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ABSTRACT
Another frontier of contemporary ethics is using whistle-blowers as a means to fight fraud and abuse in health care organizations. The federal government does this by increasingly relying on the False Claims Act and qui tam suits brought by whistleblowers. This article argues that this approach is dysfunctional for both the whistleblower and the organizations targeted by them. The article proposes that enhanced standards, informed by virtue ethics and utilized by independent bodies such as the Joint Commission on the Accreditation of Healthcare Organizations or JCAHO during the health care organization accreditation process, offer a better alternative to the current retributive approach now used by the federal government.
INTRODUCTION
Since the mid-1990s, the federal government increasingly relied on whistleblowing as a method to control fraud, waste, and abuse in the Medicare and Medicaid programs. Although not the result of a single, specific policy decision, several factors combined to create the situation. First, in 1986, an amendment to the Federal False Claims Act made the filing of whistleblower suits much easier. Second, in 1995 in an effort to combat fraud, waste, and abuse in both Medicare and Medicaid, the U.S. Department of Justice (DOJ) implemented a new anti-fraud, waste, and abuse program called "Operation Restore Trust" or (ORT).
Elected officials and managers, working in the program offices of both Medicare and Medicaid programs and even in the general public, were confused about fraud. Waste, and abuse for years. Medicare alone lost $20 billion in 1997 to fraud, waste, and abuse, translating to a loss of 11 cents of every Medicare dollar spent in the United States (HCFA, 2000). Although we will not know the exact dollar amount of Medicare and Medicaid funds lost to fraud, waste, and abuse, a reduction of any sort in those losses will not only result in a financial savings for the taxpayers but will provide much needed increase in public confidence in the future integrity of the programs.
As a method of achieving these ends, whistleblowing is not without its hazards. For example, very often during the process of disclosure the individual whistleblower is placed at extreme personal and professional risk. Although the False Claims Act allows for potential financial gain for the successful whistleblower, many whistleblowers ultimately...