Client Alert | DOJ Whistleblower Rewards Raise the Stakes for Healthcare Compliance

This alert is for general informational purposes and is not legal advice.

Healthcare organizations have a new reason to ensure their employees trust their internal compliance reporting processes. Under the U.S. Department of Justice’s Fraud Whistleblower Incentive Program (WHIP), individuals who report suspected healthcare fraud directly to the federal government may qualify for financial rewards. The program underscores the importance of making internal reporting channels accessible, responding promptly to concerns, and ensuring employees feel comfortable speaking up.

WHIP allows individuals to seek rewards ranging from $10,000–$30,000 for original information that leads to criminal charges in covered fraud cases. The DOJ may consider payment after charges are unsealed before the case is fully resolved. Awards are discretionary, and submitting a tip does not guarantee payment.[1][2]

WHIP covers federal healthcare offenses and related crimes involving healthcare benefit programs, patients, or others in the healthcare industry. The DOJ has identified hospice, home health, day care, and special services fraud as priority areas. A qualifying tip must be voluntary, written, truthful, complete, and based on original information; it must lead to criminal charges.[1][2]

What Healthcare Organizations Should Do

Although WHIP creates an additional incentive to report suspected fraud externally, organizations can strengthen their internal compliance programs by making it easier for employees to raise concerns and trust that those concerns will be addressed.

• Make internal reporting channels easy to find and use and explain how reports are reviewed.
• Review anti-retaliation and confidentiality language to ensure it does not discourage lawful communications with government authorities.
• Respond promptly to concerns, preserve relevant records, and document investigative and corrective actions.
• Give employees a clear way to escalate concerns if they believe a report has not been addressed.

The DOJ’s terms generally exclude information obtained through compliance, internal audit, or certain investigation duties from qualifying as original information. They identify exceptions, including some circumstances involving imminent patient harm, suspected obstruction, or a 120-day period after specified internal reporting. An attorney may submit anonymous tips; the tipster must verify their identity before receiving an award.[2]

The bottom line

WHIP reinforces the importance of a compliance program that employees trust and that responds effectively when concerns arise. Healthcare organizations should take this opportunity to assess whether their reporting channels, anti-retaliation protections, and investigative procedures work as intended.

A reliable internal reporting process helps organizations identify and address concerns early, including prompt follow-up and a culture where employees can raise concerns without fear of retaliation.

Our team can help you review your reporting channels, anti-retaliation language, or response procedures in light of WHIP. Contact us today if you have questions. 

Sources

[1] DOJ, Fraud Whistleblower Incentive Program (WHIP).

[2] DOJ, Program Terms and Conditions and Frequently Asked Questions.