Category: Fraud

Qui Tam: What Is It?

The term qui tam is actually an abbreviated form of the latin phrase “qui tam pro domino rege quam pro seipse,” which means “he who sues for the king as for himself.” Whistleblower is another term used to describe the same type of claim. When an employee gets wind of their employer’s illegal business practices, they have the opportunity to file a qui tam claim against them, and are usually awarded a large portion of the settlement that the government receives.

Whistleblower vs. Qui Tam Claims – Is There a Difference?

new jersey philadelphia qui tam whistleblower lawyers explanationWhistleblower and qui tam claims do essentially the same thing; they allow employees to file lawsuits against their employers for fraud or other illegal practices. Many times, especially in the healthcare industry, companies engage in fraudulent advertising to increase popularity of a product. Pharmaceutical companies are largely guilty of committing this type of fraud. Creating false or untested uses for a certain drug, or offering physicians large amounts of money (kickbacks) to recommend and prescribe certain drugs is very much illegal, and equally as dangerous.

Fraudulent billing is another problem for health programs such as Medicare. It is estimated that close to 10% of all medicare charges are indeed fradulent. Commonly, this fraud occurs in the form of :

  • Billing multiple times for one service
  • Charging for treatment that was never performed
  • Charging for expensive equipment when cheaper equipment was purchased
  • Charging for services that are actually free

Qui Tam Lawyers in New Jersey and Philadelphia

If you currently work for a company that you believe is defrauding it’s employees, customers, and/or government, contact the Mininno Law Office for a free case evaluation. The qui tam lawyers at the Mininno Law Office are specifically focused on earning significant compensation for whistelblowers who aim to end their associates illegal and potentially harmful business practices.

You may also call for a free consultation at (856) 833-0600 in New Jersey, or (215) 567-2380 in Philadelphia. Let the Mininno Law Office team work hard to earn you the full an fair compensation you deserve.

Links Between MMR Vaccine and Autism Allegedly Fabricated

This medical malpractice post will discuss a report published this week by the British Medical Journal that denounces a 1998 study performed by Dr. Andrew Wakefield. The study, printed by The Lancet, links Autism with the MMR vaccination, and has now been labeled as nothing more than an “elaborate fraud.”

Autism Study a Fraud?

new jersey philadelphia medical malpractice lawyers falsified report linking MMR vaccines with Autism Dr. Andrew Wakefield caused a significant decrease in MMR vaccinations since the publishing of his study in 1998 that claimed that the Measles, Mumps, and Rubella vaccination was, in fact, causing “regressive autism“. Regressive autism is a form of the disorder that starts to develop after a child has displayed no symptoms, and has led, up until that point, a “normal” life.

Investigative reporter from the British Medical Journal, Brian Deer, analyzed for 6 years the results of Wakefield’s “study“, and found that Wakefield deliberately misrepresented facts and lied about the conditions of his subjects. The study was based on 12 children with autistic symptoms after they received the MMR vaccine. The study consistently lies about when symptoms developed, what those symptoms were, how they affected the child, and what they meant for their diagnosis. This blatent falsification of facts has led to a decline in MMR vaccines, and a rise in the contraction of Measles. In England, the Measles virus is now described as an endemic.

While Dr. Wakefield still believes in his study and it’s results, he hasn’t acted on offers to replicate his findings. The BMJ article says:

Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. Meanwhile the damage to public health continues.

Medical Malpractice Lawyers in NJ and PA

Dr. Andrew Wakefield acted against his purpose as a doctor to heal and protect patients, and instead grossly misreported data to publish a false report. Why? One can only conculde that his motive was personal gain. Why lie about the effects of a sometimes life saving vaccination? Children likely have died after not being vaccinated for measles, mumps, or rubella, and for no reason.
The kind of negligence Dr. Wakefield acted with is irreprehensible. And while he did so outside of the operating or emergency room, other medical providers act with the same negligence inside the operating or emergency room.

If you or a loved one have been injured by medical malpractice or negligence, contact the Mininno Law Office for a free case evaluation or call for a free consultation at (856) 833-0600 in New Jersey, or (215) 567-2380 in Philadelphia.
Let our team earn you the full and fair compensation you need a deserve.

Medicare Fraud? Tips on How You Can Tell

Medicare and Medicaid services were created to help the elderly and or those with disabilities or certain other medical conditions be able to better afford medical coverage in order to pay for supplies, medical care, treatments, doctor’s visits and much more. This all seems like a good idea if it works the way it should and benefits those it is suppose to. Unfortunately though, there have been more and more cases of Medicare and Medicaid fraud and people are getting sneaky about how they get around the rules. Billing Medicare for services that were not received or provided can cost taxpayers millions of dollars each year and it also hurts those people that really need the medical care and services by causing them to pay more. To help avoid being a victim of Medicare Fraud use the following helpful detection tips. These tips include:

  • Be suspicious if a test is free and if a provider only needs your Medicare information for their records.
  •  Be aware if Medicare wants you to have a certain item or service.
  • Be cautious if the provider knows how to get Medicare to pay for an item or service
  • Be on the look out for provider that offer many tests at cheaper or discounted prices
  • Be careful if the equipment or service is free or you are offered a gift for the service

 

It is also important to know what services and equipment or medical supplies you are entitled to and report or question anything that seems out of the ordinary. As a general rule do not give out your Medicare health insurance claim number expect to your doctor or Medicare provider.

It is unfortunate that many people will try to scam those in need out of services and medical supplies for their own personal gain. It is good to know though that you can do something to help stop cases of fraud.

For additional information on Medicare fraud and prevention, you may visit:

http://www.medicare.gov/Fraudabuse/Tips.asp

If you or a loved one feel you have been a victim of Medicare fraud, please contact a  whistleblower attorney right away. They can help your case to be heard and make sure you get the care you deserve.

The “Dead Doctor” Scam: How Medicare and Medicaid Lost $70 Million In Fraudulent Claims

Most people envision Medicare or Medicaid fraud as a pharmacist billing for name brand prescriptions while dispersing the generic version, or a doctor inflating the cost of his services to bring in a few extra bucks.

Unfortunately, another type of Medicare and Medicaid fraud exists—and it’s one that took the Centers for Medicare and Medicaid Services (CMS) 7 years to put a stop to.

A subcommittee report issued by the Senate Homeland Security and Government Affairs Investigations Subcommittee on Tuesday revealed CMS has paid out more than $70 million between 2000 and 2007 for durable medical equipment that used the personal identification number of a deceased physician.

In response to the discovery, CMS deputy administrator, Herb Kuhn, assured government officials that the agency is working on a new system to stop fraudulent billing from “dead doctors”.  Apparently, the proposed system will require doctors to use a new National Provider Identifier, which will automatically cross check death records from the Social Security Administration database.

In addition, Kuhn told Subcommittee Chair Carl Levin (D-Mich.) that while the stolen funds have yet to be recovered, the agency plans to withhold future bonuses for companies found to be involved in the scam.

Withhold future bonuses?

I would hope that CMS would conduct an audit and prosecute every single company that participated in the dead doctor scam.  Patients are denied funding every day under Medicare and Medicaid because of budget constraints.  These scammers essentially stole from sick people who could have used that money to buy medicine, etc.

In addition, CMS should receive a complete administration overhaul for waiting so long to address this problem.  A few sources suggest that CMS may have known of the dead doctor scam as early as 2001—which is completely unacceptable in my opinion.

I think subcommittee ranking member Norm Colman (R-Minn) sums up the dead doctor scam the best: “We live in a high tech world…Surely we should have the capacity to figure out if doctors are dead.”

I totally agree.

Related Information:

New Jersey Whistleblower Attorneys

Wallgreen’s Pays $35 Million For Medicaid Whistleblower Settlement

On June 4, 2008, Walgreen’s drug store agreed to pay $35 million to settle a Medicare whistleblower lawsuit. In the suit, retail giant Walgreen’s was accused of substituting more expensive versions of three prescription drugs between 2001 and 2005 in an attempt to defraud the medicare system.

Pharmacist Bernard Listiza was credited for blowing the whistle on the fraud scheme and will receive $5 million as a reward for his cooperation.  This same pharmacist brought a similar suit against CVS Caremark Corporation in late 2006.

In addition, individual states such as Indiana and Ohio have accused the pharmacy of making wholesale switches without physician involvement, which is a violation of numerous state regulations on pharmaceutical drugs.  The two states listed above recovered $161,000 and $28, 479 respectively from the Medicare settlement

Related Whistleblower and Medicaid Fraud Information:

New Jersey Whistleblower Attorneys and Lawsuit Information

US SUPREME COURT FAILS TO CURTIAL IRS WHISTLEBLOWER CLAIM

This past April, the United States Supreme Court announced its decision that it would not review the case of Murphy v. IRS. Consequently, the IRS can continue to tax damages awarded to victims of whistleblower retaliation and other civil rights violations — even though such damages are not income. Under previous law, whistleblowers that were awarded significant compensation received those funds “tax free’. This law was consistent with earlier court decisions, which stated that compensation for whistleblowers was not income and, therefore, any tax on a whistle blower”s damages violated the United States Constitution.

Unfortunately, because the Supreme Court decided not to hear the Murphy case, whistleblowers and victims of civil rights violations will have to personally fight the IRS in its taxation claims.

Fortunately, a bill is pending in Congress entitled Civil Rights Tax Relief Act of 2007 (“CRTRA’). This legislation would amend the tax code to end the improper and unfair taxation of whistleblower damages as well as other damages awarded to individuals who have suffered unlawful civil right violations and discrimination in the workplace. Hopefully, this bill will get some traction in that it is supported by both employers and employees and has unusually broad bipartisan support from members of Congress.

For further whistleblower lawsuit information, click on the following links:

Whistleblower Lawyer and Lawsuit Information

CVS WHISTLEBLOWER SUIT SETTLED FOR $36.7 MILLION

On March 18, 2007, CVS agreed to pay $36.7 million as a result of allegations that the company improperly switched patients from the tablet version of the prescription drug Zantak to a more expensive version in order to increase Medicaid reimbursement. The fraud was brought to light by a Bernard Listiza, a pharmacist in Washington, DC. Following extensive negotiations between the US Attorney”s Office and CVS, CVS agreed to pay $36.7 million for defrauding the government. The United States” share of the settlement was approximately $21.1 million, with 23 states and the District of Columbia sharing $15.6 million. More importantly, the pharmacist, Mr. Listiza, received $4,309,330.74 as his share of the settlement.

For further information on whistleblower lawsuits, click on the following links:

Whistleblower Protection

Whistleblower Lawsuits For 2005 Total $1.1 Billion in Settlements

The Federal Government issued a report stating that in 2005 alone, whistleblower lawsuits resulted in a recovery of 1.1 billion dollars to the United States Government. The actual whistleblowers that brought these claims to light were awarded $166 million dollars for their involvement.

One of the largest cases from 2005 involved a whistleblower that discovered Medicare had made $21.7 billion in improper payments to doctors, hospitals and insurers in 2004. After the government recouped the money, the whistleblower was awarded over a billion dollars in compensation.

Similarly, in March 2005, a whistleblower that had previously worked for defense contractor Northorp, was awarded $12.4 million after the company settled their $1.33 million lawsuit for overcharges to the Pentagon for massive fraud and over-billing.

For further information on whistleblower lawsuits, click on the following link:

NJ Employment Lawyer: Whistleblower Retaliation and Lawsuit Information

"Arrogance, Abuse, Fraud and Medical Malpractice: How Some Physicians Beg for Lawsuits"

I read an interesting article today by MC Kean entitled “Arrogance, Abuse, Fraud and Medical Malpractice: How Some Physicians Beg For Lawsuits.” Kean basically turns the table on doctors who are portraying medical malpractice victims as “sue happy” and exposes the real greed fueling medical malpractice suits which lies within the medical community itself.

Keen states, “Physicians and mass media often depict patients and their lawyers who file lawsuits against doctors as greedy, money-grubbing opportunist. 1 It turns out this is more projection than reality. A 1990 study by Harvard researchers of 31,000 medical records subjected to evaluation by practicing doctors and nurses, “found that doctors were injuring one out of every 25 patients (latter studies put that figure closer to one out of every seven patients), and that only 4 percent of these injured patients sued.” 2 Another Harvard study of 1,452 malpractice lawsuits found that more than 90 percent of the claims evidence supported medical injury and 25 percent of the time the patient died, 60% of these injuries resulted from physician wrongdoing. The study also found when “baseless” malpractice suits were brought they were “efficiently thrown out.” Only 145 of 515 patients suffering injury, but where physician fault was unclear received compensation. On the other hand, 236 cases were thrown out of court despite evidence of injury and physician error.”

Keen then outlines some of the ways in which doctors and hospitals profit from medical malpractice. I have summarized them as follows:

  • Kickback Driven Medicine- Doctors will prescribe medication and implant medical devices that are either inappropriate for that patient or ineffective for the sake of money. Keen found that “in one study one third of the doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest”.”
  • Promoting Unnecessary Surgeries- Doctors will often fail to disclose alternate or less radical form of treatment, even when they know the alternate treatment is a safer choice.
  • Bait and Switch- This refers to a doctor switch during surgery. A person will take their time to choose a surgeon based on bedside manner, qualifications, etc., only to find out that a resident or less qualified doctor actually preformed the surgery while they were under anesthesia. The original surgeon then moves on to a higher paying client while the resident who is on salary operates on you with no supervision. Consequently, the surgeon is paid for two major surgeries while only performing one.
  • Unnecessary Procedures and Exams for the Sake of Training- Unnecessary procedures are not only ordered for patients, but they are prolonged for the sake of training. Multiple students will take turns practicing the same procedure on a sedated patient. Keen states that “informed patients while often willing to accept one or two trainees, are less likely, for example, to consent to their pelvic or anus being penetrated multiple times by multiple people. This gang bang approach to teaching is very abusive”.
  • Physicians Will Lie- Keen points out that “doctors are often arrogant and indifferent to the very concept of informed consent. Physicians patronizingly claim to know what is best for patients, while they fail to listen or respond to expressed needs, violate patients expressed will, and even do things to patients they would not allow be done to themselves”. He claims that doctors will do as they please and lie about it if it becomes a problem.
  • Physicians Target the Poor – Because of their lower income level and at times lower IQ, Keen claims “physicians target the poor, mentally disabled, and seriously ill patients who are heavily dependent upon the medical access they receive, as they are less likely to file lawsuits”

Among Keen”s many suggestions to combat some of the issues listed above ( such as being skeptical of any doctor who tries to coerce you into taking medication, undergoing several MRI”s etc.), I think the best suggestion he offers is the following:

“When you find a doctor has abused you; let the rest of us know. Post flyers, post adds, get the word out about that doctor. Start an Abusive Doctor boycott list web site in your area. As we boycott those physicians and seek care with more ethical practitioners incentives may shift a bit.”

It is so important for patients to speak out regarding medical malpractice. Doctors and hospitals have the financial backing to silence the few outspoken critics who attempt to rally congress against malpractice lawsuit caps and tort reform. With enough public outcry and bad PR for those doctors and hospitals that injure patients, change will slowly start to take place.

Admittedly, doctors are human and mistakes will happen even under the strictest regulations and safety procedures. However, it”s the careless errors that we can prevent by drawing attention to these problems. Public outcry will weed out the doctors who continue to abuse patients for the sake of money or those who continue to injure patients because they know they can get away with it.

For further information on medical malpractice or medical malpractice lawsuits, click on the following links:

New Jersey Medical Malpractice Attorneys