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A task force to help combat health care fraud involving programs intended to help Veterans was announced in October 2019.  The U.S. Department of Justice and the Office of Inspector General of the U.S. Department of Veterans Affairs are undertaking a joint effort to focus attention on the increasing harm to the financial viability of its Veterans’ health care programs.

Veterans are entitled to health care services under a program called the Community Care program, which offers fee-for-service care.  It allows non-VA health care providers in the Veteran’s community to provide health care services to the Veteran and, in turn, submit claims for payment to the VA.  Under this program, Veterans who do not have access to care at a VA facility, may be entitled to care through a nearby community provider (a doctor’s office).  To be eligible, the Veteran must meet special eligibility requirements.  In addition to this unique program, the VA also provides other health care options for the families of Veterans through programs like the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).

The authors of this blog are former prosecutors who now represent whistleblowers: Renée Brooker (former Assistant Director for Civil Frauds) reneebrooker@finchmccranie.com (202) 288-1295 and Eva Gunasekera (former Senior Counsel for Health Care Fraud) eva@finchmccranie.com

The Department of Justice needs whistleblowers to report fraud involving any federal or state government programs or contracts, including Medicare and Medicaid, as well as government spend on non-health care dollars.

Guidance is available for how to blow the whistle on your employer.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrong-doing.  Bottom line:  don’t wait and don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The authors of this blog are former prosecutors who now represent whistleblowers / Renée Brooker (former Assistant Director for Civil Frauds) reneebrooker@finchmccranie.com (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud) eva@finchmccranie.com.

Whistleblowers who report federal or state grant or contract fraud help the Department of Justice’s enforcement efforts and may be entitled to a reward under the False Claims Act.

An article published on March 24, 2019, by Harry Littman, noted that “It takes guts for whistleblowers to come forward. Protect them.”  There are protections for whistleblowers under the False Claims Act.  Reaching out to an experienced former prosecutor who represents whistleblowers for a free consultation is a good first step to understanding your rights as a whistleblower.

Guidance is available for how to blow the whistle on your employer.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrong-doing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The Department of Justice needs whistleblowers to report fraud involving kickbacks or off-label drug marketing, which can lead to patient harm.  As one example, Abbott Laboratories and AbbieVie Inc. paid $25 million for allegations that it paid kickbacks to prescribers of the drug TriCor and unlawfully marketed the drug for off-label uses.  The whistleblower, a former Abbott sale representative, received $6.5 million as her share of the recovery in the case.  The United States Attorney described how the case was not possible without a whistleblower putting the Government onto the fraud:  “We thank [the whistleblower] for coming forward and providing essential assistance to the government.  Preserving government program funds would be far more difficult without [whistleblowers] who are willing to shine a spotlight on alleged illegal practices like the ones involved in this case.  [The whistleblower’s] efforts, and those of her attorneys, were critical to our favorable resolution of this case.”

Guidance is available for how to blow the whistle on your employer.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrong-doing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The authors are former prosecutors who now represent whistleblowers / Renée Brooker (former Assistant Director for Civil Frauds) reneebrooker@finchmccranie.com (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud) eva@finchmccranie.com.

The Department of Justice needs whistleblowers to report fraud involving drug pricing overbilling in the Medicare, Medicaid, TRICARE and FEHB programs.  There are potential rewards and protections for whistleblowers who have evidence of false claims against the Government.

In declining to dismiss a whistleblower’s lawsuit against Rite Aid for alleged drug overbilling, the court laid out the basis for its decision that the whistleblower’s lawsuit alleged sufficient evidence for the case to proceed.  The allegation was that Rite Aid charged Medicare, Medicaid, and TRICARE prices that exceeded prices paid by other customers.  A pharmacist who had worked for Rite Aid stepped forward with information that allowed the case to proceed, in April 2019.

Guidance is available for how to blow the whistle on your employer.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrong-doing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The Department of Justice needs whistleblowers to continue to report health care fraud

The Health Care Industry is Responsible for Most of the False Claims Act Recoveries

Bloomberg Law published a piece in March 2019 about the the $270 million settlement with DaVita Medical Holdings LLC., the nation’s largest dialysis provider.  The claims involved fraudulent Medicare billing whereby a company subsidiary directed physicians to use improper billing codes for certain conditions, leading to payments that the Government otherwise would not have paid.  Typical for False Claims Act cases, this one involved medically necessary services at the expense of federal health care programs.  Also reported were other common schemes involving over-prescribing of opioids and the payment of kickbacks to induce physicians, hospitals, and clinics to prescribe certain drugs or refer patients to specific treatment facilities.  Many False Claims Act cases involve providers that are already subject to stringent requirements under Corporate Integrity Agreements.  As reported, Health Management Associates, a former hospital chain, also settled with the Government for $260 million making illegal payments to physicians in exchange for patient referrals.

The Department of Justice needs whistleblowers to report fraud involving the payments of kickbacks to doctors to induce referrals of patients

On March 21, 2019, DOJ announced that MedStar Health paid $35 million for allegations that paid kickbacks to a Cardiology Group in exchange for referrals and for medically unnecessary stents.  The case couldn’t have been resolved without 3 whistleblowers who were cardiac surgeons.  The whistleblowers received a reward for stepping up and reporting the wrongdoing to the Government through their attorneys.

Guidance is available for how to blow the whistle on your employer or a competitor.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrongdoing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The Department of Justice is continuing to fight the ongoing drug epidemic by pursuing companies and individuals that fraudulently compound medications, according to a DOJ press release issued on March 15, 2019.  DOJ charged 7 people in a $50 million health care fraud conspiracy targeting state health benefits programs.   DOJ needs whistleblowers to step forward and report fraud involving compounded drugs, which can lead to patient harm.

Guidance is available for how to blow the whistle on your employer.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrong-doing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The authors represent whistleblowers / Renée Brooker (former Assistant Director for Civil Frauds/Justice Department) reneebrooker@finchmccranie.com (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud/Justice Department) eva@finchmccranie.com.

The authors represent whistleblowers / Renée Brooker (former Assistant Director for Civil Frauds/Justice Department) reneebrooker@finchmccranie.com (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud/Justice Department) eva@finchmccranie.com

DOJ settled a case involving drug screening and testing fraud of Medicare patients involving a psychiatrist and mental health clinic, according to a DOJ press release issued on March 15, 2019.  DOJ needs whistleblowers to step forward.

Guidance is available for how to blow the whistle on your employer or a competitor.  Reaching out to a former prosecutor who represents whistleblowers is a helpful first step.  An attorney can guide you through the process, assist you with documenting your concerns, answer your questions and instruct you on the nature and strength of evidence you do have.  A good whistleblower attorney will provide you a free consultation.  You should seek out an accomplished attorney as soon as you have concerns, and while you are still employed by the company where you believe there is wrongdoing.  Bottom line:  don’t do it alone.  Get an expert opinion from a prosecutor who’s tried False Claims Act cases and has significant experience under their belt.

The authors represent whistleblowers / Renée Brooker (former Assistant Director for Civil Frauds/Justice Department) reneebrooker@finchmccranie.com (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud/Justice Department) eva@finchmccranie.com (202) 641-3804

The False Claims Act is a Fail Safe for Attacking the Opioid Crisis – DOJ needs whistleblowers to step forward.

The False Claims Act is needed to fight the opioid crisis with the help of whistleblowers. While it may be a blunt tool compared to sensible laws aimed at addressing the root causes of addiction, the False Claims Act will address the terrible economic and health effects of opioids wrought by wrongdoers willing to exploit others for financial gain—just as it was used effectively during the financial crisis.