03/24/2014 (press release: FalseClaims) // Kathleen Scanlan
The most important work a potential whistleblower can do from the first sign of fraud or misconduct is to organize what they know in a timeline. The importance of this seemingly simple exercise cannot be stressed too much. Inevitably there is some action that initiates the whole scheme: the patient zero of the fraud. But then fraud happens over time and most whistleblowers only stumble on the scheme later. Trying to articulate what happened and how they figured it out is daunting. The prospect of writing up “the story” feels impossible for fear of leaving out something that might be important. That’s why a timeline is so perfect. It captures actual facts and can serve as the chronology of the scheme the whistleblower is trying to expose. More importantly, it doesn’t take any special talent as a writer to create a really good one. The facts speak for themselves.
Of course this is easier said than done. Timelines take time to build. Just starting one will lead the whistleblower to think of more things to add. A good timeline reflects hours of work over many sessions. Here’s an example of how a fictitious Medicare whistleblower might build a timeline.
The whistleblower has been pushed into action because of a trigger event. That’s as good a place to start as any.
February 1, 2014 whistleblower got demoted
Obviously, something happened to lead up to the demotion. For example:
December 1, 2013 whistleblower got poor performance review
But that’s obviously not the story. Using word processing or spreadsheet programs, it’s fairly easy for the whistleblower to back-fill facts and add new events that may happen after the demotion. While technology is great, the timeline does not have to be high-tech! A package of index cards works just as well. Just put each fact on a separate card and insert it in the deck chronologically.
Reorganizing our fictitious whistleblower’s facts, the timeline might look like this:
June 1, 2013 John Jones is appointed “Director” of Department.
July 15, 2013 Mr. Jones circulates memo to employees instructing them to change patient records for all Medicare patients to show that patients who had procedure X got procedure Y. The memo says that this new procedure is intended to allow the hospital to get reimbursed more from Medicare.
July 16, 2013 whistleblower talks in cafeteria to former “Director,” Ms. Smith, who admits to knowing about the new policy. She tells whistleblower hospital senior management replaced her with Jones because she would not implement the new policy
August 1, 2013 whistleblower sends Mr. Jones email saying she will not comply with July 15 memo because it’s fraud.
August 2, 2013 Mr. Jones speaks to whistleblower, says “you had better do what I ordered if you want to keep your job.”
September 30, 2013 whistleblower sees Medicare billing summary including all the upcoded procedure Y’s on it.
December 1, 2013 whistleblower got a poor performance review.
February 1, 2014 whistleblower got demoted
This simple timeline is full of information:
• when the fraud started (July 15),
• hospital acted deliberately (replacing Smith with Jones),
• Jones on notice of fraud (whistleblower’s email)
• Medicare got billed (what whistleblower saw)
• demotion occurred after reporting the potential fraud
• witnesses (Smith and Jones) and
• documents (the memo, the email, the poor performance evaluation).
If any potential whistleblower still isn’t convinced of the merits of a timeline, consider this. A timeline captures facts and makes less for the whistleblower to keep “in his head” and can be turned over to your lawyer to grow and change over time as new facts emerge. For cases that can go on for years that is an invaluable tool, indeed.
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