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Whistleblowers Say Money Is Not Their Motivation

John Commins, for HealthLeaders Media, May 17, 2010

A spate of very large whistleblower settlements in the healthcare sector amounting to billions of dollars in fines have been reported over the last few years. For the most part, the big ticket fines are directed at pharmaceutical companies, such as Pfizer, which paid $2.3 billion last fall to settle whistleblower claims that it illegally marketed its drugs to physicians.

Hospitals are not immune from prosecution, however.

Neither are physicians.

It would be reasonable to assume that the primary motive for whistleblowers–who are eligible for up to 25% of the recovery—is money. After all, the six whistleblowers in the Pfizer settlement split more than $102 million from the federal share of the civil recovery. Ka-ching!

Not so, say most of the 26 whistleblowers surveyed in the May 13 issue of The New England Journal of Medicine.

"Every relator we interviewed stated that the financial bounty offered under the federal statute had not motivated their participation in the qui tam lawsuit," said the study, which focused on whistleblowers in 17 federal suits against pharmaceutical companies. "Reported motivations coalesced around four non–mutually exclusive themes: integrity, altruism or public safety, justice, and self-preservation."

The survey, led by Aaron S. Kesselheim, MD, of Harvard Medical School, found that the "most common theme" motivating the whistleblowers was personal integrity and strong ethical standards. "One relator reasoned: 'When I lodged my initial complaint with the company, I believed what we were doing was unethical and only technically illegal. This ethical transgression drove my decision. My peers could live with the implications of 'doing 60 in a 55 mph zone' because it did indeed seem trivial. However, my personal betrayal . . . so filled me with shame that I could not live with this seemingly trivial violation,'" the study reported.

"The relators in this group felt that financial circumstances helped to subvert such ethical standards in their colleagues, saying that most colleagues were unwilling for personal or family reasons to jeopardize their jobs."

The survey found that most of the whistleblowers tried to fix matters internally by speaking with their superiors, of filing an internal complaint.

"One explained: 'At first it was to the head of my department, the national sales director, and the national marketing director. . . . After being shooed aside, I went to the executive vice president over all the divisions of sales and marketing. Then eventually I went to the CEO of the company, the chief medical officer, and the president.' Insiders who voiced concerns were met with assertions that the proposed behavior was legal and dismissals of their complaints, with accompanying demands that the relators do what they were told," the study said.

Maybe some of these whistleblowers are now blowing smoke about their altruistic motives. Most of them are relatively well off as a result of their actions, 13 of the whistleblowers collected between $1 million and $5 million, and seven got more than $5 million. There may be some revisionist history going on at the poolside as they sip mojitos, admire their pedicures, and contemplate their rags to riches stories.

For argument's sake, however, let's assume that the whistleblowers' motives are pure: they saw a wrong and they made it right. As the NEJM study points out, whistleblower settlements between 1996 and 2005 let to more than $9 billion in recoveries. The federal government has said it will vigorously pursue healthcare fraud, in part, as a way to pay for healthcare reform. The fact is, their motives are almost irrelevant if your hospital is cutting the recovery check.

While the study focuses on the pharmaceutical industry, the lessons are here for everyone in healthcare. Listen to your employees. If they tell you something is wrong, they're probably not making it up. They're trying to save your hospital from millions of dollars of heartache and bad media attention. Ignore them at your peril.


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John Commins is a senior editor with HealthLeaders Media.

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