Healthcare Fraud Lawyer Blog

November 5, 2016

What is a Whistleblower Qui Tam Lawsuit?

It can be perilous for a single individual to expose a company’s illegal acts. Whistleblowers, as these courageous people as called, risk losing their jobs, damaging their reputations, being ostracized by coworkers and neighbors, and other detriments by daring to speak up.

Federal and state legislatures recognize the dangers and have enacted whistleblower laws, which protect those who come forward from retaliation by the persons or businesses they identify as engaging in illegal conduct. False Claim statutes also provide whistleblowers with legal recourse. These laws allow for qui tam lawsuits, which allow a person to sue an individual or business believed to have defrauded the government of public funds to recover the illegally obtained money. The person bringing suit is referred to as a “qui tam plaintiff,” and can possibly receive a large percentage of the funds collected from the wrongdoers.

By allowing whistleblowers to bring a civil action, governments acknowledge the public service whistleblowers fulfill and the hardships they endure as a consequence of their exposing fraud.

November 4, 2016

What to Do if You Get Fired for Whistleblowing

by Gregory J. Brod

The California Whistleblowers law prohibits employers, or someone associated with them and acting on their behalf, to retaliate against employees who report their employer’s unlawful activities. The retaliation can take many forms, such as:

Terminating the employee’s employment
Demoting the employee or denying the worker a deserved promotion, raise, or bonus

November 2, 2016

How Laws Protect Whistleblowers

by Gregory J. Brod

Employers are expected to act ethically and within the law. Many state and federal laws and regulations mandate how employers should behave toward their employees, their customers, unions, the business community, and the environment. But we know many government and private employers break the law in big and small ways.

As an employee you may not be aware of shortcuts your boss may take to skirt a burdensome legal requirement or even when the officers and managers of the company you work for engage in full-scale illegal behavior. Employers, like any other lawbreaker, take precautions to hide their activities to ensure they do not get caught.

David vs. Goliath

October 30, 2016

Research Hospitals Becoming New Target for False Claims Act Actions

by Gregory J. Brod

The False Claims Act is a federal statute designed to be used by whistleblowers who expose government fraud and waste. The whistleblower seeking to expose this type of deceit and corruption files a private lawsuit seeking to assert the rights to compensation for the government. Regardless of whether the government joins the suit and assists in the prosecution of the case, the successful whistleblower is permitted to recover a portion of the amount of funds he or she is able to recover for the government.

Those entities most likely to find themselves the target of a False Claims Act suit are private doctors’ offices and other healthcare providers who accept patients with Medicare and Medicaid. In recent years, however, there has been an increasing number of FCA suits filed against a new defendant – the university hospital.

Examples of FCA Claims Against Research and University Hospitals

October 12, 2016

Qui Tam Suit Settled by Three Orthopedic Clinics

by Gregory J. Brod

Accused of purchasing viscosupplements (medications used in the treatment of osteoarthritis) overseas and then billing Medicare and Medicaid at an inflated cost, three California orthopedic clinics have agreed to settle claims against them for a combined settlement of $2.39 million. Orthopedic Associates of Northern California has agreed to pay $815,794, San Bernardino Medical Orthopaedic Group will pay $971,903, and Reno Orthopaedic Clinic has agreed to pay $602,335 for their participation in a fraud scheme designed to overbill federal and state healthcare programs.

How the Scheme Worked and Was Discovered

The medications at issue in this case were manufactured in the United States and then exported to suppliers and others overseas. According to the allegations made against each of the defendants, the clinics would purchase osteoarthritis medications from these overseas suppliers and prescribe these medications to patients who had Medicare or Medicaid. The clinics were able to obtain the medications at a much lower cost than they would have had to pay if they had obtained the medications from suppliers in the United States. Because these state and federal programs reimburse clinics for viscosupplements at a set rate, each clinic was able to pocket the difference between the amount they were reimbursed by Medicare and the cost they had to pay to obtain the medications from international suppliers.

October 5, 2016

New Frontiers in Whistleblower Suits

by Gregory J. Brod

Your San Francisco qui tam lawsuit and whistleblowers’ lawsuit attorney understands and appreciates the important role whistleblowers play in American society. Whistleblowers are instrumental in exposing fraud, waste, dangerous or hazardous conditions, and other instances of “bad behavior” that put people’s health and wellbeing in jeopardy or unreasonably threatens property or taxpayer money. Whistleblower actions and lawsuits have, for example:

Uncovered unsafe working conditions on job sites;
Exposed contaminants and dangerous chemicals present in the food and/or water supply;

September 30, 2016

California Whistleblower Lawsuit Attorney Explains How Individuals Can Have a Disproportionate Impact

by Gregory J. Brod

In our society, it can often seem as if the “little guy” or “little gal” has no power or ability to resist a strong and powerful individual or corporation. This can discourage some people who may witness a large or influential person or company commit a criminal or unethical act from reporting such behavior or pursuing a qui tam lawsuit. However, actions taken by the California State Treasurer against banking giant Wells Fargo illustrate just how powerful whistleblowers can, in fact, be.

A Recap of the Wells Fargo Scandal

In recent weeks the extent of the Wells Fargo account scandal has come to light. Although investigations into Wells Fargo’s opening of unauthorized accounts goes back to 2013, only recently has it come to light that the scandal involved thousands of employees and went on for nearly five years. As detailed before Congress recently, Wells Fargo employees – under pressure to meet quotas for new accounts and getting customers to sign on for additional products or services – would open new accounts and products for existing customers without getting the permission of the customer first. Some customers would be tagged with overdraft penalties (for instance) when their checking account suddenly did not have enough money to cover all outstanding checks written against the account because a Wells Fargo employee had taken money from the checking account and used it to open a new savings account in the customer’s name.

September 19, 2016

California Company Tries to Preemptively Prevent Whistleblower Suits

by Gregory J. Brod

It is no secret that employers are not particularly fond of whistleblower laws. These laws not only provide financial incentives for those employees or stakeholders who know of a company’s wrongdoing to come forward, but they also prevent an employer from discouraging whistleblowers through the use or threat of retaliation. Despite the existence of these laws, however, companies may still try to find ways to dissuade potential whistleblowers from making reports to government agencies and/or filing suits under the False Claims Act. That, at least, is what one California company is accused of doing recently.

A (Failed) Preemptive Strike Against Whistleblowers

As opposed to retaliating against employees who had filed whistleblower claims against the company or reported the company’s activities to government authorities, California-based Health Net allegedly tried to accomplish this goal before any claim had been filed. Allegations made against the company state that Health Net made employees sign an agreement in which they acknowledged that they would not receive any severance from the company if they reported the company to a governmental agency and/or participated in a whistleblower lawsuit against the company. In other words, any employee that wished to obtain any sort of severance pay or benefits from the company needed to keep quiet about any illegal or unethical behavior in which they observed the company engaged.

September 15, 2016

Southern California Qui Tam Law Firm Comments on Beauty School Insurer Settling Whistleblower Lawsuit

by Gregory J. Brod

The insurance carrier for the for-profit Marinello Schools of Beauty has agreed to pay over eight million dollars to settle a qui tam (whistleblower) lawsuit filed against the school’s operator by six former employees. According to the suit, B & H Education, Inc. – which operates the Marinello Schools of Beauty in various locations throughout Southern California – allegedly assisted students without a high school diploma in obtaining invalid diplomas. These students would then enroll in the school and obtain federal financial aid for which the students were not eligible (federal regulations require recipients of federal student aid to have obtained a valid high school diploma). As part of the settlement, B & H Education, Inc. has admitted to no wrongdoing.

Details of the Qui Tam Lawsuit and Allegations

The lawsuit was brought by six former employees of B & H Education, Inc. against the insurer after the education company went out of business in early 2016. According to the allegations of the plaintiffs (who filed the suit on behalf of the United States), B & H would assist students in obtaining a high school diploma by allowing them to take unproctored tests, use aids like cellphones while taking tests, and enabling students to retake the same tests over and over until they were successful. Upon “successfully” completing their high school diploma in this manner, the students would then enroll at the beauty school and obtain federal student aid. The company’s schools were allegedly kept in business through the federal student loan monies that students would receive (and then pay to the school for tuition expenses and other educational costs).

September 4, 2016

Whistleblower Law Firm Explains Announcement That OSHA is Field-Testing Expedited Process for Addressing Whistleblower Claims

by Gregory J. Brod

Last month the Occupational Safety and Health Administration (OSHA) announced a pilot program it is currently field-testing in the Department of Labor’s Western region (covering Arizona, American Samoa, Guam, Nevada, Hawaii, and California). Recognizing that the processing of some whistleblower claims is time consuming, the process (called Expedited Case Processing Pilot) allows a complaining whistleblower whose claim meets certain criteria to can ask OSHA to forward his or claim along with any findings of fact made by OSHA to an administrative law judge for consideration.

Criteria for Expedited Processing and How the Process Works

Not all whistleblower claims OSHA are eligible for the expedited process. In order to qualify, the following facts and circumstances must be true: