Articles Tagged with Medicare whistleblowers’ attorney

No matter how long we serve as a law firm for Medicare fraud matters, we continue to be appalled by the nature of these crimes.  These crimes often involve more than just shifting money into the perpetrators’ wallets.  Medicare fraud often directly impacts the care beneficiaries receive or, in some cases, the care they don’t receive.  We are also disturbed by the number of people involved in certain frauds like the wide-ranging scheme to profit from prescribing unneeded medications to nursing home residents.  While there are often more active participants than we’d like to imagine (i.e. more people willing to risk others’ well-being for profit), many more are silent observers.  It is these individuals who have the most power when it comes to fighting fraud – they can become the whistleblowers in False Claims Act whistleblower litigation.

A Drug Marketing Scheme Involving Numerous Companies and Individuals

Earlier this year, The Kentucky Center for Investigative Reporting examined a plot to profit from using pushing the (over)use of certain medications by nursing home residents.  To understand the schemes, one needs to know that specialized companies operate nursing pillcuphome pharmacies.  These providers, including PharMerica and Omnicare “occupy a strategic place in the flow of drugs to nursing home patients,” buying medications from pharmaceutical manufacturers and often repackaging them in foil packs referred to as “bingo cards” before dispensing them to nursing home residents via the company’s consulting pharmacists.

Often, Medicare fraud is brought to light because a brave employee saw a wrong and spoke up.  Notably, however, insiders are not the only ones who can bring a Medicare fraud whistleblower lawsuit (aka a qui tam action).  Medicare beneficiaries can also witness and report Medicare fraud.  We are proud to partner with Medicare beneficiary whistleblowers  in addition to working with current/former employees on health care fraud matters.  We investigate the whistleblower’s concerns and, when appropriate, file suit.  Our mutual goal is recovering wrongfully diverted funds and preventing on-going/future frauds.  As a Medicare fraud whistleblower’s law firm, we also vigilantly work to protect the whistleblower from retaliation and ensure s/he receives fair compensation should the information leads to a recovery.

Example 1: Over $5 Million Recovered in Action Initiated by Medicare Beneficiary Whistleblowers

healthcashIn Fall 2012, RxAmerica (a subsidiary of CVS) agreed to pay $5.25 million to settle a Medicare fraud action that consolidated two suits brought by Medicare beneficiaries.  According to Law360, Robert Fischer filed suit against RxAmerica in a New York federal court after noticing suspiciously large payments on an Explanation of Benefits (“EOB”) report sent to him by Medicare.  As explained in a Business Wire report, Jan and Max Hauser also filed suit against RxAmerica bringing their claim in a North Carolina federal court.  The Hausers also carefully reviewed an EOB statement and they noticed that RxAmerica was charging the government more money for prescription drugs than had listed in the Plan Finder tool they had used when selecting their Medicare Part D plan.  This discrepancy meant the Hausers consumed their allowed benefits faster than expected/promised and had to pay out-of-pocket for their prescription medications.