Protecting Whistleblowers and Fighting Fraud

Good morning, good afternoon, good evening everyone depending on where you are. Thank you for joining us today. Uh my name is Crystal Chang and um I am here with the center for bioeththics. Um joined by our uh presenters and moderator for our protecting whistleblowers and fighting fraud women seminar session. At this time I will hand this over to Leah um to um take us through. If you have any questions throughout the session, please feel free to use the Q&A um and we will try our best to get through them. Thank you. >> Thank you Crystal and welcome. Thank you for joining us this afternoon um for a topic that I'm very excited to learn about. Um so the health policy and bioeththics seminar is a webinar that we convene throughout the year with the aim of learning about current issues in health policy and thinking through some of their ethical implications with the aim of fostering conversation among different disciplines and perspectives on that topic. So we hope that today gets you thinking and sends everyone out with some new questions and ideas to pursue. Um during the Q uh during the webinar, please ask lots of questions. We have time for a Q&A and please use the Q&A function on Zoom that's on the lower part of the screen in the panel control. We'll be drawing questions from the Q&A feature. So to start us off today, I want to introduce our panelists beginning with our moderator Alexander Egleman who is a senior research assistant with the program on regulation therapeutics and law. His current research focuses on anti-competitive practices that undermine patient access to affordable, safe, and innovative treatments. And his work has appeared in JAMAMA, Annals of Internal Medicine, the BMJ, and the New York Times. He's also a graduate of Habford College. So'll be guiding us through the discussion today. Presenting will be Taran Van who is professor in the school of nursing and health professions at the University of San Francisco. Dr. Van is a public health scholar and academic leader whose work has furthered efforts to control corruption in the health sector, advance health systems and access to medicines and evaluate public private partnerships and community health initiatives. Dr. Van has published over 140 articles, book chapters and professional reports and has served on international technical committees and advised the World Health Organization, Council of Europe, World Bank, Bill and Melinda Gates Foundation and other clients. She is a returned Peace Corps volunteer from Cameroon and has a PhD in public policy and global health from Boston University and a master's in health policy management from the Harvard School of Public Health. Joining her is Maya Ephrad who serves as government accountability projects director of legislative and congressional affairs. In her role, Miss Friday leads the organization's federal legislative advocacy work, and works directly with national coalition partners, legislative staff on the Hill, including member committee and leadership offices and others to defend and advance whistleblower rights. She was previously public policy council at the Brennan Center for Justice, where her work focused on voting rights, criminal justice reform, elections, and good governance reforms. She also previously served in various legislative and research capacities with the campaign for tobaccof free kids, national whistleblower center, represent us, fair vote center for American progress and the Michigan Innocence Clinic. She holds a JD from the University of Michigan Law School and a masters in public policy from the University of Michigan, Gerald R. Ford School of Public Policy. So, thank you for joining us today and what I'm sure will be a great conversation. And over to you, Alex. >> Thanks, Leah. and thank you all for joining today. Concerns about fraud and misconduct in healthcare aren't new and today they operate at a massive scale with estimates suggesting that three to 10% of healthcare spending may be lost to fraud amounting at tens or even hundreds of billions of dollars each year. Of course, these uh issues affect much more than budgets. They can undermine patient care, compromise scientific integrity, and erode public trust. Whistleblowers are often the mechanism by which these problems come to come to light. But relying on individuals to speak up raises broader questions. How about how systems are designed to promote accountability about what motivates people to come forward and how effective the laws and policies both incentivize whistleblowing and protect such individuals from retaliation. Today's discussion will move from a broader global perspective on whistleblowing and anti-corruption to a more detailed look at you the US legal framework framework and real world cases. We'll also have about 15 minutes for questions at the end. So, please submit them as we go and I'll do my best to bring them into the conversation. With that, I'll turn it over to Taran uh to get us started. >> Thank you so much. Let me share my screen. Uh so Maya and I have decided I'll give an introduction to some of the principles and uh definitions involved and I'll also present some of my findings from research that I did with a team on whistleblowing in the global context whistleblowing in health organizations. So, whistleblowing is the act of raising concerns about suspicions uh or observed suspected or observed wrongdoing. So, it doesn't have to be that you have all the facts in the row, but you have a a good suspicion that wrongdoing um is being um perpetrated and you're raising that to pos people in position to do something about it. So a whistleblower is someone who exposes information or activity deemed to be illegal, unethical or incorrect in an within an organization. So who cares? Why do we want people to blow the whistle? Well, um as Alexander has mentioned, fraud and abuse are estimated to cost 58 to 84 billion in the US alone per year. World Health Organization estimates 500 billion per year is lost worldwide from corruption in the health sector. Whistleblowing um reporting by employees is the single most important way that we detect occupational fraud accounting for 40% of fraud cases detected. Occupational fraud being deliberate misuse or misappropriation of employee employer resources and assets for personal enrichment. And um the whistleblowing also helps to detect inadequate patient care which we're very concerned about. And finally, whistleblowing enables an organization to make systemic changes to their systems to prevent wrongdoing in the future. So a few things on the nuts and bolts of whistleblowing. A whistleblowing policy within an organization will determine uh who can be a whistleblower. Definitely employees and former employees are targeted. But uh sometimes and especially in health, it's important to open up whistleblowing to people like volunteers, interns, um patients and their families and also vendors or um suppliers working with the health organization. What types of things might someone want to report? As mentioned, it could be uh something that threatens the public interest. For example, an incompetent or an impaired um person working in the health care system, inadequate quality of care, a workplace bully, bullying and harassment, corruption, which um broadly is defined as the abuse of entrusted power for private gain and fraud. uh defined as intentional deception, concealment or misrepresentation of material facts to secure unfair or illegal unlawful gain. Um when as I mentioned you don't have to be entirely certain about the facts but should sincerely think that the continuation of this activity will uh harm the public interest. Sincere belief, not trying to get back at someone. So, um, if it turns out when it's investigated that it was not abuse, you won't be, uh, blamed for having reported it. But these are things that are spelled out usually in a whistleblowing policy. Often people try first to raise an issue internally with their supervisor, with the compliance office. Uh, sometimes that can work. Sometimes there's it's difficult because you're not sure who's involved or um or nothing may happen. And in that case, someone may decide to blow the whistle externally with a funding organization, with a regulator or other ways. Um, people may report before or after leaving an organization. And then how do you report? Each organization will have a policy about the uh whistleblowing channel or channels plural. There might be a an Mass, for example, Mass General Bighgam has a compliance hot helpline, a phone number that you can report ethical or legal violations through. Boston University uses a third-party managed whistleblowing system called Ethics Point. I don't know, maybe there are other hospitals or organizations that use the same company. Uh, confidentiality is very important. Whistleblowing platforms generally allow confidential reporting or promise confidential reporting, meaning you identify yourself as a as someone who's making the report, but that identifying information about the reporter is kept confidential. Anonymity, if if you're allowed to do anonymous reporting, your name is not given. And we'll come back to that later. The pros and cons of confidential versus anonymous whistleblowing. So the work that I did with the team, I do a lot of work. Uh I'm retired now from University of San Francisco, but I have my own company and through that I do consulting on transparency, accountability and anti-corruption, anti-fraud measures in health systems globally. And in 2022, I led a team that conducted this um scoping review of whistleblowing in health organizations focused on low and middle inome countries. And the idea was to better understand how those systems work to um prevent or reduce fraud and corruption. So the first thing we looked at was the types and the frequency of corruption reported through whistleblowing systems. And what we found that is in a lot of countries, people use that um whistleblowing portal for things other than fraud or corruption. They may uh report, of course, we want to hear about any kinds of issues of harming patient care, but they also report being unhappy because they didn't get a promotion or other personal grievances that might normally go to an HR office if it was um functional reports we found were increasing at multi-ateral organizations over time uh due to two reasons. First World Health Organization reported a lot more people um using whistleblowing mechanism during COVID but also because of outreach and information given like the global fund was trying to promote use of whistleblowing systems in the different countries where they were giving grants. uh the example of the um global alliance, the Gavi Alliance, um they did report that they their reporting had substantially increased. First they had like three reports per year from 2013 to 2020 and then in 2020 or 2021 they got uh 67 reports. Now, when the the reports come in, an office has the responsibility to investigate them. 16 were found to have merit. The ones that weren't found to have merit were ones they said were either misdirected, like those HR complaints that should have gone to someone else or reflected antivaxer sentiment or just were nonsubstant substantive. Um the ones that were found to have merit were mainly related to vaccine equity that uh the gave fund was not following their own policies and procedures regarding who had access who were the priorities for receiving the vaccines when they came out. And over time as uh more supply was available these complaints decreased and they had made some changes to the system. This is a second slide I wanted to show about World Health Organization receiving complaints through their hotline. They received in uh 11 months in 2020, it's almost a year of data. Uh they received 276 reports from staff and from the general public and they were 18% were analyzed to be and found to be violations of codes of ethics or professional conduct and conflicts of interest that were undeclared. About 9% were HR issues, breaches of staff roles and rules and regulations. Um 8% were suspected fraud, corruption or bribery. 4% were abuse of authority and that included harassment and about uh 58% so the majority were concerned sounding the alarm about the danger to public health and personal safety uh due to co 19 pandemic. So a lot about lack of access to PPE. Unfortunately, we don't know whether these investigations were completed and what were the outcomes of the investigations. This is a gap in understanding how um whistleblowing policies are are implemented factors. Another thing we looked at was the factors that influence whistleblowing and we found really four main factors. One is the possibility of financial reward and Maya will talk a little more about that. We learned that financial incentives are operating or have operated in the US, India, China, and the Republic of Korea. Earlier um last this month, I learned about a whistleblowing system that has financial rewards being set up in Usbekiststan. Appeal to duty is more prevalent in multilateral organizations that that don't offer uh financial rewards but uh appeal to people's responsibility as a um employee to it's their duty to report and same with nursing profession. Um a lot of emphasis on professional values that um make it a responsibility to report wrongdoing. multiple channels for whistleblowing very important in low and middle inome countries people had set up systems that were based on web providing a report through a website or through a telephone but in Albania they found people really wanted to come in and talk personally they didn't they didn't use those other mechanisms they wanted that personal touch uh so looking at that is important and finally uh confidentiality ity and whistleblowing protection is really critical. Um, some people might be too afraid to report even with confidentiality just because they don't believe that confidentiality can really be um promised. But and PE some whistleblowing mechanisms are only confidential reporting. They don't allow anonymous because they want to be able to prosecute based on the report. But there are values to having anonymous whistleblowing even in instead of confidential. Um someone not giving their name at all can still if there are enough complaints and they have enough details you could target some internal control activities or even an audit uh based on an anonymous complaint. or um people might be able to make system improvements to reduce the possibility of corruption based on anonymous information. So there is value to having anonymous reports even though you can't prosecute based on them. Retaliation critical problem with whistleblowing. Um more than half of whistleblowers said they faced retaliation. The UN defines retaliation as any direct or indirect detrimental action that aver adversely affects the employment or working conditions of an individual such as um where those kinds of actions were threatened or taken for the purposes of punishing, intimidating or injuring an individual as a result of them that individual reporting misconduct. And our study found many as you can see many types of retaliation uh demotion pressure to quit uh loss of job changed responsibilities stalled career progression and at the extreme being referred as to psychiatric treatment. You must be crazy if you think this is happening. Um referred to as a traitor or even personal harm and death. two um medical chiefs in Utar Pradesh stayed in India in 2012 were murdered as they raised concerns about alleged corruption in a rural health program. So this is very critical and it's why we try to have legal um protections for whistleblowers. very important health policy topic and legal issue and the laws have to provide strong protection of confidentiality and repercussions for having um retaliated. So if there's documented retaliation, there should be some kind of punishment. also should be a system in place to to in um investigate claims that you've been retal that a whistleblower has been retaliated against. Um there could also be support fi financial but also psychological to whistleblowers. This is a very difficult thing to do to blow the whistle and they need some support. There are international treaties um again for that that have agreed to have protection against um protection of confidentiality and protection against retaliation. But an analysis of UN member states showed that just under half had put in place um laws that ensure freedom from retaliation and that have full protection of confidentiality. So there's a ways to go. Country context can be important to consider. Uh working globally on policies and laws. There isn't one sizefits-all. Endemic how endemic corruption is, how prevalent corruption is in the health sector is an important factor. Um prevalence of violence as a retaliation danger should be considered. and the value that in a country is placed on personal relationships and reciprocity and how things get done. This especially in China and I saw it in my work in the Philippines that um people there's a negative perception of whistleblowers as um not being loyal to the community if they're stepping out. So these we need to have tailored interventions to change social norms a bit around whistleblowing in some countries. The final thing that we looked at in our research was the impacts of whistleblowing. Could we document um things there in terms of the consequences? We showed a lot of we saw a lot of evidence of um retaliation but not a lot of evidence of the positive effects of whistleblowing and that may be because we um excluded news reports. We were mainly looking for more thoroughly studied um articles, reflective articles, academic articles maybe because it's not appearing in that literature but we need to try and document the positive effects that whistleblowing where it can be um can happen and we have some of that that Maya will talk about in the US and to conclude whistleblowing systems design and functioning really depends depends on a lot of factors, personal, organizational and contextual factors, and that includes leadership. There's not a lot of implementation research on whistleblowing, and I think we should support such research to determine the best ways to promote whistleblowing while also protecting whistleblowers from retaliation. And finally, legal and social supports are really needed for whistleblowers. This can be a very difficult thing to do, but it's a common good for society. And we should think about how to share the cost of protecting whistleblowers who choose to call out wrongdoing in the interests of protecting the public. I have uh some teaching cases on whistleblowing and we can share at least this slide uh after the workshop so that people or I can put the link into the chat so that people if you're teaching whistleblowing these are some cases I've developed that I'm happy to share and also selective references if people want to read more. So thank you Alexander back to you. >> Great. Thank you so much. Mai, do you want to go next? >> All right. I hope that's now visible to everybody. Um, I'm going to build on what Taran has just presented and so you'll see some things overlap and some things build off of it in a way that I hope sparks ideas and conversation and we're more than happy to answer questions at the end as well. Um, I will talk about some notable and some less well-known healthcare whistleblower cases. The goal there is to see how individuals can stand up, how um whistleblowing shows moral courage. It's a way of speaking truth to power. And I'm also going to talk about some key laws that protect whistleblowers in the US as a way of understanding what kind of protections do whistleblowers have in various scenarios. And if we do have time at the end, I have one current example of a legal challenge um that I think is really interesting and very on point. Um, Taran's already talked about who is a whistleblower. And so what I want to do is focus on uh what is a whistleblower in the eyes of US law. Um, there's no single law that protects whistleblowers in the US. It's a patchwork of laws, but uh the primary ones define a whistleblower uh with a few key pieces that Taran has already mentioned, but I think is important for someone to think about. Um, two key points. The first being that whistleblowers typically tend to be current and former employees and they have direct credible evidence. They tend to become aware of it while they're on the job. As Turn mentioned, that might not be literally their job. Maybe it's a volunteer in this current context. Um, but that is the way that most whistleblowers tend to first come across their information. Um, the second that's quite important with US law is that the concerns are serious. um the disclosure tends to promote legal compliance or protects the public interest. If it doesn't do so, that disclosure of a whistleblower does not actually rise to the standard of quote unquote whistleblowing that's protected under the WPA and most other US whistleblower protection laws. Um there's one additional piece here that I want to mention because I think it's particularly relevant in a bioeththics space. It's duty speech that's raised in the course of doing one's job. Um it is protected but it requires something additional. Um under the WPA that requires retaliation and what that does is it shifts the burden onto the whistleblower to prove a level of animus. Um, so for all other disclosures under the whistleblower protection act, just having a causal link between doing a protected disclosure and a personnel action, some sort of retaliation, means that the whistleblower's rights have been violated. Um, for duty speech, uh, the the retaliator, the employer can can just say there's a business reason for the decision, and that eliminates the whistleblowers protections under current US law. Um, I'm going to discuss those laws a little further in detail, excuse me, later, but I first wanted us to just look at what whistleblowers look like uh, recently in this space. So, I've excuse me, I've pulled up a number of examples and I'm not going to go through them all just in the interest of time. Um, but I want to show them to folks. You know, you can see that some whistleblowers in the past year have exposed information to Congress about medical contractors, have um shown over prescription of hormones to children. Um you'll see uh private companies here uh that are committing fraud against the federal government, right? So that is a key line that is very common that you'll see in many of these cases. Um you see leaders in organizations like Rick Wright and you also just see individuals who are working at various facilities um that come across information of fraud, waste and abuse and decide to speak up. Um you know some of these are wellknown uh the case in the middle there with Erica Chung um was Therronos was obviously very widely spoken about in the media. Um, and then you also have ones more in the past, you know, with the painkiller Vio that had very serious side effects, um, with information being covered up by the FDA. I want to give one final example that I hope folks have already heard about in their lives, um, at least if you are in the US. U, but I think folks sometimes don't think about the role of whistleblowers um, in them. So the first is with the Tuskegee syphilis study and the second is with the Stanford prison experiment. Um both of those situations of you know pretty vile um bioethical violations were first disclosed by whistleblowers and in one of those cases worked that whistleblower had to work really hard to um disclose the information make it public um ensure that it was being covered by the media and they also led to really serious changes and significant changes in the way that the US does business um for example with institutional review boards. Um, so I want to just bring us to the present here and talk about what does whistleblowing look like in 2026 in this area. So I gave a number of examples here and I think it really reflects what the healthcare bioeththics space needs and requires. Right? You've got examples such as, you know, decreasing the role or disregarding evidence for scientific advisory committees, censoring scientific research, limiting the public's ability to access information. One of the trend lines here that I often see and I think folks will identify is that transparency is incredibly important on the issue of whistleblowing. And that's, you know, an overarching goal and tactic and rationale and reason why we want whistleblowers um to have the ability to speak up. Uh and that leads us to something that Taran has already covered in part uh but I want to bring it to US law. You know, retaliation is incredibly common for whistleblowers to experience. And what does that look like? So under US law, the office of special counsel, uh this is not the special counselss that you might have seen in the news. This is an office of special counsel. Um investigates violations of prohibited personnel practices. Um these are specific examples essentially of employment related activities that are banned uh in the federal workforce. Retaliation, improper hiring practices, failure to adhere to laws, rules, and regulations. And the reason that Congress put these laws into place is because it undermines the merit system, right? It undermines the ability of this kind of good governance best practice to function. And a lot of those were actually already given as examples by Terran, so I'm not going to repeat them. Um, I'm going to spend a little time right now talking about the various laws, key laws that can protect whistleblowers in this space. Uh, the first is the False Claims Act. It's probably the one that I think is most widely known um by regular average Americans um maybe not in its name but in its function. You know, it's really a primary tool for fighting fraud um because it allows individuals to serve in this role and to sue on kind of on behalf of the government but to sue in themselves. Um hospitals, drug companies for example for defrauding government programs. Um the way that it works, the incentive here is that the whistleblower once uh the government has recouped those funds, the recovered funds, the whistleblower receives an award that is a percentage of that amount. So that can be quite high. Um there is some restrictions to it and some process to it. It can often take many years. Um but it's a way of ensuring that the US government can both prosecute fraud and also get the fraud money back to the extent possible. Um it's definitely a key law that Government Accounting Accountability Project which I work for uses to protect and defend whistleblowers. And in these examples, I've also given some examples of real life cases um where whistleblowers stepped forward, used those laws and in many cases were successful in doing so. Um another key law is under um occupational safety. Um it's really important that workers are able to report unsafe conditions and know that they're going to be free from retaliation if you know they rely on that job um to have their own livelihood. um government accountability project was involved in the expansion of the law in 2023 and I've given an example of a community health center here um which I think is an interesting one because of the accusations that the whistleblower faced after they spoke up you can see this kind of retaliation to undermine her and the end which was that a the resolution was that the whistleblower received a settlement so we see that quite often um in these situations as well and that's obvious That's often a success for whistleblowers. They get to close the case. They get restitution for what they went through. And so we don't see that as a failure just because it wasn't a court decision at the end or a jury decision. Um, another one is HIPPA that I think folks in the medical space are incredibly familiar with. It does have a set of standards um for whistleblowing and whistleblowing safe harbor. it's managed by HHS and I've given an example on that but I'm not going to go too deep into it today. Um similarly the Affordable Care Act also has a section uh that protects employees who blow the whistle and we've seen some examples um of whistleblowing in that but frankly not very many and very very rarely do we see it be successful as a way for whistleblowers to see protections after they've blown the whistle. So that's those kind of things are something to be aware of and I wanted to make sure to highlight them today. And last but certainly not least is FOYA. Um folks in the US are probably I hope familiar with FOYA. FOYA is a transparency law. Um but it's usually not the first thing that you think of when it comes to healthcare and bioeththics. Um because of the patient patient privacy issues that it comes with. Um it's a really crucial way that advocates such advocates such as myself use um to bring information both for our advocacy purposes as well as in the public sphere. Um but it's got some some serious limitations. Um one the realities of the health care space. Um two is that it's limited. There's no ability to foyer a corporation. You can foyer a government. Um and there are some additional limitations on access to information where the US in particular has has started to fall behind in comparison to other countries around the world. Um and the information asked for needs to be fairly specific too. So there's a number of functional issues with using FI FOYA, but I still think it's it's pretty key law when we think about transparency and and sunshine. Um I'm not going to go too much for the sake of time here today about current efforts but I just did want to um offer it so it'll be available later. Um I want to talk about utilizing sublower laws in the US and there's a number of ways of doing it. you know, non nonprofit organizations like the one I work for have published reports and guides um that can help walk individuals through what their rights could be and serve as, you know, kind of like a research starting point or a steps situation. There's US federal government reporting channels like the DOJ one that I've taken a picture of and put here. And then there's law firms and attorneys um many of which actually specialize specifically in this issue area and they know those laws as Taran mentioned anonymity, confidentiality, retaliation protection. Um those all vary in the US so it's fairly important for most whistleblowers to have that advocacy with them. Um because my work is legislative and congressional affairs, I hope folks don't mind. I'm going to take a minute to really shine a spotlight on the US Congress. Um, on a practical level, whistleblowers have a number of ways to use Congress, come to Congress, um, involve Congress in their cases. Many times, of course, not always. The first, uh, piece of the puzzle here is Congress's investigative and oversight powers directly from Article One of the Constitution. Right? Congress doesn't just exist to pass laws. Congressional disclosures are protected under the Whistleblower Protection Act. um they require two things, the reasonable belief of wrongdoing and a disclosure to an authorized person or entity. So that obviously doesn't mean just sending a letter and addressing it to US Congress. And that doesn't mean also disclosing to any staff member. Um in many cases there is going to be an authorized person, authorized committee um that the disclosure goes to. And again, Congress doesn't just pass laws, reports and studies, letters, committee hearings, subpoenas. These are all mechanisms that Congress has in its toolbox. The most important mechanism that I think folks sometimes forget is the bully pulpit. Members of Congress in their own role as a member, as a leader of a committee, um, can use their bully pulpit, their ability to speak out, to write letters to the editors, to speak about an issue, to write letters to companies, uh, to shine a spotlight. And we've really seen a lot of examples where whistleblowers suddenly see that they get the protections that they deserve under the law um because there's a additional eyes, right? And then someone says, "Okay, we've got to do this correctly or at least more correctly than they have been." Uh the last piece that I will highlight here is the House Office of the Whistleblower Ombods. It's actually an office that exists to serve as a resource for congressional staff when whistleblowers come to them. Um, so its mandate doesn't include uh working directly with whistleblowers. But one thing that it has done as part of its work and as part of its mandate is to put out best practices in a number of different issue area spaces. One of which is healthcare whistleblowing. Um, so I've put the link and a picture here for folks to see. So, we've been a really incredible resource the last few years of having this office and being able to know and see that congressional staff, which also have a lot of turnover, um, are getting additional training. And so, there's more and more likely to be someone in a congressional office who knows what are the best practices, how do I ensure confidentiality and anonymity, how do I work to not screw up this whistleblower and put them at risk for further retaliation? Um, so that's really been a large step forward in how Congress can work with whistleblowers and make sure that that information can become public or at least come to Congress for them to then be able to use it for their own investigations and their own oversight work. Um, we've talked about Congress. There's of course also the media, reporters, public interest organizations, um of course government agencies with investigatory or regulatory authority. And I want to come back to something that Taran spoke about in one of her first slides. Um which is what is the goal of this whistleblower. You know in individual cases I think we can think about anonymity and confidentiality and then some whistleblowers are very motivated because of financial awards. So the different reasons for motivation often play a role in us as whistleblower advocates thinking about how we want to support a whistleblower and what makes the most sense for them and for their situation moving forward. Um there's some current threats in this space. Um in the interest of time I'm going to skip this one and I'm going to give an example that I think is a really interesting one um that we're seeing right now in the US. Um the FEMA 14 uh the Federal Emergency Management Agency, FEMA, has a fairly broad mandate mandate um on disaster work. Uh about a year ago, uh it began experiencing mass layoffs and many programs, many contracts were cancelled, research was halted as part of that layoff program. Um, in August of last year, almost 200 FEMA employees signed a letter and that was sent to Congress and it identified issues of gross waste and mismanagement, abuse of authority, and it was a way for them to report and to disclose to Congress, which as I said has this oversight investigative authority from our constitution, um, about what was happening. 30 of those employees uh, signed their names. The rest were anonymous. And what those employees saw was immediate retaliation within just a single day. Uh FEMA management placed those who signed on indefinite administrative leave. They were forbidden from entering their offices, obviously halting their ability to do their work. And there were retalatory investigations of those who signed uh launched really immediately and also of those who were suspected of signing even though they were anonymous or they could be anonymous if they were the ones who signed. Um so really a full scope of retaliation very immediately. um Government Accountability Project filed a suit on behalf of 14 of those FEMA whistleblowers um to protect their whistleblower rights and their first amendment rights in the US. Um you can see what the FEMA's own legal council concluded uh last November the WPA and the First Amendment rights um were relevant here and were violated and need to be protected. Um unfortunately the employees were reinstated and then quickly uh that reinstatement was cancelled in addition retaliation. Um we also saw some action from Congress. We had members of congressional committee speak up about it um right to the office of special counsel um do a field hearing uh where they uh had one of the FEMA 14s speak up and I've included some links to public reporting on the issue. Um, so I think that is where my presentation ends today. More than happy to answer any questions with Taran and I hope you all have found this interesting so far. Thank you so much Maya and Taran. Those were incredibly insightful and thoughtprovoking presentations. Um, please use the Q&A feature if you have any questions. We've only had two or three questions so far. I do have plenty of questions myself, so I'm sure I can carry us just myself for the next 15 minutes. Um, one theme that seemed to come through across both talks is that whistleblowing can be incredibly valued at identifying individual cases of fraud and wrongdoing, but possibly less effective at driving broader structural change. So, I was curious what's needed to translate those individual cases into more meaningful system level reform or is that not even necessarily the goal of whistleblowing? Yeah, I think that uh what we ultimately want is to detect wrongdoing. So it is meant to uncover wrongdoing and that could lead to two things. It could lead to prosecution or rep repercussions for the wrongdoer, but it also should lead to double loop learning. We're not just interested in the case, but we're interested in why the case happened and things that the organization can do to um prevent that from happening in in the future. And I do think that uh you know there was a a case involving um a medical device manufacturer where they made their their salespeople were bribing. And when this came out, they the company realized that they had put a lot of pressure on the salespeople to achieve goals without having adequate resources. And so they looked at the systematic drivers of why people were bribing. Not just punishing the people who bribed, but in fact they they gave anonymity to or they gave amnesty to people who would who would come forward and talk about the wrongdoing they did. so that they could make bigger changes in the organization. So, I think both are goals. >> You know, I I think that's interesting, Taran. Right. And that's a really great example of a company that that sees it in their interest to make those changes. Um, another thing that the organization I work for, Government Accountability Project, has seen is that some cases of whistleblower, some some examples of whistleblowing can be really good drivers uh to new policy, whether that's regulatory or through Congress. Um, many times I found that members of Congress, their offices, their staff want examples. They want the real life, you know, why does this thing matter? And also having that example if it's having a whistleblower who is willing to talk to the staff members to say this is what I experienced or even having a collection of whistleblowers and having an organization that says you know here is what we have seen over the decades with thousands of whistleblowers can serve as a motivator for you know those oversight hearings for legislation for incorporating the lessons learned from whistleblowers into new law. uh many of the US laws are built off the backs of whistleblowers who stepped forward, who experienced retaliation, who found the gaps and once those gaps were identified, when there's, you know, movement in Congress that can become law and future whistleblowers don't have to go through the same thing or have additional protection. Um so when they step forward, they're not risking their livelihoods as much and their lives um in the same way as they did in the past. Um that is a is a massive goal I think at at least in the US and I think around the world that most people can agree is a positive. We want to be able to learn um from instances of whistleblowing. We want to be able to you know learn from instances of you know bioeththics violations like some of the examples I showed before. Um and create a better a better space better norms. Um and those norms have to be driven or can be very much helped by being driven um by laws that that actually protect folks and require certain things. Um so I think that's that's an important piece of the puzzle as well. Um many organizations um government accountability included engage in what we think of as impact litigation. So, our practicing attorneys will take cases that we see as having really widespread implications that say something about policy um and kind of build that into a a broader campaign of why things should change, why protection should be had, etc. >> Thank you. And then switching gears a bit, there were a couple questions about the politicization of whistleblowing and the use of the false claims act in a more politically contested areas like DEI or gender affirming care. Does that change how we should think about whistleblowing? And more broadly, how should we think about the weaponization of whistleblowing, including its use against marginalized groups? >> You know, uh, whistleblowing in the US, uh, was something that came up during the founding father's time. It's been around for a long time. Um, there was a instance of whistleblowing, I think, in in the Confederate army. Um, so whistleblowing has long been a bipartisan goal, crosspartisan, nonpartisan, whatever you want to call it. Um, we have seen, you know, in the last years, um, more polarization in how folks think about a whistleblower, um, whether that whistleblower happens to to talk about an issue that that is important to them, um, or aligns with their goals. for us as an organization um whistleblowers deserve protections and they deserve identification as a whistleblower um across the board and that's really important. I think instances where whistleblowers are undermined um is very hard to see and the implication of that of course is you know a potential um minimization or or retrenchment of whistleblower protection laws which is really deeply concerning. Um so making sure that whistleblower champions on Capitol Hill um whistleblower advocates in Washington DC, across the US, internationally as well of course um are continuing to uplift whistleblowers and acknowledge what they've put on the line in order to speak truth um is really important. >> Um and then there was a question related to incentives uh and whistleblowing. So it seems with the false claims act uh the US has placed certain some strong financial incentives on whistleblowing. Um how well do these incentives work and there are there gaps when the harm is primarily to patients scientific integrity or public health rather than government spending and how should we think about you know incentives more broadly when it comes to whistleblowing. Taran, I'm wondering if you want to speak to your research that that found how incentives can push people to come forward or you want me to take it? >> I think um if you could take it, it'd be good. I'm I'm not sure I I'm Are we looking for more than a financial award or I'm not quite sure I understood the question. So, so it seems like a lot of well the false claims act was about recovery for the government but there are a lot of different avenues for which whistleblowers uh reveal very important information related to like patient safety and you know a lot of different areas where there it's not necessarily tied to recovery of money. So are there ways we could more incentivize those forms of whistleblowing? Yeah, definitely. And I I think what the literature has showed is that leadership in the organization is very important and leadership in the profession. So um we s we saw in the multilateral organizations and in nursing that there are powerful professional um professionalization norms that say you see something that's wrong. It's it's really important that you talk about it and a leader can make this clear as well and being able to talk about these things and not shy away from it because we want to pretend. I mean, the US makes a return on investment of five to eight dollars per $1 spent in fraud investigations and fraud trying to detect and uh recover from fraud. So, they make money on it more more than they're spending, but US doesn't want to invest in it because they're ashamed that they have fraud because if you investigate fraud and you find it, that's a bad thing. And I think it that's where leaders don't want to talk about it. They don't want to acknowledge it because they don't want to have a reputational hit by having corruption. But but I do think we do things because leaders make it possible for us to do things. So I think this is a way where people could, you know, make it clear that there's a mechanism, let everybody know about the mechanism. I mean, my students tried a whistleblowing portal in one organization and found that it wasn't working and they were able to they just dialed the number just to see what it would be like to, you know, what was going to happen when they called and it was out of order. Nobody knew that on the staff, you know. So, they you want to make sure these systems really work and, you know, talk to people. If there aren't lots of reports, then maybe this system isn't working or there's no reporting at all happening, you know, let's find out what's going on. >> Yeah, I I think that's something I've seen as well. Um this idea of well, there's not that many reports, so everything must be, you know, flowing swimmingly. Um and that's not necessarily the case, right? It could mean that whistleblowers don't feel that they can step forward and say, "Hey, I'm seeing something." Um maybe concerns raised to supervisors are being shut down. You know, retaliation protections are incredibly important because I think most people will think to themselves, well, I see this information. I came across it. It's not good. I don't know what to do. Someone's lives are at risk. You know, safety is at risk. Um and they also have, you know, in most cases, um you know, well, I need to have my job. I need to have my livelihood. what will happen if I'm blacklisted from my industry um after I do this, after I step forward and say something about it. Um so that cultural context is incredibly important and raising a culture where whistleblowers are respected and honored is really important. Um every year July 30th, whistleblower advocacy organizations and whistleblowers celebrate National Whistleblower Day. It's not a federal holiday in the US, but we still celebrate it. And one of the things that we've heard from whistleblowers is just being in a room where I'm being respected and I'm being honored. I'm being said told, you know, this is a really good thing what you did. It was brave. It was helpful. Um, it saved lives. It made our community better. Um, it's really important to them. And it's also, I think, turn it sounds like also really important for future whistleblowers to know, well, this is how whistleblowers are treated. Um, so if I come across fraud, waste, and abuse, I can step forward and be treated like that and not terribly. >> Great. Bringing off that, you have both discussed how country context and culture shape whistleblowing. Are there examples where shifts whether it's in norms, protections or institutions uh have that have made whistleblowing more effective? Um, and what drove uh drove those changes? Well, and it doesn't even have to be countrywide. It could be within, you know, organizations. >> Well, I I can think of I uh it was very helpful for the global fund. They publicized when they had an incident of corruption and they I mean it really was a small amount compared to how the billions that they give. It was a small amount that was affected but they they followed through and they made sure that um there were repercussions for the country and uh for the people who had engaged in the fraud and after that they created various portals and one was through the global fund itself but also for through watchdog organizations if people don't feel comfortable go complaining to the independent um inspector general in an organization, they can go to this NGO that will then feed those complaints to the organization. Um but they they did have success because they were transparent in publishing reports. They have the best reports of their fraud investigations, you know, lots of good detail. They're putting it out there and then they're following up and having rep, you know, having um repercussions for for the act of the fraud, not just letting it go because, oh, we got to work with these people, so let's just sweep it under the rug. And I think that made a difference also having the resources for people and repeating the education. I think it's it's it's not one and done. You don't just tell people uh even having an ombbudz in an organization or an integrity line that's not whistleblowing but you just have a you have a dilemma and you want to talk to someone about it. I mean having these kind of resources for people who may or may not end up blowing the whistle but who want to explore something that's really important to give them help. >> Great. I think we have time for one more question. Um it's uh my you mentioned the federal court case which represents a major potentially existential threat to whistleblowing at least the false claims act under the false claims act. Um and it it seems like whistleblowing has traditionally been seen as a bipartisan tool for uh exposing fraud and and misconduct and really protecting public resources. Do you think the polit the politics around whistleblowing are shifting and how do we ensure the uh future longevity and sustainability of whistleblowing? >> Yeah. Um you know I appreciate the question. I think that whistleblowing remains a really strongly championed issue by people across different political persuasions with different viewpoints on other things. I know that when we do whistleblower advocacy in DC, in the US, um we have an international program as well at our organization. I know how many different people we work with, how many different types of organizations, and we really see championship of whistleblower protection laws from very high up members of Congress and senators um across the board. So I am really optimistic that whistleblower has been remains um a really powerful tool that has acknowledgment of that and that uh whistleblowers continue to be honored and respected. Uh that takes continued education, right? As Taran just said, you know, staff at various organizations need continuing training and education and so does the public. So do advocates. Um so that goes across the board. Um, and I actually see a future where whistleblowing continues to be really highly respected, acknowledged for being incredibly important. Um, and that framework is is one tool, but a really important tool um, for how we want how we want to fight fraud. >> I think that's a great positive note to end on. Leah, do you want to take it from here? >> Yes. Thank you. And thank you to for you to you for this wonderful conversation. And I want to thank the hosts of this webinar uh the Petri Flom Center the center for bioeththics and the program on regulation therapeutics and law and my co-convener Erin Kessleheim. And so thank you uh Dr. Van Ephi man for for leading us through this discussion today and providing resources like what what it is that we can do as individuals. Um and thank you to everyone who joined us this afternoon and we will see you next year.