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There are some instances in which healthcare managers must protect themselves, even if means blowing the whistle on your employer, says Josh Hyatt, MHL, CPHRM, senior risk management specialist with NORCAL Mutual Insurance in San Diego. Hyatt also was previously a Medicare fraud investigator with the Centers for Medicare and Medicaid Services (CMS).
Hyatt says he has reported a past employer for intentionally committing fraud. In that instance, he says, he was upfront about his intention to report the alleged fraud because the institution was making no effort to correct it. "I told them that I had to report it because if I didn’t I could be prosecuted," he says. "I suggested they get their books in order, and then I provided my notice."
Hyatt did not file a qui tam lawsuit when he reported his former employer; he choose instead to just move on after reporting. He suggests that the more public, more aggressive action of a qui tam lawsuit would have a more detrimental effect on a career than simply reporting fraud and receiving no reward.