The fraud shield
In the recent WakeMed Medicare fraud case, U.S. District Judge Terrence Boyle expressed frustration with the fact that criminal charges were not brought against the perpetrators of the fraud (a mid-level manager and staff).
In the end, he reluctantly approved the settlement (which included a deferred prosecution agreement) citing that if criminal charges were brought against this individual then WakeMed would lose its Medicare and Medicaid participation standing, thus denying care to thousands of people.
This case illustrates why these two issues should be “disconnected” in our current laws. In short, charges should be brought against someone who commits a crime. The current system allows employees of large hospitals to “hide behind” or be “protected by” the “good” provided by their respective institutions.
The WakeMed case sends a clear message to all mid-level hospital managers: Commit fraud and be immune from punishment.
As a matter of policy, these two issues should be separated in the law. Individuals should be able to be brought to justice without endangering the mission of their employer; likewise, individuals who commit fraud should not be shielded from justice by their employer’s mission.