Blowing the whistle

Wednesday, Sept. 3, 2008 | 2:07 a.m.

In the 1990s the Justice Department started relying on whistleblowers in private industry to combat health care fraud in the Medicare and Medicaid programs.

A study recently published in the Annals of Internal Medicine estimated that from 1996 to 2005, whistleblower complaints recouped at least $9.3 billion. Researchers say that comes from about 75 percent of the 379 cases they reviewed. Not included in that number are some notable victories, including the government’s $920 million settlement in 2006 with Tenet Healthcare Corp., one of the nation’s leading hospital companies.

Under the law, whistleblowers can receive up to 25 percent of any money collected by the federal government, and that prompting has apparently worked. About 90 percent of the health care fraud cases pursued by federal prosecutors come from whistleblower complaints.

The number of whistleblower complaints has decreased, although judgments have increased, in part because of the inclusion of pharmaceutical companies under the law. In recent years, whistleblowers have charged drug companies with defrauding state health care programs by overcharging for medication, making false claims about drug performance and selling drugs not approved by the Food and Drug Administration.

In the fiscal year that ended in September 2007, the federal government won more than $750 million in judgments and settlements against drug companies in fraud cases.

This should be seen as a shining example of the whistleblower laws. Whistleblowers, who often take great personal risks by pointing out fraud, have saved the taxpayers billions of dollars.

The law, however, excludes government employees from filing whistleblower complaints in health fraud cases, and that should be changed. Under pressure from the business community, lawmakers have balked at making a change, and that is ridiculous. If a government employee has tried to point out a problem and gotten nowhere, he should be encouraged to make a whistleblower complaint.

Considering the success of the law, lawmakers should be looking for ways to increase its use, not limit it.