Blowing the whistle on healthcare fraud: should I?

PURPOSE

The purpose of this article is to explore some of the factors involved when a nurse practitioner (NP) is confronted with a healthcare fraud situation. Ethical concepts and decision-making strategies are provided, as well as practical legal considerations.

DATA SOURCES

Government Internet Web sites; healthcare management, ethics, and nursing journals.

CONCLUSIONS

There are many forms of healthcare fraud. Healthcare fraud saps financial resources from the healthcare system and from individuals. The decision to blow the whistle on a colleague or organization is not an easy one and has potential for great discomfort. There are ethical decision-making strategies and practical considerations for the process of whistle-blowing should it become necessary.

IMPLICATIONS FOR PRACTICE

NPs may be confronted daily with billing and reimbursement issues. Being prepared to recognize healthcare fraud and knowing the ramifications of whistle-blowing are important tools to have in one's practice repertoire.