Ethics And Whistle-blowing

[Cufiju]

In the last week I've become aware of possible fraud involving Medicaid/Medicare (in the US) at the local mental health clinic I frequent. "Possible" is the key word here; there have been numerous ethics violations tied to one employee (with whom I had face-to-face contact for a bit and now has regular contact with approving my paperwork). I am not...convinced...that internal management will handle this appropriately, as the possible fraud and definite ethics violations have not been dealt with.

I know about this because my mental health medical records/paperwork are tied up with this person and I asked questions about discrepancies on what I'd seen/said originally and what was in the final documentation. I've been flagged as a "difficult client" because I won't swallow this bullsh*t.

I have also been asked to not whistle-blow. The asking has come from someone else who works with me in a therapeutic capacity that is an honest person and is disgusted at what is going on. Their response is to leave their current position and then "come what may" because they won't be there to go down with the clinic.

I don't think it's ethical to wait. If one employee is causing the mayhem and upper level supervisors and management knew about it, did nothing, even after being repeatedly reminded about it...then I see no point in waiting for anything internal to happen.

I could really use some advice. I went looking for a therapist to help with PTSD and instead I find a hornets nest.

 

[Elamuv]

In the last week I've become aware of possible fraud involving Medicaid/Medicare (in the US) at the local mental health...

Wow... this is a tough situation. I'm so sorry you are in this position. I can see where this could get even trickier for you if you've already been labeled. IF what you are saying is actually the case, then its probably not a facility you want to be associated with any longer. If it were me, I think I would look for another provider, transfer, get a copy of my chart, and then report it. I'd hate to see you stuck in the middle of this. I wish you much luck.

 

[Eso]

I have also been asked to not whistle-blow. The asking has come from someone else who works with me in a therapeutic capacity that is an honest person and is disgusted at what is going on. Their response is to leave their current position and then "come what may" because they won't be there to go down with the clinic.

Why is this person asking you not to whistle-blow if they are leaving? That's confusing to me. Do you mean they are asking you to wait until after they've gotten out?

 

[Utivoj]

OP, here:

I'm finally getting my records after unbelievable amounts of excuses, duplicate forms to fill out and just outright lies of "no, you cannot have a copy." It took a meeting with everyone involved to realize that, yes I am entitled to the records because they are mine. This has me concerned because one reason I could see why this clinic has been so reluctant to allow me to even see my records (much less have copies!) is they are either modifying them or there is discriminating evidence in them. Either way, I'm not happy; the stress and anxiety this has caused has been excessive.

The person is asking me to not whistle-blow because the original information exposing the possible fraud wasn't obtained via chain-of-command in the clinic. Basically someone suspected things weren't right and matching up, did their own detective work, found out why (client notes with falsified face-to-face meetings on them) and then told "internal management" about it once they were leaving. My therapeutic person doesn't want to be involved with this...but if the falsified face-to-face meetings were billed to insurance, then anyone who was working at the clinic at that time could come under scrutiny.

So...I'm thinking of releasing the sh*t towards the fan after I get my records and comb through them. I realized earlier today how exhausted and triggered this secret-keeping is making me, as that's something I grew up under: don't tell about the abuse because no-one will believe you and no-one will do anything anyway and you'll just get the sh*t beat out of you later.

 

[Uhav]

yes I am entitled to the records because they are mine.

My therapist's office will not release your mental health records to you. They will only transfer to another mental health professional's office.

Im not sure if that's the State or the office or what.

Just thought Id throw that out there. Not sure if its relivent, especially since they said they would release them?

 

[Tegudu]

I think your whistle blowing avoider is being a little naive. If there is going to be an investigation they will speak to whomever was there no matter where they may be in the future. Are you sure she isn't involved?

 

[Wafiwe]

OP, here:

By law, I'm allowed my mental health records; so maybe a state thing? What I'm asking for is also rather specific: every piece of paper I've signed (releases, initial who-are-you-what-brings-you-here forms, update forms, some treatment forms (such as crisis plans and person-centered plans). I've also requested copies of assessments. I cannot have copies of therapy notes or notes from a support worker that are part of my record; however I am, by law, able to read those in the presence of a therapist who should answer any questions I have.

I'm not sure exactly why my whistle-blower avoider is being an avoider. Three different employees who have left this clinic have alerted supervisors/management to what was going on (a variety of ethical violations, at least) and...nothing. Yet I, as a client, am being seen as a threat. Just exactly who is crazy here?

 

[Kolug]

Yeah, the person asking you to wait is just plain stupid. She WILL be investigated whether or not she's still employed. I'd report now. What's the difference? If she already gave her notice, she won't be there much longer anyway. It's not like you report and investigators are there in 5 minutes. The wheels of justice grind slowly. The truth is that while she may be an honest person who hasn't been falsifying records herself, I'm guessing she has known about the fraud for awhile.

 

[Ewoji]

My husband is an attorney for the Medicaid Fraud Control Unit in the state we live in. Every state in the US has a unit like this as part of their Attorney General's Office. He handles Whistleblower cases all the time. If you report it to your state, it is investigated under seal without the agency even knowing they are being investigated until there is enough evidence to come forward. The identity of the Whistleblower is also protected, so should you choose to follow through with reporting, know that it will be 100% confidential.

 

[Lozuh]

OP, here:

Thank you all for your input. Ewoji, a special thanks for that tidbit. I have found that I can anonymously report if I choose...but this is a bit complicated. My state would like to have the clients' names/Medicaid numbers involved (which I DO NOT have) instead of the folks perpetrating the possible fraud/covering it up. But I'm going to report and send what information I have in the hopes that something will be done, at the very least an investigation.

The main fall-out from this huge mess is that I've been labeled a horrid client in a small community where there are few mental health treatment options and I can no longer see anyone from this clinic because of trust/confidentiality issues. Reporting to Medicaid/Medicare is just one thing I'm doing; I'm also filing a HIPPA complaint and reporting to my state's licensing board. So the sh*t really will hit the fan for this clinic.

I suppose no therapy is much better than bad therapy, right?

 

[Edijot]

If you are willing to go through this process than I hope that you have a lot of good peer support. My thoughts are it costs you nothing to just walk away and wash your hands of the whole thing.

If you are ready for tons for stress and lies and cover up and being black listed etc than go for it. The question is Are you prepared to fight this fight and accept the consequences, been there done that. Long story

 

[Acurif]

OP, here:

As I am already dealing with stress, lies and cover up and also being blamed as a client for the unethical employee's inability to perform their work to acceptable standards, I suppose a bit more won't change much, now will it? To walk away from a situation just because someone has decided to fully embrace the Peter Principle and bully everyone who calls them out on it is not how I was raised. I also know that I am not the only person at this clinic that has been impacted with falsified therapeutic notes and possible fraud for billing for services that weren't rendered.

If all of us decided to keep walking away and washing our hands of things that cost us trouble...well. I didn't ask for this fight; I asked for therapy. Instead, this massive SNAFU was forced upon me. The amount of anger and frustration I have from that alone fuels me to keep going.