On this blog, we often bring Boston readers news about healthcare companies that have defrauded or allegedly defrauded the government and then get their just desserts after a whistleblower reports their misconduct. While this type of fraud seems to be more common in the healthcare industry than in other sectors, it certainly happens in other fields, too.
Thursday, April 19, 2012, marked the final session in Bob Thomas' Health Care Fraud and Abuse seminar at Boston University School of Law. The students were asked to reflect and answer the following question: if you were advising policy-makers, what aspects of the health care system and enforcement systems around it would you recommend keeping, and what aspects would you recommend changing?
Given how many Boston residents have Sprint-Nextel as their wireless provider, a recent story out of New York might be of interest. That's where the state attorney general is suing Sprint-Nextel for allegedly under-collecting and under-paying millions of dollars in state and local sales taxes on its calling plans.
There are many reasons that damages and fines are levied against wrongdoers. As Boston readers can probably guess, one of those reasons is to punish the defendant, both in hopes of making a point and in an effort to discourage future wrongdoing by making the misconduct too expensive.
This week, students in Bob Thomas' law school course on health care fraud and abuse were treated to an insider's glimpse into the defense perspective on whistleblower claims and government enforcement actions. The session was the third of four outside speaker presentations, designed to demonstrate the unique challenges of lawyers and other professionals practicing in the health care fraud arena: compliance officers, whistleblower attorneys, defense lawyers, and prosecutors.
Yesterday, a group of four experts on whistleblower retaliation claims put on a panel presentation at the Boston Bar Association on this burgeoning area of the law, in what turned out to be a lively and informative three hour session. If anyone were to think this area of the law is just a straight-forward extension of traditional employment law, this session showed how far wrong that thought would be, with now over twenty federal statutes containing express whistleblower protection and anti-retaliation provisions (as well as many similar state laws), all containing substantive and procedural nuance. It seems clear when a whistleblower or his/her attorney is evaluating options in a potential retaliation scenario, understanding this landscape - and how different these laws are from one another - is critical.
The action is heating up at the U.S. Commodity Futures Trading Commission ("CFTC") which instituted a whistleblower program in 2011 after passage of the Dodd-Frank Act. Congress created whistleblower reward programs for both the SEC and the CFTC in Dodd-Frank as a result of the financial fraud at the heart of the 2008 Great Recession. The CFTC now lists over 40 actions on its website that may qualify for a whistleblower reward.
WellCare Health Plans, Inc. has settled civil fraud allegations brought by several whistleblowers, including SF United Partners, clients of the Whistleblower Law Collaborative, for $137.5 million. The case involved multiple allegations that this managed care organization defrauded the state and federal health insurance programs, Medicaid and Medicare in particular, through a variety of different fraud schemes. This civil fraud settlement is the final chapter in a multi-year investigation that also involved the company's previous settlement of criminal fraud and SEC charges.
If Boston readers have checked in with this blog from time to time, they have probably noticed that we have written a few posts about healthcare companies defrauding or allegedly defrauding the government.
As Boston readers know, doing the right thing is not always simple. It should be, but it isn't.