Health care, at least in this country, has been based on fear for a long, long time.

In the 1940's and early 50's, it was polio. Nobody had a clue as to how it could be avoided, but every summer, every kid was just waiting to get hit.

In the 50's and 60's, it was the big heart attack. The docs didn't do much about prevention, and couldn't do a whole lot if the attack were really bad. Even if it wasn't too terrible an "MI," you would probably die within a year.

By the late 70's, the focus seemed to shift to the big C--Cancer. This disease has been with us for eons, but it was now consuming our attention to a greater extent. Since the 70's ushered in the notion of gender equality, we had our his and hers matching cancers: prostate and breast. And, just to make sure that there was plenty of guilt and fear to go around, we had our sin cancers--lung, colon, and stomach, caused either by smoking or by eating the wrong foods

In the 90's, the fear has spread to the docs, as well. Beaten down by the government and the insurance companies, they're striking back. But this time, it's positive.

These individuals, who often risk their livelihood and reputation to expose wrongdoing, are empowered by a 135-year-old federal law known as the False Claims Act. The legislation -- amended in 1986 to expand protections for many whistle-blowers -- now provides legal recourse against retaliation as well as the powerful incentive of a qui tam settlement, a cut of which goes to the whistle-blower. (Qui tam comes from a longer Latin phrase translated as "Who sues on behalf of the King, as well as for himself.")

Armed with such protection, health care workers ranging from doctors to billing clerks are blowing the lid off a panoply of fraud and abuse, with staggering results. Since 1987, the number of qui tam cases filed annually has risen from 33 to 530. During that time the Justice Department has recovered $1.8 billion in health care fraud settlements. Last year alone, prosecutors secured more than $625 million stemming from false claims in Medicare and other federal programs.

A recent issue of Hippocrates magazine details a few examples.

UNNECESSARY SURGERY

Dr. Paul Michelson was one of the first doctors to file an amended False Claims Act case. In 1986, as head of the Scripps Clinic ophthalmology department in La Jolla, California, he became convinced that a fellow doctor at the clinic was performing unneeded laser surgery on glaucoma patients. Puzzled by the volume of surgery Raymond Chan performed, Dr. Michelson confronted his colleague, who brushed him off. He then reviewed Dr. Chan's case records and concluded that he was not only doing unwarranted laser surgery but in many cases overbilling for it.

His suspicions were confirmed when Dr. Chan's secretary suggested that Dr. Michelson, too, could make more money if -- like his colleague -- he billed simple laser procedures as invasive surgery. Dr. Michelson says he took his findings to Scripps administrators but that they, too, ignored him. They later declared Dr. Michelson "incompatible" with the clinic and refused to renew his contract.

Dr. Michelson didn't suffer professionally: He received privileges at another hospital and opened a private practice. And he was vindicated in 1990, when the defendants agreed to settlements -- $355,000 in fines and $100,000 in attorney's fees for the clinic, and $250,000 in fines and $75,000 in fees for Dr. Chan.

Dr. Michelson received $50,000 of the settlement. He promptly gave the money to nonprofits, including Taxpayers Against Fraud (the public interest group that helped him file the suit), and to his alma mater, Johns Hopkins, to help establish a medical ethics program.

BILLING FRAUD

Andrew Hendricks was fresh out of a three-year residency in dermatology and looking for a place to practice, when an interested group in New Jersey invited him to spend a day in its office. While there, Dr. Hendricks was surprised to see many patients getting a Grenz ray treatment whether they appeared to need it or not. Worse, even though the machine made a lot of noise, nothing was registering on the meters. When he broached the subject, one of the doctors shrugged him off. "Oh, we just do that as a placebo," he was told.

But the patients were being charged a hefty fee for the procedure. Troubled, Dr. Hendricks spoke with a number of established outside dermatologists; none of them could tell him where to report his suspicions. Still, it was clear he couldn't work there. He turned down a lucrative offer from the group and set up his own practice in North Carolina.

Fifteen years later Dr. Hendricks found himself confronted with another ethical dilemma: The lab handling the blood work from his practice appeared to be tacking on unnecessary tests and charging for them.

He went to see Neil V. Getnick, a False Claims Act attorney. The scam was simple, Dr. Hendricks explained. Every time he ordered a single cholesterol or thyroid test, Roche Biomedical Laboratories would do an entire panel of tests -- HDL, LDL, and so on in addition to a cholesterol count, for example. The lab rep assured Dr. Hendricks he was getting a bargain, that it was just as easy to do six tests for the price of one. But when his patients showed him their Medicare bills, Dr. Hendricks found the government was indeed being charged full freight.

"It appeared right from the outset that this was a very serious case," says Getnick, who told Dr. Hendricks to gather proof. The physician willingly turned detective, collecting detailed Medicare bills from his patients and visiting the lab, where he could see that the multiple testing was complex and deliberate, not the all-in-one deal he had been led to believe.

Dr. Hendricks and Getnick filed a qui tam suit in 1993 against Roche, which subsequently merged with National Health Laboratories and Allied Clinical Laboratories to form the Laboratory Corporation of America. In 1996 LabCorp agreed to a $182 million settlement, plus another $5 million in fines. Dr. Hendricks's share of the settlement was $9 million. "For a while I was afraid the lab might retaliate by claiming I wasn't ordering the right tests and report me to the government, trying to use the things we were doing against me," says Dr. Hendricks.

But there was no retaliation. Dr. Hendricks, 50, emerged not only unscathed but with the resources to fund the New Netherland Museum, a pet historical project, and establish his own medical fraud hotline (800/245-7154).

There are those who would say that Hendricks and Michelson won the lottery, so to speak, by ratting on their colleagues. Maybe so, but at least they were rewarded for doing the right thing--and that's mighty rare these days.