Articles Posted in Health Care Fraud

Why come forward as a Whistleblower?

I’m often asked, why come forward as a whistleblower?  Because the Department of Justice can’t fight fraud alone.  It needs individuals inside companies with knowledge of what’s going on—people who are trying to “do the right thing”—to share information with the Justice Department.  The opioid crisis is a good example.  DOJ needs to hear from whistleblowers with knowledge of wrongdoing who work for health care providers, labs, rehab clinics, drug insurance plans, pharmacy benefits managers (PBMSs), and pharmacies.   The Justice Department has made opioid fraud one of its enforcement priorities.  Another example is Medicare fraud of every variety.  In a single recent year nearly $90 Billion Medicare and Medicaid dollars were misspent.  That number increases every year.  There’s a lot of misspent dollars to be recovered on behalf of taxpayers.  And, there are retaliation protections for whistleblowers who help the Justice Department and potential rewards under the False Claims Act.  And, you could receive a percentage of a recovery.

“Doing the right thing” requires a certain amount of what I would call “sustained and healthy anger” directed at the wrongdoer.   New York Times-best selling author Tom Mueller reminds of this in a Washington Post article and a book he’s written called“Crisis of Conscience: Whistleblowing in an Age of Fraud.  From my experience at the Justice Department, unchecked corporate power is what usually lies behind bad acts.  Anyone working in the corporate world can be an effective whistleblower, regardless of their pay grade.  We all have eyes and ears.  The False Claims Act is successful because of whistleblowers who are often not corporate-level executives but rather the “boots on the ground.”

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.

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 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.

Through a $465 million settlement, Finch McCranie’s Michael A. Sullivan and James J. Breen of the Breen Law Firm successfully represented a whistleblower whose qui tam case under the False Claims Act helped return hundreds of millions to the United States and various states for Medicaid rebates underpaid on new EpiPen products introduced in 2009.

The Department of Justice announced the settlement on August 17, 2017, of two qui tam cases pending in the District of Massachusetts, United States, et al. ex rel. sanofi-aventis US LLC v. Mylan Inc., et al., and our case, United States, et al. ex rel. Ven-A-Care of the Florida Keys, Inc. Mylan Inc., et al..

These cases illustrate the importance of the False Claims Act to uncover and stop fraud and false claims in health care and other industries, which harm taxpayers by stealing taxpayer dollars needed to provide medical care and other services.

Today the Department of Justice announced the largest settlement in its history with a skilled nursing facility chain–a qui tam whistleblower case under the False Claims Act that our firm and our co-counsel Mark Simpson worked side-by-side with DOJ to prepare for trial.

We applaud the exceptional work of DOJ’s attorneys, as well the outstanding attorneys of the U.S. Attorney’s Office for the Eastern District of Tennessee.  Below is our press release on today’s settlement:

$145 Million Settlement in Groundbreaking Health Care Fraud “Whistleblower” Case by Atlanta’s Finch McCranie LLP and U.S. Department of Justice

Yesterday the Justice Department apparently responded to the frequent lament, “Why has almost no one gone to prison for the financial crisis?” DOJ signaled that it will now look to hold responsible both culpable individuals and their companies for corporate misdeeds–both criminally and civilly.

If DOJ means what it says, this policy change is profound. It should hit corporate officers whose business models are based on fraud and false claims. It should also snare high level executives who turn a blind eye to wrongdoing, and who typically get away with it.

Corporations can act only through the humans who run them. Sometimes those humans steer the business to corrupt methods.

Until yesterday’s change in DOJ policy, however, the few corporations brought to heel by DOJ for crimes, fraud, or false claims absorbed the consequences, while the individuals who directed the wrongdoing usually escaped responsibility. Those individuals were free to continue their corrupt practices at the same firm or a different one.

New U.S. Deputy Attorney General Sally Yates plans to change that result. As a federal prosecutor in Atlanta, Yates was not afraid of pursuing big cases against individuals and their companies, as I learned from representing clients in some of those cases.

Yesterday Yates issued a Memorandum titled, “Individual Accountability for Corporate Wrongdoing.” It is far-reaching, if implemented. Yates announced “six key steps to strengthen [DOJ’s] pursuit of individual corporate wrongdoing, some of which reflect policy shifts and each of which is described in greater detail below:
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