William LaCorte, a physician in Louisiana, has earned a $59 million whistleblower reward after Pfizer agreed to pay $784 million to settle allegations of false claims to Medicaid for Protonix, a heartburn medication. The complaint alleged that Pifzer’s subsidiary, Wyeth, failed to pay rebates to Medicaid to account for price discounts that Wyeth had provided to other customers.
Dr. LaCorte is no stranger to high-stakes whistleblower litigation. He received $38 million in whistleblower rewards from prior qui tam or whistleblower lawsuits against other pharmaceutical companies, including one in which Merck agreed to pay $250 million to settle allegations that it offered hospitals better terms than Medicaid for its heartburn medicine, Pepcid. Because of whistleblowers like Dr. LaCorte, the government recovered $2.8 billion in settlements last year under the False Claims Act, which allows individuals to commence whistleblower lawsuits on behalf of the government and share in any recovery. In return, the government paid whistleblower rewards totaling $597 million. Pharmaceutical cases tend to result in the largest whistleblower rewards. For example, a former sale representative for Endo Pharmaceuticals recently collected a $33.6 million whistleblower reward after the company agreed to pay $140 million to settle allegations that it engaged in off-label marketing of Lidoderm, a pain medication. In 2012, the government distributed $300 million in whistleblower rewards when GlaxoSmithKline agreed to pay $2 billion to settle allegations of off-label marketing and illegal kickbacks involving a number of its drugs. The key to a successful whistleblower case is having evidence of fraud or false claims submitted to Medicare or Medicaid. Mere allegations or suspicions of fraud are not enough. A successful whistleblower case requires evidence. And that creates some risks for potential whistleblowers. Gathering the evidence to support Medicare or Medicaid fraud claims may expose whistleblowers to allegations that they violated HIPAA privacy restrictions, company confidentiality policies, and even criminal statutes such as the Federal Computer Fraud and Abuse Act. If you have evidence of healthcare fraud or false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. But you also need legal advice to comply with your own obligation to maintain the privacy of confidential information. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Children's Hospital Allegedly Filed False Cost Reports to Increase Reimbursement Rates from Medicare and Medicaid.
James A. Roark, Sr., a former employee of Children's National Medical Center, will receive a $1.9 million whistleblower reward for coming forward with evidence that his former employer submitted false cost reports to the government in order to increase its reimbursements from Medicare and Medicaid. The whistleblower reward resulted from a settlement agreement in which the hospital agreed to pay $12.9 million in restitution to the government. The whistleblower claimed that the hospital filed false cost reports that misstated its overhead, which resulted in higher reimbursement rates and overpayments from Medicare and Medicaid. According to the settlement agreement, the hospital also misreported its available bed count on an application for the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. The CHGME Payment Program provides federal funds to freestanding children's hospitals to help them maintain their graduate medical education programs that train pediatric and other residents. Under the False Claims Act, an individual citizen may commence a whistleblower or qui tam lawsuit on behalf of the government to recover money for false claims submitted to Medicare, Medicaid, and other government programs. The qui tam lawsuit is filed "under seal" (in secret) and the whistleblower's evidence is given to the government, which then must conduct an investigation. If the government recovers money as a result of the lawsuit, the individual whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. If you have evidence of false claims submitted to Medicare, Medicaid, or other government programs, you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. |