Technology gives corporations incredible power to manage information. When that power gets weaponized to conceal fraud, employees who discover it often don’t know what to do next. But they’re in a unique position to stop it. Common Types Of System Manipulation The schemes vary widely. Some involve sophisticated…
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Companies are making false claims about what their AI can actually do. They’re pitching capabilities to investors, customers, and government agencies that simply don’t exist. If you work in tech and you’ve seen your employer misleading others about AI performance, you might have more options than you realize….
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Medicare fraud in nursing homes takes many forms, but upcoding remains one of the most pervasive and damaging. When facilities deliberately inflate billing codes to maximize reimbursements, they’re not just defrauding the government. They’re compromising care for some of our most vulnerable citizens. If you work in long-term…
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Stark Law. Hospitals are often in a constant battle for patients. A steady stream of referrals from physicians can significantly boost a hospital’s revenue and reputation. Here’s why: Because referrals can be so lucrative, there are two laws regulating how those referrals can be made. At a very…
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Referrals drive revenue. Hospitals are often in a constant battle for patients. A steady stream of referrals from physicians can significantly boost a hospital’s revenue and reputation. Here’s why: Increased Patient Volume Physicians are often the first point of contact for patients seeking medical care. When they refer…
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The Ninth Circuit just brought “some discipline . . . to the sometimes loose” use of jurisdiction in the context of the False Claims Act. In Stein v. Kaiser Foundation Health Plan, Inc., the court concluded that a bar for whistleblowers—the “first to file bar”—is merely procedural, not…
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Overbilling, Upcoding, and Unnecessary Medical Procedures. Overbilling Overbilling occurs when healthcare providers charge for more services or more expensive services than were actually provided. It can take several forms: Billing for services not rendered: Providers submit claims for treatments, tests, or procedures that were never actually performed. Duplicate…
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Waivers in employment and separation agreements. Waiver clauses in employment or separation agreements can create a chilling effect by discouraging employees from reporting misconduct or engaging in whistleblower activities. These clauses often try to limit an employee’s ability to report wrongdoing to government authorities, or restrict their right…
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Double invoicing. I struggle to think of any situation where creating a separate set of invoices would be a legitimate business practice. There’s just no legitimate reason to create a whole separate set of books. When it comes to business practices, double invoicing is like the fashion equivalent…
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Incentives matter. Fun fact: It’s hard for a hospital to lose money. Health care spending in the U.S. just keeps going up and up, people are getting older, and medical bills aren’t getting any cheaper. If a hospital is losing money, something is going wrong. The typical response…
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