and the penalties that are imposed, that’s what funds these federal offices and what makes these people successful in their careers."