Wiki Is this Fraud? What should I do?

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theresaquinlanmills@msn.com

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I have a provider who knowingly denied patients their refunds. I just found out he has issued only two patient refund checks for the entire year so far. (Those were because of specific patient requests.) He has 3 reports I generated indicating the patients and the amounts of refund due for each. I spoke to him and reminded him these refunds should have been issued by now.
1. I want all of the patients to get the money that is owed to them.
2. I do not want to be complicit in any type of fraud.
3. I no longer want to work for someone who would act this way but I need to continue until I can find work elsewhere.
What should I do?
Should I give the provider time to correct the situation and pay the refunds out?
Should I report him to Medicare?( most of these are Medicare patients)
Note: I work remotely. This man is emotionally unstable and knows where I live.
 
Hoo boy. You are in a tough spot.
However, yes, keeping patient refunds is a problem, whether it's Medicare or a commercial payer. Here's a great article with some good citations.

Inform the provider that he needs to refund patients, keep great records, document what you have shared, said, and reported, and forward all of the documentation to your home email in case he fires you (this way you can defend yourself if he points fingers in your direction and also so that you can keep your current job until you find something else). You can report him to Medicare, and as a whistleblower, you'd be protected by law, but you may want to inform the local authorities if you believe he might threaten you. If he does anything like that, you can also report him to the state licensing board for inappropriate behavior.
 
Pam Warren said:
Hoo boy. You are in a tough spot.
However, yes, keeping patient refunds is a problem, whether it's Medicare or a commercial payer. Here's a great article with some good citations.

Inform the provider that he needs to refund patients, keep great records, document what you have shared, said, and reported, and forward all of the documentation to your home email in case he fires you (this way you can defend yourself if he points fingers in your direction and also so that you can keep your current job until you find something else). You can report him to Medicare, and as a whistleblower, you'd be protected by law, but you may want to inform the local authorities if you believe he might threaten you. If he does anything like that, you can also report him to the state licensing board for inappropriate behavior.
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Thank you for the citations and for your advice! I've already emailed myself all of the records. I spoke to my provider about the refund issue again and he decided to issue the refunds. Once I have proof from the bank that the refunds were actually issued, I will start looking for another job. You help put my mind at ease. your help is much appreciated! I hope you have a healthy and prosperous new year filled with fun and happiness :)
 
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