Whistleblowers Rewarded For Revealing Healthcare Fraud

One June 3, 2009, The United States Attorney Office, District of Hawaii, announced that Queen’s Medical Center (QMC) of Honolulu has paid $2.5 million to resolve allegations that it overbilled Medicare, Hawaii’s Medicaid, and TRICARE. This marks the settlement of two congruent lawsuits that were filed by two “whistleblowers” that were former pharmacy technicians at QMC.

Under the federal and State of Hawaii False Claims Acts, the government is able to recover up to triple damages, plus penalties, for fraudulent claims made to government programs. Of the $2.5 million QMC has paid, the government received $2 million, of which it shared $400,000 with the whistleblowers. United States Attorney for the District of Hawaii Edward H. Kubo, Jr., praised the two technicians for their courage in coming forward with the case.

As part of the settlement, QMC, the largest private hospital in Hawaii, will maintain a compliance program to ensure its fulfillment of all applicable program rules and requirements for the next five years. The hospital has pledged to continue its efforts to provide high quality health care while complying with health care rules.

In the case, the former technicians alleged that QMC submitted false bills for medications it dispensed and billed federal programs for services the hospital was not eligible to perform. While QMC has agreed to the settlement, it has denied the government’s contentions.

If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

Small Pharmacy Chain Does the Right Thing

With Medicare and Medicaid fraud becoming more and more prevalent it is imperative that whistleblowers like Dan Bieurance and Neil Thompson do the right thing when companies like Walgreens repeatedly over-bill taxpayers. Not all pharmacy chains are as suspect. Take The Stop & Shop Supermarket Company (Stop & Shop), which recently voluntarily reported and returned $269,000 to the Massachusetts Medicaid Program.

From the Press Release:

Stop & Shop…discovered during an audit in 2006 that it had not reported the lowest price it had accepted for certain prescription drug products to MassHealth.  By not reporting the lower prices to MassHealth, Stop and Shop was overpaid by $269,000.  Massachusetts law requires pharmacies to charge Medicaid no more than the lowest price they are willing to accept from any “payer.”  If the pharmacies’ price is lower than the price calculated by the state’s pricing formula, then the state will pay the lowest price.

It is encouraging to see companies self-policing themselves and doing the right thing for their companies and American tax payers. When companies do engage in fraud, either as a mater of practice or oversight, whistleblowers must come forward to do the right thing for them.

Pharmacist Blows Whistle on CVS – America’s Largest Pharmacy Chain Settles for $37 Million

CVS, America’s largest pharmacy chain, recently agreed to a $36.7 million settlement over charges that they defrauded taxpayers by overcharging Medicaid for prescription drugs. The federal and state investigation of CVS began in 2003 when Bernard Lisitza, an Illinois pharmacist, alerted authorities to CVS’s practice of overcharging Medicaid to fill prescriptions for ranitidine, the generic form of the popular drug Zantac ®.

Mr. Lisitza, who will collect over $4.3 Million as his legal reward portion of the settlement, delivered evidence to the government that CVS was fraudulently switching prescriptions from the price-capped and less expensive tablet form of ranitidine to the more expensive capsule form in order to charge the government a higher price.

According to the government complaint, the illegal switch caused the federal government to pay CVS more than four times what it would have paid for the tablets. Capsules and tablets are considered different drugs and state pharmacy laws often prohibit the substitution of capsules for tablets. Because ranitidine capsules are so rarely prescribed, the federal government had not set a price ceiling as they had for tablets.

The case alleged that in switching the prescriptions, CVS had violated federal and state False Claims Acts which prohibit submitting fraudulent claims to the federal government. Companies that violate the False Claims Act may be found liable for damages up to three times the amount of the fraud, and $5,500 to $11,000 per false claim. The False Claims Act allows the whistleblower, known as the relator, to awards of 15%-20% of the government’s recovery in a settlement or lawsuit.

Pharmacists like Mr. Lisitza are in a unique position to uncover fraud and have played a critical role in helping state and federal governments recover tens of millions of dollars in false and fraudulent charges.

If you are seeing fraud on the government, contact us by calling 800.377.1812 for strictly confidential advice from experienced counsel, with no fee obligation.