We asked the question a year ago, “Do you work for an ethical company?” While we all wish we did work for an ethical company, unfortunately, many do not.
Corporate crime goes on every day in the United States but often goes undeterred because wrongdoers take steps to hide their activities. Therefore, whistleblowers, ethical people with inside information about wrongdoing, play an essential role in the fight against corruption. To encourage those with information to come forward, the government has created programs to reward people who assist in obtaining relief from the wrongdoers.
Whistleblowers are often employees of the wrongdoer, but competitors, suppliers, customers, and other stakeholders may also have valuable information that can lead to a whistleblower action. All types of workers come forward – accountants, production workers, compliance personnel, purchasing agents, human resources managers, and executives.
New York Attorney General Letitia James recently announced a $4 million settlement with two individuals and their two therapy companies. The settlement resolves allegations that the couple and their companies falsely billed Medicaid and other federal health care programs for physical therapy services, as well as for having had non-licensed individuals provide physical therapy services.
The scheme was to bill federal agencies for physical therapy services provided or supervised by someone other than the licensed physical therapists identified on the bills, including unlicensed aides; it included billing for backdated physical therapy services.
From the Attorney General’s press release, “The case was initiated by former employees who contacted the Pelton Graham office and acted as whistleblowers, who received a portion of the settlement. The whistleblower lawsuit was filed under the qui tam provisions of the federal and New York False Claims Act, which allow people to file civil actions on behalf of the government and share in any recovery.”
Whistleblowing is a lonely business. It takes a lot of bravery to make that call, a lot of determination to see it through, a lot of faith in yourself, excellent advice, and a great team around you.
One step that can be helpful to a successful whistleblower action is convincing the government to join the case. In the case discussed in the press release above, the Attorney General’s office was convinced to take up the case.
In addition to using uncertified therapists and physicians and false billing statements, other common health care abuses include:
- Kickbacks or bribes
- New drug approval abuses
- Off label marketing (misbranding)
- Overcharging for products and services
- Upcoding – assigning an inaccurate billing code to a procedure or treatment to increase reimbursement
- Unbundling or fragmentation – breaking up one procedure into several to increase the cost
- Unnecessary procedures
- False or exaggerated billing or billing estimates
- False certifications that products meet government specifications or guidelines
Retaliation is an all-too-common result of whistleblowing, despite numerous laws designed to prevent it. Pelton Graham attorneys are an experienced retaliation lawyer team and will fight to protect your rights if you make a claim.
At Pelton Graham we get results – we don’t take every case, but if we take yours, we promise we’ll do our very best to get you the best possible result.
If you have any questions regarding your rights as an employee, applicant, independent contractor, or want to know anything related to the workplace, you can contact us for a no-obligation, no-cost consultation by telephone, video conference, or in-person at our nearest office.