Fraudulent billing practices to directly increase products often seem to be the focus of healthcare fraud lawsuits. However, as a recent settlement under the False Claims Act (FCA) highlights, healthcare fraud issues may be somewhat more indirect. A former quality control analyst for a medical device manufacturer noted defects in a device that ultimately cost taxpayers money, according to the Department of Justice.
Members of law enforcement and the United States armed forces rely on bulletproof vests to preserve their lives. The Department of Justice recently announced that a fiber manufacturing company has agreed to settle a whistleblower lawsuit that alleged the company was aware that the fiber known as "Zylon" was not suited for use in bulletproof vests, yet the manufacturer continued to market and sell the fiber for use in protective vests.
The opioid crisis continues to make headlines - and government officials continue to take note. In late February, Attorney General Jeff Sessions announced that the federal government is stepping up its efforts to attack the opioid epidemic through the Department of Justice Prescription Interdiction and Litigation Task Force. The unit will use both civil and criminal legal mechanisms to gain better control over opioid prescription abuse.
Several former employees of a chain of dental clinics brought forward evidence that the clinics were performing unnecessary dental procedures on children and billing Medicaid for the services. The whistleblowers filed five lawsuits under the False Claims Act to recover taxpayer money that was fraudulently obtained through an allegedly unlawful incentive plan, according to a statement from the Department of Justice (DOJ).
The Department of Justice (DOJ) recently announced a settlement in a pharmacogenomics whistleblower lawsuit. Pharmacogenomic testing analyzes a patient's genetic makeup to help identify the proper drugs and doses of the drugs that may provide the best benefit for the individual patient's condition.
A chiropractic management company operating four pain clinics in Tennessee has agreed to settle a whistleblower lawsuit involving opioid prescriptions. A former office manager for the chiropractic and pain management company noticed medical and billing discrepancies. The worker brought the information forward in a whistleblower lawsuit filed under the federal False Claims Act (FCA).
Kmart Corp. has agreed to settle a health care fraud lawsuit that alleged the big-box retailer overcharged state and federal health care programs for prescription medications. The case came to light after a pharmacist noted discrepancies in what the pharmacy chain charged Medicare, Medicaid, and Tricare for generic drugs. For his involvement in coming forward with the lawsuit, the pharmacist will receive $9.3 million of the settlement. That is 29 percent of the $32.3 million overall, according to NBC News.
We have reported previously about the enormous drain that health care fraud places on tax dollars and the adverse impact fraud may have on healthcare costs. Whistleblowers are a vital resource in discovering fraud in government contracts. The False Claims Act allows individuals to file a lawsuit in federal court to help recover taxpayer money. For their involvement, whistleblowers are entitled to a percentage of any money recovered through settlement or verdict in court. Whistleblowers often work in mid-level jobs and notice some kind of anomaly that may involve fraud.
Companies of all sizes may engage in business connected to government contracts. It is not only large, multi-national corporations that seek reimbursements for providing health care services or goods. The Department of Justice announced earlier this month that it is joining a lawsuit filed against a husband and wife team who allegedly ran a dramatic scheme to overbill Medicare for services through a process commonly referred to as "upcoding," according to the Chicago Tribune.
The opioid epidemic has attracted nationwide attention. The Wisconsin Department of Health says that opioid overdoses took more lives than car accidents in 2015. While public officials in Wisconsin and nationwide continue to look for ways to get control over opioid abuse, the Department of Justice recently reached a partial settlement in a whistleblower lawsuit that centered around promoting opioid use. The overall lawsuit remains under seal as other defendants were not part of the recent settlement, according to the DOJ.