External Investigators' Follow-Up Intentions When Whistleblowers Report Healthcare Fraud: The Effects of Report Anonymity and Previous Confrontation

Abstract

Whistleblowing reports, if properly investigated, facilitate the early detection of fraud. Although critical, investigation-related decisions represent a relatively underexplored component of the whistleblowing process. Investigators are responsible for initially deciding whether to follow-up on reports alleging fraud. We report the results of an experimental study examining the follow-up intentions of highly experienced healthcare investigators. Participants, in the role of an insurance investigator, are asked to review a whistleblowing report alleging billing fraud occurring at a medical provider. Thus, participants are serving as external investigators. In a between-participant design, we manipulate the report type and whether the caller previously confronted the wrongdoer. We find that compared to an anonymous report, a non-anonymous report is perceived as more credible and follow-up intentions stronger. We also find that perceived credibility fully mediates the relationship between report type and follow-up intentions. Previous confrontation is not significantly associated with either perceived credibility or follow-up intentions.

The Public’s Self-Avoidance and Other-Reliance in the Reporting of Medical Insurance Fraud: A Cross-Sectional Survey in China

“… 10 , 11 As a quasi-public good, medical insurance funds deserve to be supervised by the public, and the value of public reporting in preventing and identifying medical insurance fraud has become commonly recognized and utilized in medical insurance anti-fraud efforts. 12 , 13 Federal regulators in the United States take whistleblower information about medical insurance fraud seriously, with almost half of the medical insurance fraud losses recovered from 1996 to 2005 coming from lawsuits filed by whistleblowers. 14 China has also taken various measures to encourage the public to report medical insurance fraud, mainly including offering financial rewards to whistleblowers and protecting their information.…”

Who is More Likely to Report Medical Insurance Fraud in the Two Scenarios of Whether It Results in a Direct Loss of Individual Benefit? A Cross-Sectional Survey in China

“…1,2 Medical insurance funds around the world lose approximately $260 billion annually due to medical insurance fraud, equivalent to 6% of global health spending. 3 Countries have attached great importance to the construction of medical insurance anti-fraud tools, among which the reporting of medical insurance fraud by people has become an important tool of great interest because it helps to detect medical insurance fraud early, [4][5][6] and federal regulators in the United States value the information provided by whistleblowers on medical insurance fraud, and almost half of the fraud losses recovered between 1996 and 2005 came from lawsuits filed by whistleblowers. 6 China also places great importance on individuals reporting medical insurance fraud.…”