New York Injury Attorneys Blog

It’s not only high-level health care and pharmaceutical company employees who can initiate whistleblower claims. One of the most successful instances of the False Claims Act in recent years was a lawsuit brought by a 63-year-old disabled Medicaid patient.Richard West, a veteran of the Vietnam War afflicted with muscular dystrophy, was heavily reliant on the care Medicaid afforded him. He was confined to a wheelchair, used a ventilator to breathe, and required in-home nursing care. This explains why he became so alarmed when he received a notice that his Medicaid benefits were going to be cut off after exceeding his monthly maximum.Richard was certain that he had not gone over his monthly limit, so he looked into where his Medicaid payments had been going in recent months. What he found was a pattern of drastic Medicaid overbilling by his healthcare provider, Maxim Health Services. Maxim had billed Medicaid for 735 hours of nursing service that had never been provided to Richard, the equivalent of $20,000 of fraudulent charges.Horrified by the thought that Maxim would take advantage of patients’ disabilities for profit, Richard brought this information to all the authorities he could think of. He contacted officials in the New Jersey state government, Medicaid, and Veteran Affairs, but they all failed to take action against Maxim.Finally Richard decided to file a lawsuit against Maxim under the False Claims Act. His case was picked up by the government, and in September 2011 resulted in a $150 million settlement. Eight former Maxim employees pleaded guilty to felony charges of fraud.For his persistence, Richard was awarded $14.8 million by the government.Medicaid is designated by the US Government Accountability Office as a high-risk government program, meaning that it is particularly susceptible to wasteful spending and fraud. Schemes like those committed by Maxim occur all the time, taking money away from taxpayers and valuable services away from people in need. All it takes is one brave person willing to do the right thing to bring this fraud to an end.Sources: “Case Studies,” Taxpayers Against Fraud Education Fund.”Medicaid Program,” U.S. Government Accountability Office.Amy Bingham, “Patient Whistleblower Exposes $150 Million Medicaid Fraud,” ABC News, December 7 2011.

I’ve written before about how it pays to do the right thing. For employees who become aware of fraud perpetrated by their own companies, that payment can take the form of huge monetary rewards from the government.The US federal government and many state governments have set up incentivized whistleblower programs that in some cases will pay large sums of money to individuals for reporting the fraudulent behavior committed by their employers.For Jill Osiecki, a sales representative for the American biopharmaceutical company Amgen, it took over a decade of witnessing numerous illegal activities committed by both individuals and the management at her company before she decided to take action. Jill had even taken part in some of Amgen’s schemes, when she was asked to promote certain drugs contrary to their FDA approved use.Jill reported Amgen’s illegal behavior to the company’s internal compliance department, in the hopes of correcting the widespread off-label promotion, illegal kickbacks to doctors and health clinics, and other fraud. Instead she was fired from Amgen for bringing these schemes to their attention.Fortunately Jill had protected herself by collecting evidence of the company’s fraud for the federal government, and after her dismissal she was able to make a false claims case.The False Claims Act is the oldest and most effective whistleblower law in the US. It allowed Jill to bring a lawsuit against Amgen on behalf of herself and the federal government. The only work required of Jill was providing the necessary evidence of Amgen’s fraud. The government then took over the case and prosecuted Amgen.Under the False Claims Act, the whistleblower is entitled to 15%-25% of the government’s settlement. In Jill’s case against Amgen, the government settled for $762 million. Needless to say, Jill was handsomely rewarded for taking action.Large corporations like Amgen that commit such widespread fraud can cost the government billions of dollars in unnecessary expenses. The False Claims Act and other whistleblower laws exist to incentivize integrity, and to get ethical employees and the federal government behind the same cause.Jill’s experience with the False Claims Act should serve as a reminder to never let the fear of punishment or ostracization keep you from doing the right thing.Sources: “Ten Questions with Whistleblower Jill Osiecki,” Taxpayers Against Fraud Education Fund.