Utah Med Law

Whistle-blower law is an area of the law that rewards people for informing against entities that are breaking the law.  In return for blowing the whistle they often reap great financial gain when they expose corruption in the workplace.  It is often applied when a person comes forward and reports violation of Medicare anti-kickback rules.

Medicare has explicit rules named Stark laws that governs physician self-referral for Medicare and Medicaid patients. The law is named for United States Congressman Pete Stark, who sponsored the initial bill.  In a nutshell the law prohibits health care facilities from rewarding physicians for referral of patients to those facilities.  Congress believed that physicians should not be enticed into referring patients to specific facilities in exchange for items such as lower rent on office space or kickbacks to the referring physician in fees charged by the facilities.  This was primarily an effort to remove the appearance or actual conflict of interest and to promote the efficient use of health care delivery.

A recent case involving Tulare Regional Medical Center and its parent, the Tulare District Healthcare System, in Tulare California.  Tulare Regional Medical Center agreed to pay more than $2.4 million to settle a recent case.  The hospital and health-care system were accused of providing physicians with office rent and land sales substantially below fair-market value and forgiving debts in exchange for referring patients to the hospital, according to the settlement, which was announced Monday.

The United States Justice Department is charged with the task of investigating and prosecuting these types of cases.  The Justice Department is woefully underfunded and it is generally recognized that these types of cases are widespread and perhaps even ingrained in the way that health care facilities go about doing business.  According to the Fresno Bee the case involved twenty physicians, one doctor's group and a laboratory were involved. The doctors and lab were not identified by name.  The allegations were raised in a whistle-blower lawsuit filed last year in U.S. District Court in Los Angeles by the hospital district's former chief financial officer, Maria Lucy Reimche. As a whistle-blower, she will get about $500,000 as part of the settlement, Justice Department spokesman Thom Mrozek said.

My question is why was the whistle-blower named and not the physician?  If we are trying to expose fraud why name the accuser and not the accused.  There is of course some clause in the settlement that claims that the facility is not admitting any wrongdoing by paying the settlement.  On the other hand we all know facilities do not pay unless they believe they are responsible.  It is ludicrous to me of course that the doctors name remains secret.

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