Eli Lilly agrees to pay $1.4 Billion in Qui tam fraud involving Zyprexa

Whistleblowers have a lot to celebrate in the wake of the recent $1.4 billion settlement from drug maker,  Eli Lilly. The drug giant, Eli Lilly, plead guilty to promoting its drug Zyprexa for uses not approved by the Food and Drug Administration (FDA). Included is a criminal fine of $515 million, the largest ever in a health care case, and the largest criminal fine for an individual corporation ever imposed in a United States criminal prosecution of any kind. Eli Lilly will also pay up to $800 million in a civil settlement with the federal government and the states. Whistleblowers will share in about 20% of the government's share in the $800,000.

This settlement should help more whistleblowers come forward. AM Law Daily gives an insightful summary on how whistleblower cases have increased in the past year. I have to admit, at our firm, over the past year and even more recently, whistleblowers have been contacting us regarding qui tam claims. I think that this can be attributed to the large whistleblower rewards and media attention over the past year.  One word of caution, if you are a whistleblower with critical information, talk to an Attorney about your claim and rights before making statements public. This way you have a better way of protecting your claim.

Click here to read more on the $1.4 billion qui tam settlement from Eli Lilly from the Department of Justice.

Let's see how 2009 will treat qui tam and whistleblower claims under the new administration.

Senator Grassley joins in the filing of a whistleblower tax fraud briefs to the Supreme Court

On January 19, Senator Charles Grassley filed an Amicus Curiae ("friend of the court") brief in the U.S. Supreme Court case of Allison Engine Co., Inc. v. United States ex rel. Sanders. The Sanders case will have far-reaching impact on the viability of America's most important whistleblower protection law: The False Claims Act.

According to Stephen Kohn, President of the National Whistleblower Center, "If the Supreme Court were to find against the whistleblowers in this case, it will open a loophole by which fraudulent companies will launder their dirty contracts through subcontractors, thereby defeating the presentment requirement."

The Whistleblower Protection Blog and TAF generously provided the briefs filed by the Petitioner's, Respondents, Senator Grassley and Tax Payers Against Fraud.

Click here to see the release issued by the Whistleblower Law Center.

Houston Firm Pays $300,000 to Resolve Qui Tam suit for military containers in Iraq

Eagle Global Logistics, paid the United States $300,000 to settle a qui tam suit. The company’s local agent in Kuwait allegedly overcharged the military for rental charges on shipping containers to Iraq for the period from January through June of 2006, according to the Justice Department. The Houston-based company’s containers were for shipments of military cargo to Iraq under an EGL subcontract with KBR, the prime contractor for the U.S. Army’s LOGCAP III contract for logistical support of military operations overseas.

This matter stems from allegations in a suit filed against EGL under the qui tam or whistleblower provisions of the False Claims Act. Under the False Claims Act,  private persons may bring a suit on behalf of the United States alleging the submission of false claims to the government and may receive a portion of the proceeds of the suit. The whistleblowers, David Vavra and Jerry Hyatt, will receive $36,000 as their part of the settlement. Congratulations to these brave whistleblowers for speaking up.

Click Here to read more on this case from the Department of Justice.

U.S. Attorney files $1 million qui tam suit against nursing home operator

Federal authorities have filed a qui tam suit  seeking $1 million in fraudulent claims plus civil penalties against a company that operated five nursing homes in the St. Louis area, saying that the facilities provided what amounted to "worthless" health care.

The suit claims that Cathedral Rock Corp., based in Fort Worth, Texas, committed Medicaid and Medicare fraud when it billed the government for care it didn't provide, U.S. Attorney Catherine Hanaway said in a statement to the press.

Investigators, who intervened after two nurses filed a "whistle-blower" lawsuit in 2003, found numerous residents at the facilities suffered from dehydration, weight loss, and preventable bed sores that eventually led to amputations. 

The two nurses, Michele Kimball and Anna Juelfs, who filed the original suit, "qui tam action" could receive 15 percent to 25 percent of the damages recovered in the action, according to U.S. Attorney Hanaway.

Click Here to read more about the case in the St. Louis Post Dispatch.

 

Pharmaceutical Fraud and Sicko

The level of fraud in America today is sickening. There is no comparison between the qui tam fraud in corporate America and the fraud of fake injury “victims”. I guarantee you the damage done to the American economy, the American ideal and the American tax system from qui tam fraud is 1000 times greater than all of the insurance scams put together. The fraud is so disturbing that it is actually hard to believe.

Coming this summer is a movie called Sicko. It is a documentary about the health and drug industry. I am almost certain it will document the conspiracy going on between doctors, drug manufacturers and the FDA.

As we speak (or rather, as you read) the drug lobby and their corporatist party lackeys are trying to make the FDA the final oversight of the drug industry and take away a injured victims right to sue if they are hurt by a drug. It is my prayer that this movie spurs politicians NOT to permit the drug lobby to have the FDA be there ONLY oversight. We must keep the drug companies honest and the only way they will be an honest broker is if they are held accountable through civil lawsuits. Is the system perfect? Certainly not. But it is far better than any other system out there. It is only through the power of the pocketbook that we can control the moral-less corporate beast.

So, you ask, why am I so “up in arms” about the FDA issue right now?

Here is the simple fact. Doctors are being paid to lie. The drug companies are so invested in their new drugs that they must turn a blind eye to bad data in their testing to make sure the drug gets FDA approval. Once the FDA, which is incompetent or under-funded/overworked or a combination of these problems gives the drug company the approval they are free to hurt or help as many people as the doctors can hook on the poison of their poorly tested pills.

As an example, I read a recent article in the St. Pete Times about a new drug called Ketek. Ketek is an antibiotic for persistent colds and coughs. Aventis Pharmaceuticals, Inc. (now Sano-Aventis) is the manufacturer of Ketek. The drug maker offered the doctors $400.00 PER PATIENT to test Ketek. Dr. Anne Kirkman Campbell, in Alabama was able to sign up over 400 patients. According to the article, she was able to sign up more patients than any other doctor in the entire nation by a huge margin.

In the past few years there has been a proliferation of lawsuits against pharmaceutical companies because of improper testing of their drugs. In this case Aventis hired an objective oversight company called PPD, Inc. PPD was hired to oversee the study and doctor testing of their new blockbuster drug. The oversight company would review the doctor’s charts and information and determine if the results were realistic and in line with every other doctors results.

Once PPD figured out the obvious and outrageous amount of fraud Dr. Campbell was committing, the question is “What did Aventis do?” The answer is the exact opposite of what it should have done. Instead of investigating the fraud and discounting the data and firing Dr. Campbell from the study, Aventis tried to ignore the fraud. No one at Aventis reported the crime to the FDA. Aventis did not even throw out her improper data. In fact, they did more than just ignore the fraud. Instead they flew a team of people in to Dr. Campbell’s office to review her files and to coach her though the FDA’s questions. Aventis actually included the fraudulent data in their submission to the FDA.

So, you again ask, what did the FDA do if the fraud was so clear? Even after Federal agents found Dr. Campbell's fraudulent data, as well as many other problems at many other doctor offices, the FDA APPROVED KETEK!

Our system is simply completely broken. The fox is watching the hen house and the farmer is being paid off by the fox as well.

Ketek was given to patients on false and fraudulent data. Eventually evidence arose linking 53 reported cases of liver failure including two transplants and five deaths to Ketek. Due to the rising tide of evidence Dr. Campbell was finally charged with 21 counts of fraud and sentenced to 57 months in prison.

That is not enough. Dr. Campbell is only one third of the problem. The system is the problem. Nine other doctors in this study alone had exceptionally high enrollment and they all had problems in their data. No one is looking into their data. If at all possible the FDA and the Drug Company and the Doctors will all turn their heads and ignore negative data. To make money on the fraud they are all willing to risk human life and tragedy for the benefit of a buck. The system is broken and the FDA simply CANNOT BE the final line of defense to protect the American public from harm.

Aventis made over $400,000,000 just during the initial launch months for Ketek. I pray the many lawsuits for the deaths of those poor individuals who were given this poison for the common cold and lost their lives far outweighs that amount. The only way corporations will learn that it is a good business decision to protect and care for the consumer is through this type of behavior modification – take away the profit motive to harm the public.

Click Here to read the St. Petersburg Times article. It will make you… Sicko.

Insurers are being charged in Qui tam suit for overbilling government for Katrina Damage

According to a recently unsealed qui tam suit, several major insurance carriers are being charged with over-billing the government for Hurricane Katrina damage in Louisiana. In this suit, a group of former insurance adjusters, gave compelling evidence that they personally reinspected over 100  properties with flood and wind damage. In every instance, the federal flood program was overcharged for storm damage, while underestimating wind damage claims.

The suit has been under seal in the in U.S. District Court in New Orleans since it was filed last August. A  qui tam or whistleblower suit, filed by a private individual on behalf of the government, is automatically placed under seal for a period of time. Government prosecutors investigate the evidence and determine  whether they want to take it over.

In this whistleblower suit, Judge Peter Beer, unsealed the suit and cited the  the defendants for "defrauding " the U.S. government and violating the False Claims Act by knowingly submitting fake Katrina damage bills to the government for payment. While insurance companies "maxed out or nearly maxed out" flood policies from the Federal Emergency Management Agency, they "substantially underpaid" payments for wind damage at the same properties.

"Rather than follow in good faith the streamlined procedures that FEMA had set up, defendants instead systematically adjusted, paid and submitted reimbursement claims to NFIP regarding losses that obviously should not be covered by flood policies. They did so in massive quantities," the complaint reads. "Defendants defrauded NFIP by misattributing wind damage and other non-flood losses to the flood policies underwritten by the Government rather than correctly attributing such losses to causes that are covered by their homeowners policies."

There is an estimate of $9.24 billion being discussed as a possible amount that the flood program was overpaid in Louisiana from Katrina and Rita flood damage.  

All eyes are on Louisiana to see how this qui tam case develops.

Click Here to read more about this in the Louisiana Times Picayune.

Medical helicopter provider investigated for Health Care Fraud

Last week, the Justice Department investigators seized records from a major medical helicopter provider, Air Evac Lifeteam. They are being investigated for possible health care fraud.

The company is cooperating with authorities and have turned over documents to the Federal bureau of Investigations. Health Care investigations can typically be about improper billing matters, Medicare or Medicaid Fraud.

Air Evac Lifeteam has grown their business by focusing on servicing communities in rural areas. They sell minimal annual subscriptions under $100. When the subscriber needs emergency medical attention, they call Air Evac instead of 911.  This is economical compared to the cost of an ambulance ride.  How does Air Evac make their money?  They bill the private insurance company, Medicare or Medicaid for anywhere between $5000 - $10,000 for the helicopter ride to the hospital.  I know this is a premium, service, but this price seems expensive for the service. 

Time will tell if the FBI investigation will uncover a Qui Tam claim for Medicare or Medicaid or even false billing evidence against Air Evac Lifeteam.  Let's hope the whistleblower in the qui tam suit had all of the necessary documents, so they can share in an award if there turns out to be one.

Click Here to Read New York Times article on Air Evac and the potential health care fraud.

UK passes new Qui Tam Law

What do they say about imitation? Isn’t it the best form of flattery? Well the English, have been flattering us since we won our independence back in the 1700s. Their most recent bit of flattery/imitation is the creation of a Qui Tam law which creates a financial incentive to report fraud on the government.

Previously the laws in the United Kingdom permitted the private citizen to bring an action for fraud on behalf of the government. However, the private citizen had no right to share in any of the government’s bounty. Based on that statement alone I am sure 90% of my readers said to themselves, “Who in the heck would ever report any fraud?” In other words, we are, for the most part, capitalistic in our motivation to report fraud.

But, believe it or not, there are people who will actually sue to simply stop the fraud. Those people I affectionately call the “Crusaders.” The Crusader is zealous in their desire to stop the negative activity. It turns out that the English are pretty similar to us Americans.

In England the people who would use the old law were pretty much the Crusaders. Crusaders are almost always bound together in an organization that pursues the crusade. Take environmentalists for instance: many environmental groups will litigate over issues that have no monetary significance. The group is simply committed to its own cause and agenda, say the gopher tortoise or some unique owl. The group does not, for instance, want Johnny’s Development Corp. to tear down the trees and kill the owls and turtles. That is what the English Qui Tam law was about.

The new UK Qui Tam statute will carry far more incentives for the private citizen to report fraud then the old law. I am curious to see what happens in the future. It is my bet that the number of whistleblower claims they have pop up sky rockets. Remember that for every dollar the government now spends on Qui Tam cases they get a return on that investment of almost 15 dollars. Now that is a good investment of time and money.

Click Here to read more on the new UK Qui Tam statute from a recent article in The Times UK.

Brian


Join Brian LaBovick, Esq. Live on Radiopalmbeach.com

We are pleased to announce that Brian F. LaBovick, Esq. will be featured on Law Talk online which can be accessed at www.Radiopalmbeach.com Monday evenings from 7pm - 8pm EST.

Attorney LaBovick will cover Qui tam - False Claims Act issues and verdicts along with other breaking legal news that affect consumer rights.

Tune in on your computer by going to www.Radiopalmbeach.com and join in the discussion by calling in or emailing questions.  If you have a question beforehand that you want aired during the show, you can submit them to info@labovick.com prior to the show.

 

U.S. Joins Medicare Fraud Case Against Health Essentials Solutions

The United States has intervened in three qui tam suits accusing Health Essentials Solutions Inc. (HES) of false claims billings to Medicare, the Justice Department announced today. Specifically, HES is accused of upcoding – the practice of improperly assigning a diagnosis code to a patient discharge that is not supported by the medical record for the purpose of obtaining a higher level of reimbursement. Additionally, it is alleged that the Kentucky-based provider of geriatric care knowingly charged Medicare for medically unnecessary services.

The investigation of the allegations in the qui tam complaints was conducted by the U.S. Attorney's Office in Louisville, Ky., the Department's Civil Division, and the Office of Inspector General of the Department of Health and Human Services.

Click Here to Read more about the case from the DOJ

Loma Linda Behavioral Medicine Center settles Qui tam suit

The Loma Linda Behavioral Medicine Center in Redlands has paid the government more than $2 million to settle allegations that it fraudulently overbilled federal health insurance programs. The government received notice that a federal judge had unsealed allegations against Loma Linda BMC contained in a "whistle blower" qui tam lawsuit.

The qui tam settlement - includes interest -resolves allegations made against Loma Linda BMC in a lawsuit filed pursuant to the qui tam provisions of the False Claims Act. The qui tam lawsuit  was filed in 1998 by a former employee of Health care Financial Advisors (HFA). The lawsuit alleges that HFA helped its hospital clients seek reimbursement for unallowable costs.

The Loma Linda BMC qui tam settlement is the latest in a series of settlements with defendants in the suit. Last year, Jackson Memorial Hospital in Miami paid more than $14 million and St. Elizabeth Regional Medical Center in Lincoln, Neb., paid more than $4 million to settle qui tam allegations that they had failed to disclose and return overpayments made by the Medicare and state programs.

Click Here To Read about the case in the Corporate Crime Reporter and Redlands Daily Facts

U.S. Intervenes in three Qui Tam Lawsuits against 3 major players

Three major corporations: Accenture, Hewlett Packard and Sun Micro Systems, are being charged with violating the Federal False Claims Act. The U.S. DOJ has decided to get involved with the qui tam claim.  They are accused of solicting and providing improper payments and other things of value on technology contracts with government agencies.

Click Here to read more from the U.S. DOJ

CTI pays $10.5 Million to Settle Medicare Qui Tam Suit

Cell Therapeutics, Inc. (CTI) settled all government claims arising out of a Department of Justice investigation into allegations regarding alleged overpayments by Medicare to doctors who prescribed the anti-cancer drug, TRISENOX. As part of the settlement, CTI will pay $10.5 million plus interest and the Department of Justice has agreed to fully release CTI from all liability for the issues under investigation, including claims asserted in a qui tam lawsuit. The terms of the settlement contain no admission of wrongdoing by CTI.

According to a recent Seattle Times Article, Peter Kessler,  Assistant Attorney General for the Justice Department's Civil Division, stated "They misled a lot of doctors by telling them that the drug was medically accepted."  Cell Therapeutics blamed Medicare billing issues on consulting firm, Lash Group, a unit of pharmaceuticals distributor AmerisourceBergen. Lash denies the company's allegations.


Click Here to read more on the Seattle Times Article

 

Georgia is on track for State Qui Tam Whistleblower Law

Georgia made history this week by passing a "State False Medicaid Claims Act" in the Senate. It is now enroute to Governor Sonny Perdue's office for his blessing and signature. One passed, it will be the newest state to follow the federal False Claims Act. 

Many states are creating State False Claims Acts in response to the incentives Congress adopted in the Deficit Reduction Act. New York recently approved a State False Claims Act.

Representative Edward Lindsey and Senator Seth Harp  sponsored this Bill.

Click Here to read the Georgia Whistleblower Bill.

Road construction Fraud settlement nets $11.75 million to the government

There are a million ways to rip off the government. That is why the Qui Tam law’s (Federal False Claims Act) language is so broad. Yesterday I blogged about an HMO getting slapped with a huge verdict and penalty for ripping off Medicaid, last month I was upset by defense contractors posting ghosts instead of, and today I am blogging about a road contracting company which failed to follow the government regulations on hiring disadvantaged business entities.

What happened here is that two construction companies were awarded government contract to perform road work. As a part of the award the construction companies promised to hire disadvantaged business entities (DBEs) to do the work. What are DBEs? DBEs are businesses are owned by minorities, women, or socially or economically disadvantaged people. The purpose here is to get more people to enter the road construction industry.

The two companies were Ajax Paving Industries Inc. and Dan's Excavating Inc. These two companies were supposed to accurately report DBE construction to the Department of Transportation. Obviously they did not take this requirement seriously and failed to report accurately. What these companies did was report that a company called Borbolla Construction did major work on their projects, when in truth, Borbolla did not do more then simple administrative work. The companies now must pay $11.75 million back to the government and enter into a new agreement with the Department of Transportation to comply with the law.

The unfortunate thing in this construction fraud case was that there was no “known” whistleblower. The government stated it found the fraud on its own. This means no one is sharing in the fraud money. I find that hard to believe. What made the government suspicious? I wonder if someone gave the government a heads up on the fraud and did not have an attorney ready to protect their share of the award. Now that person is being locked out. Who knows? The government press release  bragging about the award doesn’t say. We may never know. At least we know the government went after the fraud and the bad guys are paying back a large sum of money, making good on their contract and following the rules in the future.

Click here to read more from the Department of Justice on the Construction Fraud settlement.







Amerigroup gets hammered in Qui Tam suit

I don’t know why, but I just love it when big corporate powers get hammered. Maybe you don’t read the Chicago Sun Times newspaper or keep up with Qui Tam based fraud nationally, but if you do then you know that last week an Illinois HMO was hit with a $334 million dollar judgment. This is the largest fraud verdict in the history of Illinois.

The beauty of the judgment is that not only did the company get hit with a $144 million dollar judgment but they were also slapped with a huge penalty by the Judge. God Bless him for using the law to correct bad behavior. Everyday huge corporations laugh at the anti fraud laws and say to themselves, “we are above the law, even if we are caught,  we will tie this thing up forever in court and when the chips finally fall we will “negotiate” out of paying any penalty and just pay back what we defrauded our great nation. “ Be warned, if you end up in Judge Leinenweber’s court, he is going to properly punish your company for fraud.

 


The company is called Amerigroup and they were caught by one of their own former vice presidents, Cleveland A. Tyson. I am sure that Amerigroup has nothing good to say about Mr. Tyson, but at this point, Mr. Tyson is entitled to a large cut of the $334 Million dollar total judgment. Even at the statutory minimums, (15%) he is going to be a wealthy man and our tax dollars are being refunded.
Amerigroup claims they are completely innocent of defrauding Medicaid. They feel they have enough to appeal the judgment. What did I say about companies tying things up in court?

The great thing about Qui Tam is that, although, this case is the biggest in its jurisdiction, according to the Chicago Sun Times, it is only the 5th largest judgment for the past year. There are 4 other cases that have larger verdicts. Isn’t that delightful, that huge repayments of fraud money are going back to the people? Well at least it is split between the people (tax payers) and the whistle blower (Relator) in a fair percentage. One word of warning about Qui Tam cases. They are not easy. Attorneys for the Amerigroup whistleblower (Relator) spent about 25,000 attorney hours. They are true champions of justice. They, along with the whistle blower, took a huge risk and made their good work count. Now, they will need to survive the appeal.

Can you believe that Amerigroup has moved out of Illinois? What a shame? I wonder if Amerigroup is facing such troubles in any of the other 10 states they conduct business?

What did Amerigroup do, you ask? They defrauded Medicaid by taking federal money and then not following the rules. Amerigroup did not want to insure pregnant women. They set up a system to exclude those people from their HMO. That makes sense, doesn’t it? Why insure people who will need medical care, regardless of what the law requires? HMOs want to charge a premium and accept Federal money to insure people who will not need medical care. Who else other than people with health risks are actually on Medicaid. Isn’t that the point of the system, to help the people at risk?

Florida False Claims Act Gets 3x Damages from Small Fish

I am amazed at how many people find ways to rip off Uncle Sam. Not only do the big players figure out ways to cheat the government, but even small fish do not play it straight.

Take the case of Vidya Bhoolai. Bhoolai figured out a great way to defraud the government.   Ms. Bhoolai (who is my same age) figured out she could bilk Medicaid while running two assisted-living facilities. What she did was actually quite simple. She would bill Medicaid for services which her facilities never actually provided. The total amount she billed for services she was not providing was about $210,000.00.

Last week Judge William Gary ordered Bhoolai to pay (3x) treble damages for her fraud. I love seeing that. Usually in the Qui Tam cases the Defendant somehow snakes a plea deal to avoid paying treble damages. In this case there was no plea deal. The Judge had the opportunity to come down hard. He ordered her to pay more than $640,000 for the numerous (300 or so) violations she committed. Florida has its own False Claims Act. 

The $640,000 was inclusive of both the past due fraud amount of $210,000.00 plus the fines.   However the wheels of Justice turned slowly. Ms. Bhoolai was arrested two years ago. The investigation immediately revealed that Ms. Bhoolai had used Medicaid's online filing system to overcharge Florida for more then 25 patients. The patients lived from Tallahassee to Miami. Some patients did not reside in either of Bhoolai’s homes.

Its no wonder Ms. Bhoolai received such a tough deal while other major Qui Tam defrauders get away with so much more. Ms. Bhoolai was charged with both Civil and Criminal charges for her fraud. Now that we know Ms. Bhoolai owes the money, lets hope she pays it back before she is finishes serving her 10 years of probation.

Brian

Rumors Don't Count

Everyone knows that if you blow the whistle on your company for ripping off the Federal Government that the False Claims Act will protect you. In fact, the law specifically states that …. Any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under this section, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement with the same seniority status such employee would have had but for the discrimination, twice the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees. An employee may bring an action in the appropriate district court of the United States for the relief provided in this subsection.

However, under a new decision of December 2006 this law will not apply unless, like the detectives in Drag Net you have the facts. Just the facts. The whistleblower can’t rely on rumors to report fraud.

This fact became painfully clear to Sharon Lang in a December court decision. Ms. Lang worked for Northwestern University at the Northwestern Medical Faculty Foundation (lets just call it the Foundation). Ms. Lang was working at the Foundation when it was applying for a bond rating with the Federal Reserve. She heard rumors that the Foundation big wigs were lying to the Fed Reserve Board about some very important information. Their intent was to paint a sunny picture to the Fed so the Foundation would get a better bond rating, which would lead to better loan rates. When Sharon found this out she felt it was her obligation to report this activity to the FBI, which she promptly did. 

Unfortunately, Sharon forgot to get something that was very important to a Qui Tam case. EVIDENCE. In this case the United States Court of Appeals for the 7th Judicial Circuit found that Sharon’s whistle blowing was based strictly on rumors. The reason is that the legislature never meant for whistle blowing to be based on rumors. Without some “objective” basis for the claim the whistleblower isn’t actually blowing the whistle but in fact simply acting like “chicken little” (yes the Federal Judge actually compared Sharon to the old fable and recent movie star). Since Sharon and the other gossips had no hard evidence or even any first hand knowledge of the “alleged” fraud she did not become an official “whistleblower” under the statute.

Needless to say, the Foundation was not happy with Ms. Lang. Therefore, after making the complaint to the FBI, Ms. Lang was fired. This was upsetting to Ms. Lang as she claimed she was discharged in retaliation for her report to the FBI. Hard to imagine, but maybe it’s true. (Sorry about the sarcasm.) 

Ms. Lang then sued Northwestern Foundation for violating her rights under the False Claims Act. The trial judge said, you’re a gossip and not a whistleblower and threw her claim out of court. The actual holding was that Sharon did not have a remedy under 31 USC 3730(h) because there was no action filed, or to be filed, under the False Claims Act, but it works the same way.

The Court of Appeals agreed with the trial judge and affirmed his decision. The appeals court based their decision on Neal v. Honeywell, Inc., 33 F.3d 860 (7th. Cir. 1994), which limits protection to legitimate False Claims Act violations and does not give protection to employees who… "behave like Chicken Little… without advancing any goals of the False Claims Act."

The Court in Lang’s case said that she played the part of Chicken Little by calling the FBI about imaginary fraud without having any objective basis for her belief. They went on to say that if Lang was a problem for her management team that was too bad for her because the False Claims Act is not intended to protect problem employees who are likely more problems then they are worth to management. They also said that Lang’s intent was irrelevant and that without objective facts the False Claims Act simply does not protect her.

“What Lang actually believed is irrelevant, for people believe the most fantastic things in perfect good faith; a kind heart but empty head is not enough. The right question is whether her belief had a reasonable objective basis, and sensible jurors could find that it did.”

So, my friends, while I agree that the FBI can’t chase down rumors of crazy employees, there is an obvious danger here. That danger is that employees often see and hear about fraud but are never in a position to gather any real evidence of that fraud.   Certainly we don’t want employees to run amok with allegations of fraud that border on the fantastic; but what about the rational and reasonable claims. Is it really a “fantastic” or irrational claim that the foundation was falsifying information to the Federal Reserve to save a percentage point or two on multimillion dollars of debt? Sure sounds reasonable to me. Further, if the FBI had investigated and found evidence of fraud, wouldn’t Ms. Lang then get protection? It appears not.

If you hear any good gossip don’t spread the rumor. Keep it to yourself and go find hard evidence. Then find a good Qui Tam attorney to document the case. After fully documenting and preparing a solid case turn in the crooks. If you don’t properly set up your case, the bad guys are going to get off every time.

Brian F. LaBovick, Esq.

Medicare Fraud - False Claims Act

Medicare is a lifeline to millions of Americans. For the elderly it is often the only source of medical care, treatment, and nursing facility options. Medicare also creates jobs for thousands of doctors, nurses, technicians and other health care workers, whose livelihoods are funded by Medicare programs. The program is massive, and like many large government programs, opportunities for fraud frequently arise. The Medicare Ombudsman's Office is devoted to controlling waste and fraud, but can only do so much with limited resources. Thus the bulk of the responsibility for identifying unscrupulous medical billing practices is placed upon front line health care workers including caregivers, specialists, and medical billing and office staff.  

Our nation's sick and elderly depend on everyday Americans employed in the health care industry to police waste, fraud, and corruption. Thanks to a law called The False Claims Act, honest health care workers are empowered to correct wrongful behaviors of powerful providers such as hospitals and pharmaceutical companies. Once the wrongful conduct is reported through a lawyer, the health care professional is given special “whistle-blower status” and cannot be fired for reporting the fraud. As if preserving precious Medicare resources weren't reward enough, the worker exposing the corrupt provider may share a portion of the government's recovery—potentially millions of dollars.

Vigilant health care workers have exposed numerous forms of Medicare fraud, including:

Billing brand-named drugs where generics were actually provided
Billing for phantom tests and services
Up-coding inexpensive procedures as more expensive
Up-coding nursing or intern work as doctor services Kickback schemes

For example, after bringing hospital podiatry fraud scheme to Medicare's attention, one health care worker was awarded $400,000 of the $2 million recovery. Another hospital worker reported that the hospital had received over $14 million in erroneous payments, and received a $2.1 million award for coming forward. A hospital billing employee discovered a $2 million “up coding” scheme, where his employer had billed Medicare for premium services that were never provided. He was awarded over $300,000.

If you have reason to believe your employer is defrauding Medicare, however large or small, becoming a whistle-blower is easy. Your first step is to speak with a lawyer, assured that any information you give will be held in the strictest confidence. After reviewing your case, your lawyer will help you decide if becoming a whistle blower under The False Claims Act (a qui tam relator in legalese) is right for you. Your lawyer will prepare your case, and submit it to the proper authorities for review. During every step of the process, your lawyer will make sure that your interests as well as your job are protected. Most lawyers skilled with False Claims Act cases like yours will accept your case at no charge to you, asking only for a share of the eventual settlement. 

Stop losing sleep over doubts about your employer's Medicare billing practices. Talk to a lawyer experienced in Medicare False Claims Act cases who can investigate and evaluate your case, giving you an opinion as to where your employer really stands. Doing so is a blessing to vulnerable Americans who depend on Medicare, as well as a potential windfall for the whistle blower.