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.
Dog and pony shows are not the only corporate form of seeking new business. Corporate events may go beyond generic glad-handing to attract new business. A former executive of an international medical device and medical service organization brought forward evidence that the eye care company was offering doctors lavish vacations to entice them to direct traffic to the business, according to The National Law Review.
Since 1983, Medicare has provided benefits for eligible terminally ill patients under The Medicare Hospice Benefit program, according to the National Hospice and Palliative Care Organization. The use of these services has increased in recent years, with Medicare reimbursements for hospice care exceeding $15 billion in 2015.
Office workers in the pharmaceutical industry, employees of companies that do business with the government - and more and more frequently today billing professionals, nurses or other healthcare workers - may notice anomalies or excesses in bills sent to the United States government. Medicaid and Medicare provide substantial sums of money as reimbursement to hospitals, doctor's offices, clinics and other healthcare resources each year.
A former analyst at Duke University says in a federal lawsuit that the institution and faculty members falsified research to unlawfully obtain federal grants to conduct medical research. In the recent whistleblower claim against Duke University, the whistleblower says that a researcher manipulated research results and data to obtain up to $200 million in federal grant money from such agencies as the National Institutes of Health and the Environmental protection agency. Included in the lawsuit are University officials, who the whistleblower says acted negligently in supervising the research faculty member.