Hospice Patients Alliance: Consumer Advocacy


If you work in the health care field, in hospice or elsewhere, eventually you are likely to observe behavior or practices that are not in accordance with the standards of care. In fact, you are likely to observe some form of health care fraud, on a minor or major basis. What you do in response to that fraud can have significant impact upon your life, your professional status, future job prospects and financial well-being.

Making the wrong decision about fraud in your workplace can cost you your job, your license and even end up putting you in jail; health care fraud is a felony criminal violation! Don't think that employers will sit idly by while you complain about their intentional, conscious wrongdoing!

All throughout your professional training, you have been instructed that if you observe a problem at your job, you should work "within the system" and "report it to your supervisor." Then, if you do not get a proper resolution of the problem, you have been trained to report to the next higher supervisor/manager, and on up the "chain of command." Well, if the upper management at the agency you work for is at the root of the problem and has been intentionally violating the standards of care, you might be very effectively destroying your own employment at that agency and others, if you protest too loudly.

With the "business" approach to health care dominating more and more, many health care agencies have lost their concern for the standards of care, and respect for patients' rights has been thrown to the wind. You will quickly become labeled as "a troublemaker" or "a disgruntled employee," especially after they find a reason to fire you.

Of course, terminating employees can cost the agency (in the form of unemployment benefits), so it is likely they'll harass you or irritate you enough to get you to resign...so they can avoid paying you the unemployment benefits. It's no secret that employers will put you under intense scrutiny to "find" something with which to complain about you, and "write you up" for your "inferior" performance. This process will be repeated, with many emotionally draining confrontations with lower management personnel who will have been instructed to berate you for your performance, find fault and get you to resign.

Some managers even will call you into a private "behind-closed-doors" meeting with one or probably two managers who are especially "gifted" at degrading you, mocking your skills, criticizing you for any weakness or fault they can find or fabricate, and even yelling at you. Do not stand for it. This is harassment and retaliation! If you stay at your employment, even after they begin to harass you, you're working up a thick file of documentation which will tell any new employer how "bad" you are, and how "poor" your performance is. Eventually, you may have difficulty getting a new job. Some nurses have already experienced these forms of retaliation as a "reward" for being professional, ethical and trying to maintain their integrity. That is one reason so many really dedicated nurses "burn out" and leave the field.

Well, you may think that employers are not "allowed" to tell any prospective employer what's in your file, that they only tell when you worked there and for how long, and you will be very mistaken in your beliefs. What's to stop human resources personnel at different local employers from speaking with one another, especially if they're friends and agree among themselves to "keep quiet" about retaliating against you. Don't you think that human resources personnel from different agencies associate with one another at some professional level, or belong to the same "association" of human resources professionals??? There's nothing stopping employers from speaking on the phone confidentially to tell the new employer that you're a "troublemaker." If you can imagine any form of retaliation, you can be sure that your employer will use it if necessary, if the employer is really corrupt. How would you know if they did go behind the scenes and slander you in private? How would you ever know? They used to call it "blackballing," and it still exists!

If you observe problems at your place of work, yes, certainly, voice your opinion and see if appropriate changes are made. But once you are convinced that no meaningful change is going to occur and it is the agency itself that intends to commit these violations of the standards, perhaps for financial gain, you may need to look for another job and think about getting out of there as fast as you can! This does not mean you no longer have an obligation to report the violations. Just protect yourself and your family as well as reporting the fraud to the federal government. You can always report fraud after you've found a new job.

On the other hand, you could stay at your current employment and report the fraud anonymously, but sometimes the employer will figure out that you are the one who reported them. If they do, again, they'll find a way to get you to resign or to force you out, if they don't outright terminate you. Agencies that commit fraud always have "sweet-talking" administrators who can talk out of both sides of their mouths and say anything necessary to make the agency look "professional" and "clean" from the legal angles. However, when the U.S. Office of Inspector General or U.S. Attorney's Office performs their investigations, they will find the wrongdoing and prosecute the white-collar criminals involved. Health care fraud must stop. If it doesn't, health care as we know it will no longer exist, and professional services in your field will no longer be "professional." The patients will no longer be able to get decent services and will suffer terribly. All of us will be "slaves of the system," unable to speak up or advocate at all for our patients.

Be smart. Protect yourself, your family, your job and protect the profession. Every professional journal in your field advises that if you are in a situation in which you must violate the law or standards governing your license, and you stay, you are responsible for your actions. The only course of action which allows you to retain your integrity is for you to get another job, however unpleasant or difficult that may be. Nobody wishes to change their employment if they feel comfortable at their employment. But remember, you won't feel comfortable at your employment if you stay at an agency that is committing fraud...at least, you won't feel comfortable if you have any integrity.

If you stay at the agency, you run the risk of yourself being found guilty of some federal or state law, or of being found guilty of violating your license, depending on the circumstances in your situation. If you do things which you know are "wrong" or illegal, you could go to jail for many years. There have been nurses used as scapegoats for the agencies who instituted the illegal activities. Don't think for an instant that the agency would not sacrifice you in order to protect its own interests! Health care agencies do it every day! They "nail" the nurse or doctor to the wall, while saving their own skin. If they can, they'll blame it on you. You need to voice your objections, document your objections in whatever way you can, get out and report the criminal activity to the authorities.

What if you have already "made waves" at your workplace, and the employer considers you a "troublemaker" already? What if you're looking for a job and having trouble getting another job? You may wish to not be too "picky" about the work you take, and avoid moving directly to a job at a similar employer. Take the positions that are available from employers willing to hire you and get on with your life. You may successfully find another job by changing to a different area of the health care field for a year or so. It may be helpful to consider part-time or contingent work for two or three employers at the same time. You may need to work for these two or three employers on this part-time basis for a year or so, until the fraudulent employer (who is trying to retaliate against you) is "down the list" on your resume, and can no longer "blackball" you. Don't think they won't do it. Be wise.

If serious retaliation is being taken against you, you definitely need legal counsel. A competent attorney specializing in employment related law is needed to help you protect your rights. There are several laws at the federal and state levels which provide protections against employer retaliation against "whistle-blowers" who report violations. However, legal remedies through the courts may take a year or two, and for a final decision, count on an even longer time because the former employer will likely appeal any court decision not favorable to the employer (and they almost always do appeal any ruling against them).

The quickest way to get your life back together after a miserable experience with a corrupt employer is not always to get the "perfect" job that you always wanted. If you can get it, fine...but if you're having trouble, assume that your previous employer is retaliating against you (most likely in a way that you could never prove in court) and take some "stepping-stone" jobs temporarily. You need to be practical and understand that your former employer is actively trying to hurt your chances for new employment in the health care field. A war is occurring in the health care field, and it's being waged by corrupt white collar criminal administrators against health care professionals who dare to speak up against the outrageous violations of patients rights and standards of care.

Taking a job as a stepping stone to putting your former employoer behind you may be the smartest thing you ever did, to preserve your financial well-being, your emotional well-being and your professional reputation. The "blackballing" of employees who "cause trouble" still occurs, only employers are very "slick" and very "clever" in how they go about avoiding getting caught in the act. Any employer who intentionally violates the law to commit health care fraud will not hesitate to retaliate against an employee who makes waves, complains and reports their violations. They hire lawyers and consultants who tell them how to deal with "those types of employees" without getting into legal trouble.

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