Our Los Angeles Whistleblower Attorneys reported that one of the largest prescription drug companies swiftly agreed to settle a False Claims Act (FCA) whistleblower claim for false billing of Medicare and Medicaid. The crux of the complaint was that in 28 states, including California, Omnicare billed the government for drugs that it did not actually dispense.
The courageous whistleblowers were two pharmacists working at one of Omnicare’s facilities. They noticed that the computerized systems permitted Omnicare to falsely bill Medicare and Medicaid (Center for Medicare and Medicaid Services, or CMS) for generic drugs which were not the ones that were actually dispensed. The system was fraudulently programmed to go around the verification mechanism. For their brave reporting report to the government, they will receive approximately $2 million dollars. This is especially just because Omnicare pharmacies fill prescriptions for patients at nursing homes and long term care facilities – who otherwise would not be checking what medication was provided. This placed many of the elderly’s lives at risk and may have even caused hospitalization or death.
Under the FCA, the court has the right to order the defendant to pay triple the actual damages that the jury finds. In addition, the FCA also permits statutory penalties from $5,500 to $11,000 for each false claim submitted by the defendant, Omnicare. As result, the whistleblower will receive approximately 15 to 25 percent of the total FCA recovery plus attorney’s fees which in this case was around $1.5 million.
As the main enforcement arm of the federal government, the Justice Department reviews all cases filed under the FCA. Then, once the whistleblower case is assessed, the government decides whether it will prosecute or allow the whistleblower to bring the complaint on the government’s behalf.
The FCA is used to stem out fraud related to billing, staffing, and kickbacks. Examples of these are when healthcare companies are supposed to abide by state and federal laws and chose to ignore them. They also bills for services that were not provided or the bill was submitted at an improperly higher rate of reimbursement for the services. In addition, healthcare companies are often fount to illegally bill the government for substandard services by fraudulently certifying otherwise. Alternatively, these companies may realize that they have credit from their services that they have to repay to the government, but the companies do not reimburse the government within the 60 day time frame. See these blogs for more examples of the FCA.
If you witness any potential false claims or fraud in California (i.e. requests for reimbursement to the government, not actually rendering work when reimbursement is received, or receiving and knowingly retaining an overpayment) by your company, or you are retaliated against for voicing your concern about potential wrongdoing, immediate action is vital. Contact the experienced employment law whistleblower and wrongful retaliation attorneys at Stephen Danz & Associates for a free consultation to discuss your circumstances and legal options.