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Legal Exception Of General Employment In The United States

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In general employment in the United States is at will, meaning that both employer and employee are free to terminate the relationship at any time, without warning, for any reason. Of course, there are some legal exceptions to at will employment at both the state and federal level. One of the most important of these exceptions protects whistleblowers. Employees have information about organizations that is not public. Therefore, laws have established the rules concerning this special knowledge. In the case of insider trading, employee special knowledge could distort public trading of equity shares so insider trading is not allowed. In the case of whistleblowing, employee special knowledge can protect the public interest so whistleblowing is protected. …show more content…

An example of whistleblowing illustrates. Healthcare Fraud A Tucson woman working for a major healthcare provider as a medical reimbursement specialist discovered irregularities in the files of patients covered by Medicare, Medicaid, and the Federal Employees Health Benefit Program. The patient files showed charges for care that were not supported by documented services. The diagnostic codes were in the general area of treatment but were for more expensive procedures. This practice is called upcoding and is illustrated by the following example: 24600 Treatment of closed elbow dislocation; without anesthesia 24605 Treatment of closed elbow dislocation; requiring anesthesia Substituting the more expensive code (24605) is not detectable to the payer. Without an insider that understands the specifics and realizes that miscoding is systematic and intentional, detecting this fraud is not …show more content…

The information really belongs to the company. The employee is a custodian of the information because it is necessary to perform work. The exception to this is public interest. Depending on the type of misbehavior that is being exposed, different laws may apply. However, all of these laws have the concept of “public interest” in common. Society has enacted laws and regulation for various purposes. If an organization is circumventing these societal rules, the public interest is not being served. Exposing such misbehavior is permissible, and the employee should expect legal protection from retaliation. Evidence and Whistleblowing Before deciding to blow the whistle, one of the most important considerations is evidence. Cases that have significant hard evidence are more feasible to pursue. In a medical fraud example, if patient charts cite one treatment and billing records cite a different treatment, hard evidence exists. In a case of gender discrimination, the comments of a manager recited from memory, are not hard evidence. The comments may still have value but are subject to assessment in a way that hard evidence is not. Also expecting forthright testimony from co-workers may be unrealistic, despite any courage shown around the coffee pot.

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