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.
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) firstname.lastname@example.org (202) 288-1295 / Eva Gunasekera (former Senior Counsel for Health Care Fraud) email@example.com.