Healthcare whistleblowers expose alleged fraud, pocket $1 million-plus awards
Several whistleblowers who exposed alleged healthcare fraud at companies they worked for will pocket $1 million-plus awards.
Two recent settlements illustrate how whistleblowers can expose alleged healthcare fraud, which costs the federal government billions of dollars each year, said Scott Williams, CEO of Ethic Alliance.
In one recent case, a former accountant will pocket $1.4 million for blowing the whistle on several pharmacies that allegedly violated federal laws by waiving copays, charging the government higher prices than permitted, and trading federal healthcare business with other pharmacies.
The U.S. Justice Department announced Oct. 12, 2022, that DermaTran Health Solutions LLC, Pharmacy Insurance Administrators LLC, Legends Pharmacy, TriadRx and other business entities will pay $6,876,564 to settle allegations that they violated the federal False Claims Act.
The settlement stems from claims made in a lawsuit filed in federal court in Georgia by a former accountant for DermaTran under the qui tam or whistleblower provisions of the False Claims Act, which allows private citizens to sue for false claims on behalf of the United States and share in any recovery by the government. The accountant, who is not being publicly identified, will receive $1,434,775 from the settlement. One of the pharmacies involved in the settlement, PIA, will also pay her attorney’s fees, according to the Justice Department.
“Health care providers that try to boost their profits by submitting fraudulent claims to Federal health care programs threaten the integrity of those programs and drive up prices for everyone,” said Tamala E. Miles, Special Agent in Charge with the U.S. Department of Health and Human Services Office of Inspector General.
In another recent settlement, Carter Healthcare Affiliates and two senior managers will pay $7.2 million to settle allegations that from 2014 to 2016 they billed the Medicare program for medically unnecessary therapy provided to patients in Florida, the Department of Justice announced Oct. 18, 2022. Carter Healthcare is an Oklahoma-based for-profit home health provider.
Two therapists formerly employed by Carter Healthcare, Sharon Mahaffey and Mark Brimer, who exposed the alleged fraud will together receive $1.3 million as their share of the settlement. Mahaffey and Brimer sued Carter Healthcare under the qui tam provisions of the False Claim Act, the Justice Department said.
In a separate case, the Justice Department announced Oct. 18, Carter Healthcare agreed to settle another whistleblower case by paying an additional $23 million. The case alleged that between 2013 and 2020, the company improperly paid its home health directors in Oklahoma and Texas to induce referrals of home health patients.
“Patients deserve care based on good medicine and informed choice that is free from the corrupting influence of money and other motivating enticements,” said U.S. Attorney Robert J. Troester, in a statement. The parties charged in the case did not admit liability, the Justice Department noted.
The allegations were first brought in a qui tam lawsuit filed by whistleblowers, who have not been publicly identified. The whistleblowers will share in the settlement amount, the Justice Department said.
Related posts: https://www.justice.gov/usao-ndga/pr/dermatran-and-three-other-pharmacies-pay-over-68-million-settle-civil-claims ; https://www.justice.gov/opa/pr/carter-healthcare-affiliates-and-two-senior-managers-pay-7175-million-resolve-false-claims ; https://www.justice.gov/usao-wdok/pr/oklahoma-city-home-health-company-and-two-former-corporate-officers-agree-pay-229
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