Who Brings Government Fraud Whistleblower Claims?

We frequently write about healthcare fraud and other forms of government contract fraud.  We cannot overemphasize the role that whistleblowers play in prosecuting these cases.  According to the Justice Department, nearly $3 billion of the $5.69 billion recovered through settlements and judgments in civil False Claims Act (“FCA”) litigation in Fiscal Year 2014 stemmed from qui tam lawsuits filed by private whistleblowers.  Who are these whistleblowers?  In some cases, they are high-ranking executives in companies that committed fraud.  However, whistleblowers can also be “rank and file” employees, the “everyday” workers who form the majority of any large operation, or even company outsiders.  Our law firm for government fraud whistleblowers works with people from all ranks of society who take step forward and join the fight against fraud.

Settlement In Suit Brought By Medical Technician

Last month, the Sacramento Bee reported that Quest Diagnostics agreed to pay $1.8 million to settle Medicare fraud claims.  According to the allegations, Quest submitted duplicate claims for Medicare reimbursement for the same test performed on a single day and a single patient.  A Quest spokesperson suggested IT issues caused rare cases of duplicate payments impacting a “miniscule percentage” of the company’s annual Medicare claims and said Quest is updating its billing systems to prevent a recurrence.

The Bee reports that the underlying lawsuit began four years ago when a phlebotomist (someone who draws blood) raised concerns about the company’s billing processes.  In July 2009, the phlebotomist was hired to work at a Quest location in Red Bluff, California.  According to the federal complaint, within three months she began asking supervisors about instances of double billing and, after being told to “listen more and back up everybody,” she was placed on leave in February 23, 2011 and terminated that June.  She filed formal FCA allegations, becoming a whistleblower “to stand up for what she knew was right.”  The U.S. government investigated and, according to sources including the Corporate Crime Reporter, substantiated her allegations.

Additional Examples of “Everyday” Whistleblowers

Other notable cases include:

  • A suit brought by a company pharmacist alleging Kmart provided improper inducements to Medicare beneficiaries was settled this month, according to the DOJ, in an agreement that includes a $1.4 million payment by the retailer.
  • A $5.5 million payment is part of an agreement resolving allegations Mercy Springfield Communities submitted Medicare claims while paying referring physicians bonuses that violated federal law by taking into account the economic value of the referral. As detailed by the DOJ and The Springfield News Leader, the whistleblower suit was filed under the qui tam provisions of the FCA by a hospital pediatrician.
  • A settlement in excess of $1.5 million will resolve a suit brought by a triage nurse under the FCA’s whistleblower provisions. Per a DOJ Press Release, the lawsuit alleged that Alive Hospice overbilled Medicare and Tennessee’s state provider by billing for services beyond those medically necessary.
  • In a previous post, linked below, we discussed False Claims Act cases against several for-profit education organizations. Disputes of this nature include:
    • A suit involving allegations of improper payments to admissions counselors that ended with The University of Phoenix paying $67.5 million pursuant to a December 2009 settlement agreement. The DOJ refers to the whistleblowers simply as former employees, while The Arizona Reporter clarifies, calling them enrollment counselors.
    • Although largely unresolved, there have been several whistleblower complaints filed against Education Management Corp. (“EDMC”). According to TribLive (a portal for several Western Pennsylvania newspapers), a suit including allegations of misconduct in the recruitment of military veterans who were eligible for GI Bill benefits was filed in December 2014 by six former admissions officers and a military paratrooper who was an online student with EDMC.

A Varied Group Linked by a Commitment to the Truth

While some of these whistleblowers are certainly highly educated professionals, they were still simply employees or consumers (the paratrooper-turned-EDMC-student was, in general terms, a consumer of the company’s services) who spoke up.  Certainly, current/former executives do file whistleblower complaints.  For example, this month the DOJ announced that Columbus Regional Healthcare Systems (“CRHS”) will pay $25 million to $35 million to resolve allegations of improper billing and inappropriate physician relationships brought by the former managing director of a center owned by CRHS (The Ledger-Enquirer provides a timeline the newly hired managing director’s attempt to raise concerns internally).  However, many whistleblowers are “ordinary people,” employees who saw something wrong and spoke up.  In many, if not most, cases, we suspect they tried to voice concerns internally before taking the next step.

Don’t hesitate to report fraud because you feel like you aren’t “the whistleblower type.”  Whistleblowers are a varied group wih one essential commonality – honesty.  It is a bit unfair to call them “everyday” given the importance of their role, but not all whistleblowers sit in boardrooms.  If you suspect you’ve witnessed health care or government contract fraud, our government fraud attorney welcomes your call.  It IS people like YOU who bring these claims and make a true difference.


Note: In most cases, settlements involving the FCA do not amount to an admission of liability and all claims mentioned above should be considered unproven allegations.

See Related Blog Posts:

Whistleblowers’ Law Firm Alert: For-Profit Schools Committing Federal Student Aid Fraud

Beneficiary-Reported Medicare Fraud

(Image by Bruce Bortin)

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