Cincinnati, Ohio whistleblower lawyer investigating qui tam healthcare fraud cases and kickback lawsuits on behalf of plaintiffs nationwide.
Medical specialists in fields like labor and delivery, pain management, cardiology and other practice areas regularly refer patients for tests, procedures, surgeries and other services, making the an attractive target for illegal kickback schemes. Referring fellow physicians or other health care providers or pushing certain medications can violate specific kickback statutes and can lead to fraud allegations.
Whistleblowers in recent years have come forward and reported illegal healthcare kickback activities, and have been awarded for the money they recovered for government programs like Medicare and Medicaid.
It is illegal for doctors and specialists to take money from providers and pharmaceutical reps and medical device suppliers in return for the referral of Medicare and Medicaid patients. In turn, it is illegal to pay others for Medicare and Medicaid patient referrals.
Any healthcare kickback scheme can be reported by whistleblowers and those who come forward can be awarded in kickback lawsuits. Kickbacks in health care are highly discouraged as they are likely to lead to:
Joe Lyon is a Cincinnati, Ohio whistleblower attorney reviewing healthcare kickback lawsuits and qui tam claims on behalf of plaintiffs and health care whistleblowers nationwide.
The Anti-Kickback Statute (AKS) is a criminal law that prohibits the payment of “remuneration” to induce or reward patient referrals or the generation of business involving any product or service payable by federal health care programs—drugs, medical supplies, or health care services for Medicare or Medicaid patients.
Remuneration in kickback schemes can include anything of value, including money, free rent, hotel stays and meals, and excessive compensation for medical consultancies. Regarding federal health care programs, paying for referrals is a crime.
Criminal penalties and administrative sanctions for violating the anti-kickback statute may include fines, jail terms, and the loss of a medical license. Physicians who pay or accept kickbacks may face penalties of up to $50,000 per kickback instance plus 3X the amount of the remuneration. Whistleblowers can be awarded up to 30 percent of the recovered amount.
The Department of Justice obtained more than $3 billion in settlements and judgments from civil whistleblower cases involving false claims against the government in 2019, many of which involved illegal health care kickback schemes.
Other important federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).
The kickback statute applies to all sources of referrals. Even waiving copays can demonstrate an illegal act in some cases for Medicare and Medicaid patients. It is legal, however, to provide free or discounted services to uninsured people.
According to the government, anti-kickback laws are concerned with preventing financial considerations from warping physicians’ medical decisions. Some health care kickback lawsuits have been filed when hospitals pay doctors enormous sums in salaries and incentives, often expecting hospital referrals.
Hospitals may disguise physicians’ salaries, or even base their pay on how much business they generate. Doctors generate business each time they order a procedure or test, or decide that a patient needs to be admitted overnight or see a specialist. The average internist can generate up to $3 million in hospital revenue each year.
Medical device and drug companies have found ways to sidestep bribery and anti-kickback laws in the past, though in light of the opioid crisis, the Justice Department has been trying to crack down on practicing doctors working almost directly for pharmaceutical companies.
In a recent whistleblower settlement, ResMed Corp., a medical equipment manufacturer, agreed to pay more than $37 million to resolve alleged False Claims Act violations for paying kickbacks to suppliers, sleep apnea labs and other health care providers.
The settlement resolves allegations that ResMed provided companies with interest-free loans, free services which enabled them to order resupplies for their patients with sleep apnea, and free equipment to non-sleep specialist physicians. When companies give free equipment to doctors to generate business and increasing profits, federal health insurance programs pay the bills.
The plaintiff’s attorney made the following statement: “Medical decisions should be based on what is in the best interest of the patient and not based on financial incentives and related schemes.”
The agreement resolves five whistleblower lawsuits under the qui tam provisions of the False Claims Act. The False Claims Act allows citizens with knowledge of healthcare fraud against the government to bring a lawsuit on behalf of the U.S. government and to share in the recovery. The ResMed whistleblowers will receive over $6 million in the settlement.
Teva Pharmaceuticals agreed to pay $54 million to settle a whistleblower lawsuit claiming it paid doctors to prescribe Copaxone and Azilect. Former Teva sales reps sued the company in 2013, alleging the company set up a program to pay doctors to prescribe the drugs through large speakers’ fees.
Novartis has been facing numerous healthcare fraud lawsuits, and whistleblowers have identified illegal kickbacks to at least 20 pharmacies for selling the medication Myofortic. Pharmacies who switched kidney transplant patients from a competitor’s medication to Myfortic were compensated in the form of rebates and discounts. The kickback scheme resulted in huge growth in Myfortic sales.
Another whistleblower lawsuit alleges that Novartis handed out illegal kickbacks to physicians in exchange for prescribing the medications Lotrel, Valturna and Starlix. The Swiss corporation allegedly enticed, bribed and rewarded doctors in a kickback scheme that lasted years. This led to Medicare and Medicaid reimbursing Novartis with millions of dollars.
Whistleblowers involved in Qui Tam lawsuits and recover government funds can be rewarded handsomely for having the courage to come forward with information leading to the recovery of ill-begotten government money. When individuals or companies defraud the government in healthcare, financial or defense contractor work, one whistleblower can make a difference by coming forward.
Many whistleblower are understandably reluctant to file a Qui Tam lawsuit against an employer, because in the process they may lose their job and close relationships in potential retaliation. Joe Lyon is a Cincinnati fraud lawyer assisting plaintiffs in large settlements and can protect against retaliation.
When plaintiffs have evidence of government fraud and takes action in qui tam lawsuits, they are advised to contact a Cincinnati government fraud lawyer to guide them through a complex legal process. The rewards can be substantial though it is crucial to consider the implications of bringing a lawsuit against an employer.
Employees who have filed whistleblower lawsuits in the past have been wrongly terminated, demoted and discriminated against at work, which is grounds for yet another claim against the employer. The False Claims Act provides job protection to whistleblowers because of the wide range of professional and personal risks taken by whistleblowers.
Qui Tam lawsuits filed under the False Claims Act reward whistleblowers if the information provided by a plaintiff allows the government to recover funds lost to company or individual fraud.
The most common forms of government fraud involve the healthcare, finance and defense industries, where large amounts of money change hands in various transactions. Whistleblowers can receive 15 to 30 percent of the total recovery of a successful fraud lawsuit.
Because qui tam lawsuits usually involve large government contracts in healthcare, finance or defense, the recovery amounts can be quite sizable, and the awards for whistleblowers are commensurate with the total recovered. The Justice Department (DOJ) recovered over $4.7 Billion from False Claims Act cases in 2016 alone.
The Department of Justice awarded plaintiffs (whistleblowers) in government contractor fraud cases over $500 million for information and specific evidence leading to the recovery of government funds.
If you have information regarding health care fraud or illegal company kickbacks, and have questions about potential qui tam legal action, contact The Lyon Firm (800) 513-2403. You will speak directly with Mr. Lyon, and he will help you answer critical questions regarding whistleblower settlements and health care kickback lawsuits.