Who is a whistle blower in health care fraud contexts?

• A. A patient who notices billing errors but does not report them.
• B. A health care employee with inside knowledge of wrongdoing who reports it.
• C. A third-party vendor who audits claims.
• D. A regulator who enforces fraud laws.

Answer: (B)

A whistleblower in health care fraud contexts is someone who has inside knowledge of wrongdoing and reports it to the appropriate authorities. In practice, this is typically a health care employee who witnesses fraud—such as improper billing or kickbacks—and comes forward to expose it. The insider access and the act of reporting to authorities define the role, and protections or incentives like those under the False Claims Act support such reporting. A patient who notices billing errors but doesn’t report them isn’t a whistleblower, a third-party vendor that merely audits claims isn’t inherently one unless they report misconduct, and a regulator is an enforcer, not a whistleblower.