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When Shining A Light on Injustice Pays Off: Some of the Largest Whistleblower Cases in Healthcare of This Decade

When wrongdoing takes place in healthcare, it doesn’t just cost money. The health and safety of innocent lives may be at risk when healthcare protocol isn’t followed or resources are incorrectly allocated.

That’s why it is of the utmost importance that all healthcare fraud is reported to the proper authorities as soon as possible. While this can be an unnerving process for potential whistleblowers, shining a light on injustice is worth it when wrongdoers are held accountable for their actions.

To demonstrate the potential outcome of stepping forward and doing the right thing, here are some of the largest whistleblower cases in healthcare in the past decade:

Johnson & Johnson

In 2013, global healthcare giant Johnson & Johnson was ordered to pay more than $2.2 billion to resolve criminal and civil investigations. The fraud surrounded the prescription drugs Risperdal, Invega, and Natrecor. Johnson & Johnson and its subsidiaries were promoting the drugs for uses not approved by the FDA and paying kickbacks to physicians and long-term care pharmacy providers.

The complaint goes on further to state that Johnson & Johnson was aware that Risperdal posed a health risk for the elderly, but they downplayed these risks to market the drug as safe. They also marketed the drug to children with mental disabilities, despite the drug being dangerous for children. These are just two examples, there were other cited incidents of promoting their drugs for off-label or dangerous uses.

Johnson & Johnson was also found to have paid speaker fees to doctors to influence them to write prescriptions for Risperdal. Additionally, they paid kickbacks to Omnicare Inc. in order to promote the use of Risperdal for elderly dementia patients in nursing homes.

As a result, Johnson & Johnson and its subsidiaries paid $485 million in criminal fines and forfeiture and civil settlements with the federal government and five participating states totaling $1.72 billion. The whistleblowers in the Eastern District of Pennsylvania received $112 million, the whistleblowers in the District of Massachusetts received $27.7 million, and the whistleblower in the Northern District of California received $28 million.

Abbott Laboratories

In the same year, Abbott Laboratories was ordered to pay $5.475 million for several violations of the False Claims Act and other federal laws and regulations. The settlement brought about by whistleblowers coming forward covered fraud that took place over the span of five years.

During that time, Abbott Laboratories allegedly offered physicians paid teaching assignments, consulting arrangements, speaking engagements, and scholarship grants to encourage them to get the hospitals they work with to purchase Abbott’s carotid, biliary, and peripheral vascular products. These kickbacks resulted in violations of the False Claims Act since Medicare paid the claims submitted for these devices since the purchase decision was driven by financial inducements.

This settlement was the result of a comprehensive investigation kicked off by a whistleblower complaint who received financial compensation for their efforts.

Reckitt Benckiser Group

In 2019 Reckitt Benckiser Group (RB Group) was the center of the largest recovery case concerning an opioid drug in United States history. The settlement had RB Group paying $1.4 billion to resolve criminal and civil liabilities around their drug Suboxone.

Suboxone is approved for use by recovering opioid addicts to help treat withdrawal symptoms. However, the active ingredient (buprenorphine) is a powerful and addictive opioid. The RB Group and its subsidiary at the time, Indivior, promoted Suboxone to physicians, pharmacists, Medicaid administrators and others as a safer and less-abusable drug, even though those claims were never factually established.

Whistleblowers played a key role in working with the U.S. Attorney’s Office and the Department of Justice’s Consumer Protection Branch to hold the RB Group accountable for their role in the opioid crisis.

In each of these cases, not only was the injustice exposed and corrected, but the whistleblowers who came forward were given a substantial award. Additionally, healthcare organizations were held accountable for their wrong decisions and will act with integrity moving forward.

But whistleblowers can’t enact change alone. They need the right team of legal professionals on their side to ensure confidentiality, follow proper procedures, and help them secure a reward whenever possible. If you are ready to take the first step in shining a light on injustice but need expert guidance, contact us today for a confidential consultation.

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The Nurses Know All: Tips for Whistleblowing in Nursing

Now more than ever, nurses are being recognized for the unsung heroes they are. Nurses are heavily involved in so many aspects of patient care and are critical to the operation of healthcare facilities. Since nurses are so heavily involved in patient care and work closely with doctors and other care providers, they are also more likely to witness wrongdoing in the workplace.

Nurses are highly educated to determine whether or not a patient is receiving quality care and are experienced in knowing when care providers are partaking in fraudulent activities. There is a legal and ethical obligation for nurses to report illegal, unethical, unprofessional, or unsafe practices under the American Nurses Association Code of Ethics. Therefore, any suspicion of healthcare fraud or malpractice should be given further thought.

Nurses have a unique vantage point which can make them valuable whistleblowers. The team at the DJO Whistleblower Law Group has tips to offer for whistleblowing in nursing.

1. Gather clear evidence of illegal, unethical, and/or unsafe practices

Witnessing wrongdoing provokes an emotional response and it may be tempting to take immediate action. However, it’s best to reserve judgment and delay action until there is clear evidence and documentation of the illegal or unethical action.

Document your complaint in writing in as much detail as you can so you do not forget any important details. Keep documentation as objective as possible, stating only facts and actions. Then, carefully monitor the situation for documentation, paperwork, transactions, or conversations that could prove a violation of the False Claims Act or other compliance regulations.

2. Don’t let fear of retaliation dissuade you from coming forward.

The top reason nurses don’t come forward is out of fear of retaliation and/or losing their job. However, if you follow the proper whistleblower protocol you are usually protected from certain forms of retaliation once you blow the whistle. The important thing to keep in mind is that you are not protected if you just confront the wrongdoer directly–you have to follow the right steps.

Nobody can deny that blowing the whistle has its pros and cons. But letting fear or retaliation stop you from coming forward will just allow the fraudulent activity to continue. The Whistleblower Protection Act and other anti-retaliation laws will protect you while you take the brave step of coming forward.

3. Avoid consulting people directly involved with the situation.

It might be tempting to confront the wrongdoer directly to avoid a complicated legal battle. But people engaged in bad actions typically won’t welcome your questions or concerns, and may even take punitive action against you. Remember, after all, you are not protected from retaliation until you officially blow the whistle.

4. Consult with an attorney who specializes in healthcare fraud cases.

There are options for third parties to consult when you witness fraud. While many options may be easily available, they don’t always provide the right experience for the situation. For example, The Joint Commission or the National Committee for Quality Assurance doesn’t always offer confidentiality or retaliation protection.

The best course of action is to consult a law group with attorneys who specialize blowing the whistle in healthcare. They will be able to offer confidential consultations, give advice, guide you through the process, and help you potentially secure a financial reward for bringing injustices to light.

Nurses who are employed by healthcare providers participating in fraud are encouraged to step forward, and the DJO Whistleblower Law Group will take those steps with you.

 

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What Protections Exist for Whistleblowers in the Respiratory Industry? Tips and Advice from the Experts

People who witness fraud in the respiratory industry may hesitate to come forward out of fear. This is a valid concern; we have all heard stories of people being retaliated against, or punished in some way for speaking up for what is right.

However, there are laws and acts in place that protect whistleblowers from potential adverse reactions by employers. There are also steps that potential whistleblowers can take to make sure they are protected and ensure confidentiality of all consultations and proceedings.

What protections exist for whistleblowers in the respiratory industry?

There are laws in place for the sole purpose of protecting whistleblowers that would like to learn how to report respiratory fraud. They include:

The False Claims Act

The False Claims Act (FCA) is a federal law that makes it illegal for any person or organization to make a false record or file a false claim in order to obtain reimbursement from programs like Medicare, Medicaid, or Tricare. Under the FCA, individuals who report a violation are protected from discrimination, harassment, suspension, or termination.

The Whistleblower Protection Act

The Whistleblower Protection Act (WPA) was passed in 1989 to — as the name implies — protect whistleblowers. Under the WPA, federal employees cannot have punitive action taken against them by their employers for coming forward with information that evidences:

  • A violation of law or regulation
  • Gross mismanagement or waste of funds
  • An abuse of authority
  • A threat to public health or safety

The WPA applies to current employees as well as applicants.

Whistleblower Protection Enhancement Act (WPEA)

In 2012, Congress passed the WPEA to strengthen the WPA. There were grey areas where it was unclear whether or not the whistleblower was protected, so the enhancement made the following clarifications: In an individual is still protected by the WPA…

  • Even if disclosure was made to someone involved in the wrongdoing.
  • Even if wrongdoing has already been disclosed by someone else.
  • Regardless of the reporter’s motive.
  • Even if the disclosure was made while the individual was off duty.
  • Regardless of the amount of time that has passed since the wrongdoing.
  • If the report is in regards to censorship of research, analysis, or technical information that exposes wrongdoing.

OSHA

OSHA has a Whistleblower Protection Program (WPP) that prohibits employers from firing, laying off, demoting, denying overtime or promotion, or reducing pay or hours for anyone who takes actions protected by the WPP. The WPP includes over 20 statues of protection which you can find here.

Tips and advice from the experts

For those considering blowing the whistle on fraud in the respiratory industry, consider the following tips and pieces of advice for maintaining the highest level of protection and confidentiality:

Know the fraudulent activities you can report

Some examples of fraud within the respiratory industry include:

  • Data mining
  • Billing for non-compliant patients
  • Waiving co-insurance
  • Billing for products or services that never occurred
  • Forging or changing medical orders to receive payments for respiratory devices or treatments
  • High-pressure sales tactics
  • Avoiding lawful return of equipment
  • Multiple billing for home sleep tests

Note that this list isn’t exhaustive, but it contains the most commonly seen instances of fraud.

Consult with a leader in whistleblower representation

Once you’re certain you have a case that warrants reporting, it’s important to consult with an attorney who specializes in helping whistleblowers report respiratory fraud. They will know the proper course of action to follow whistleblower protection laws. They also can guarantee confidentiality while working hard to secure a financial reward for your bravery whenever possible.

Nobody should hold back information about fraud or wrongdoing out of fear. There are protections in place to make sure you don’t face any negative repercussions. Attorneys like the team at the DJO Whistleblower Law Group can guide you through the process, making you feel comfortable and secure the entire time.

Find out more by contacting us today.

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Are You Considering Becoming A Whistleblower? Here’s What to Know About Healthcare Fraud Attorneys

If you are considering becoming a whistleblower, you’re sure to have a lot of questions. First of all, the team at the DJO Whistleblower Law Group wants to thank you for making the courageous decision to come forward.

Next, we’re here to help you with the questions you may have. One of the first being “Where do I start?” The first place to start is to consult with a healthcare fraud attorney. If you have never been a whistleblower before (which most people haven’t), you might not know a lot about healthcare fraud attorneys.

Here is some information about healthcare fraud attorneys to help get you started.

They are experts in the different types of healthcare fraud

There are many different things that constitute healthcare fraud. Presenting your concerns to an attorney may uncover more instances of fraud than you initially thought. They are experts in numerous types of healthcare fraud, including:

  • Upcoding
  • Multiple billing
  • Billing for services not rendered
  • Paying kickbacks for a referral
  • False care certifications
  • Waiver of coinsurance payments
  • Commission only sales reps
  • Fraudulent billing of healthcare services
  • Fraudulent patient assistance programs

…and so much more. So, if you find yourself witnessing some kind of healthcare fraud, be sure to disclose as much detail as possible to the attorney as they may recognize signs of additional fraud.

They can help you determine if you have a good case and what would be the best course of action.

Something that holds many potential whistleblowers back from coming forward is not being sure if there is legitimate case of fraud taking place. Healthcare fraud attorneys can provide a consultation to let you know if you have an actionable case.

and a number of state-level regulatory bodies, healthcare fraud attorneys can provide expert advice on how to effectively blow the whistle in your unique situation.

What to know about the team at the DJO Whistleblower Law Group

The healthcare fraud attorneys at the DJO Whistleblower Law Group spare no effort to make sure everyone who seeks guidance in doing the right thing is given the best possible experience.

Our team consists of expert attorneys who focus specifically on whistleblower cases. For example, our Director of Investigations, Christopher Piacentile, CFE is a highly skilled certified fraud examiner and certified FCPA expert with more than 25 years of experience within over 200 fraud cases.

With decades of experience and hundreds of cases behind us, our team has been directly involved in recouping hundreds of millions of dollars. We’re here to be the resource you need when making the decision to be a whistleblower. From private consultations to see if this is the right move, to representation during your proceedings, the team at the DJO Whistleblower Law Group will be at your side every step of the process.