The threat of whistleblowers extends beyond employees and former employees. Beneficiaries who spot fraud can become whistleblowers as well. In recent years, beneficiaries have become more aware of the possibility of fraud. A partnership between OIG and the AARP aims to educate senior citizens about fraud and abuse issues, and to promote OIG’s hotline.
While beneficiary whistleblower cases are relatively rare and can be hard to prove, don’t dismiss patients who cry fraud. Take the following actions to reduce the chances of a beneficiary taking his or her complaints to the government:
· Advertise your own hotline: Encourage patients to call you before they call the government. Put a number on bills that beneficiaries can call with any questions or complaints.
· Make sure patients know what they’re signing: This is a common cause for beneficiary accusations of fraud. Often, patients will sign an advance beneficiary notice (
· Route beneficiary complaint calls away from billers: Have the public relations department handle such calls because the biller’s explanation might be too technical. The public relations representative should get an explanation from the biller and, then, return the patient’s call.
· Don’t let a patient leave angry: An angry beneficiary is a potential whistleblower. Listen to patients and explain to them what happened, so there’s much less chance they’ll say, “I’m going to the government.”
Good, direct advice. Nothing gets people more frustrated that having the feeling that their complaints and needs are not taken seriously – that no one cares. Your principle goal here is simple: keep your patients satisfied and confident that everyone in the practice cares about them as a patient.
Complaint calls should be handled by the administrator/manager. These kinds of calls deserve prompt attention by someone who can make sure that the problem is attended to and fixed. If there are problems in your internal process, you can turn your attention to making those changes only after the needs of the patient are taken care of. The patient doesn’t care about your internal process and how the problem arose – rightfully so, they want the problem fixed and move on.