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Courage of their convictions: Uncovering fraud in health care system

The stories of four physicians who became whistle-blowers.

By Tanya Albert, amednews staff. Feb. 4, 2002.

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When Congress strengthened the False Claims Act in 1986, news about defense contractors charging hundreds of dollars for hammers and toilet seats motivated it. Health care fraud wasn't on the radar.

Fast forward to the present, and the situation has changed dramatically. Now, health care settlements represent 75% of government fraud recoveries. And many health care officials grumble about the law, which increased the role whistle-blowers can play.

A Taxpayers Against Fraud study, "Reducing Health Care Fraud," released in 2001, found physicians and hospital administrators are concerned that the government has been overzealous and unfair in its enforcement.

But a handful of physicians have seen the other side -- they have blown the whistle on fraudulent activities and set in motion some of the most influential False Claims Act cases.

These doctors "are true believers in the system, and they are really offended by the manipulation by the few," said Mary Louise Cohen, a lawyer at Washington, D.C.-based firm Phillips & Cohen, which specializes in qui tam cases.

Whistle-blowers receive 15% to 25% of the money the government recovers. But physicians who have pursued such suits say money can't be the motivating factor for dedicating several years to a case.

Here are four of their stories. In each case, the group accused of wrongdoing settled the suit, which is not an admission of guilt.

In the mid-1980s, Paul Michelson, MD, a La Jolla, Calif., ophthalmologist, noticed that a colleague was performing a certain procedure far more frequently than normal. [...]