igor-ovsyannykov-252342-unsplash-copy-300x200The Occupational Safety and Health Act was passed in 1970 and created the Occupational Safety and Health Administration (OSHA) to protect employees from dangerous working conditions and to standardize workplace safety. Over the years, it has been amended many times and now includes provisions that protect employees from retaliation from their employers when they either report injuries under the OSHA reporting requirements or if they file a complaint against their employer for a violation of OSHA standards. Many states have a state version of OSHA and, in the case of California, have state laws that prohibit retaliation against whistleblowers, as well.

What Conduct is Prohibited by Federal OSHA Whistleblower Laws?

Simply put, an employee is protected from “adverse actions” if they avail themselves of the rights guaranteed by OSHA. Adverse actions can include:

jonathan-perez-409943-copy-300x200Every day we hear shocking news about the opioid epidemic, from the number of deaths from overdoses to the sheer amount of distribution arrests to the amount of money government is spending to combat the problem. One of the areas that the public may not know about, however, is how much of the problem is being created by dishonest health care professionals across the country through fraud and illegal practices.

The Opioid Epidemic

We are bombarded with statistics about the enormity of scope of opioid use in our country. For example, in FY2016, the Centers for Disease Control and Prevention (CDC) estimated that 42,249 Americans died from opioid overdose in our country.  The Substance Abuse and Mental Health and Services Administration (SAMSHA) estimates that 11.8 million Americans over the age of 12 have abused prescription opioids and heroin in the last year. The federal Department of Health and Human Services announced in September of this year that they have awarded over $1 billion in grants to “help combat the crisis ravaging our country.” Obviously, the problem is incredibly dangerous, incredibly real, and at the forefront of discussion in the US.  What is not as obvious is what role healthcare fraud plays in fueling this problem.

jonathan-perez-409943-copy-300x200A doctor was arrested on December 13, 2018 for improperly distributing opioids to his patients and billing Medicare for the drugs. The doctor now faces 45 federal charges relating to healthcare fraud for not only prescribing illicit drugs to patients but requiring those with insurance to accept injections so that he could bill additional costs to public health programs like Medicare. While this is an extreme example of pharmaceutical fraud, there are numerous smaller incidents of pharmaceutical fraud that take place every day. If you believe your employer or healthcare provider is engaging in pharmaceutical fraud or any type of healthcare fraud, contact the qui tam attorneys at Willoughby Brod immediately to report the fraud.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the False Claims Act (FCA) or California False Claims Act (CFCA) and result in false claims to insurers and Medicare/Medicaid.

daniel-frank-201417-copy-300x200One mistake that many Medicare recipients make is assuming that all their basic medical needs are covered under Medicare. In fact, there are a lot of commonly needed medical services that Medicare does not pay for. By becoming informed about the coverage gaps in your Medicare policy, you are not only preventing yourself from any surprises when you receive your healthcare bill, you are also increasing your ability to detect any fraudulent billing schemes from your healthcare provider or anyone else who tries to tell you that services not covered by Medicare are actually covered. If you do detect any violations by your healthcare provider or employer relating to Medicare billing, contact the whistleblower attorneys at Willoughby Brod immediately.

Dental Care

Even though every individual requires regular dental cleanings, and many Medicare recipients find themselves requiring dentures, Medicare does not pay for these basic dental needs. The only dental care that Medicare may pay for is dental care required while hospitalized as a result of an emergency.

kyle-glenn-629501-unsplash-1-copy-300x200As a whistleblower who has filed a qui tam case, your goal is to convince the government to prosecute your case. However, this is usually not an easy task. In fact, there are many situations in which the government may choose to dismiss your False Claims Act (“FCA”) claim, and the Department of Justice (“DOJ”) has outlined seven circumstances under which your qui tam claim may be dismissed. If you believe you have a strong qui tam claim, contact the qui tam attorneys at Willoughby Brod today to learn more about the strength of your case and your options moving forward.

False Claims Act

Section 3730(c)(2)(A) of the False Claims Act provides the following: “The Government may dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the Government of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion.”

jonathan-perez-409943-copy-300x200During this final week of Medicare open enrollment, you may receive multiple calls each day regarding your Medicare coverage. Many of these calls may be scams, and unless you know exactly what to watch out for, these scams can be difficult to spot. Make sure you follow the guidelines below and report any Medicare fraud you detect to the proper agencies. If you believe your employer or healthcare provider is the one committing the fraud, contact the qui tam attorneys at Willoughby Brod to learn how you can report the fraud and receive an award for your tip.

Four Tips for Avoiding Medicare Scams

  1. Do not give out your Medicare number to anyone other than your doctor or someone who should have it.

chris-greenhow-662446-unsplash-copy-300x225While whistleblowers sometimes get a bad rap as “snitches,”the opposite in fact is true. By revealing their employers’ illegal actions, whistleblowers help society in ways that only whistleblowers can. If you have any doubts about whether you should blow the whistle on your employer’s illegal actions, contact the whistleblower attorneys at Willoughby Brod today to learn more about the ways in which whistleblowers help society and the ways in which you can contribute to that cause.

  1. Whistleblowers help citizens save money.

From 1986-2016, recoveries made from whistleblower cases under the False Claims Act alone totaled over $28 billion. That is $28 billion that could have ended up in the hands of fraudsters rather than back in citizens’ pockets. By blowing the whistle on fraudulent acts, whistleblowers not only protect those who are directly harmed by the fraud but also send a message to fraudsters that the actions they wish to engage in are unacceptable and will not go undetected.

jonathan-perez-409943-copy-300x200One of the most common types of healthcare fraud in violation of the False Claims Act (FCA) is pharmaceutical fraud. It is also one of the most highly reported types of healthcare fraud, with over $4.5 billion of financial penalties issued from qui tam lawsuits in 2012 alone. While whistleblowers are important to the healthcare industry in general, it is clear that their contribution to the pharmaceutical sector has been huge. If you suspect that you have witnessed pharmaceutical fraud, contact the qui tam attorneys at Willoughby Brod today to learn more about your options moving forward.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the FCA or CFCA and result in false claims to insurers and Medicare/Medicaid. There are several predominant types of pharmaceutical fraud, which are highlighted below.

james-williams-502481-unsplash-copy-300x225There is no such thing as “good” fraud, but on the hierarchy of Medicare fraud from bad to worst, hospice fraud is arguably one of the most despicable types. Medicare Part A covers hospice care for patients who are “terminally ill,” or have a life expectancy of six months or less. If you believe you have witnessed hospice fraud, make it your duty to report the fraud and honor an individual’s last moments in this world. The whistleblower attorneys at Willoughby Brod are experienced at helping whistleblowers bring their claims forward and protecting them in the process. Contact us today for a free consultation and to learn how we can help.

What Does Medicare Provide by Way of Hospice Care?

As mentioned above, Medicare Part A covers hospice care for patients who are deemed by a medical professional to be terminally ill, which is defined as having a life expectancy of six months or less. Medicare covers only hospice care for terminally ill patients and not any curative treatments, although hospice patients can continue to receive curative care coverage for conditions unrelated to the cause of their terminal illness.

rene-bohmer-430927-unsplash-copy-200x300One common concern that holds people back from becoming whistleblowers is the fear that they will face discipline for being involved in the same fraud they are now reporting. Sometimes employees feel coerced by their employer into partaking in fraudulent actions, and other times the employee may have been the one to spearhead the fraud. In both cases, if you have had a change of heart, and not only do you no longer wish to participate in the fraud, but you want to put an end to it altogether, contact the qui tam attorneys at Willoughby Brod today to learn more about what steps you should take next.

When You Participated in the Fraud but Did Not Spearhead it

Both the False Claims Act (FCA) and the California False Claims Act (CFCA) want to afford whistleblowers the maximum protection possible so as not to deter people from coming forth as a whistleblower. Therefore, in most circumstances, a whistleblower who partook in the fraudulent act they are now reporting will not face any penalties for participating in the fraud.

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