Magazine article Drug Topics

Whistle-Blowers May Soon Target Pharmacy Fraud

Magazine article Drug Topics

Whistle-Blowers May Soon Target Pharmacy Fraud

Article excerpt

Pharmacy will most likely become a target of modern-day bounty hunters bent on collecting big bucks for helping Uncle Sam ferret out health-care fraud, experts predict.

Blowing the whistle on health-care fraud is definitely a "growth industry," and as part of the system, pharmacy will eventually be targeted, said Robert Vogel, a Washington, D.C., attorney specializing in such cases. "Health-care fraud is brazen beyond belief, but they haven't caught on yet that anyone has an incentive to stop them, because no one has until now," he told Drug Topics.

That incentive to expose health-care fraud, pegged at $80 billion annually, is not exactly chump change. The current superstar among health-care whistle-blowers is Christopher "Jack" Dowden, a Californian who was awarded $15 million for pointing the finger at National Health Laboratories Inc. The medical lab firm anted up $111.4 million to the United States last year to settle a Medicare fraud case, and Dowden pocketed the megamillion bounty.

An employee of Blue Cross & Blue Shield of Florida was awarded $1.5 million in September, after the insurer agreed to pay $10 million to settle a suit for mishandling the Medicare program. And a public interest group, Taxpayers Against Fraud, banked $36,000 from a $400,000 settlement against a California neurologist who was allegedly overbilling for diagnostic tests.

Bounty hunters in the Old West rounded up rascals on Wanted posters with a six-shooter. Today the weapon of choice is a lawsuit. Passed in 1863 to combat fraud against the Union Army, the False Claims Act allows private citizens to file suit on behalf of Uncle Sam against anyone who has made false claims against the government. If federal attorneys take over the case, the informer can collect up to 30% of any settlement, plus attorney fees.

There are as many motives for taking legal action as there are whistle-blowers, said Vogel, a former Justice Department trial attorney. Some, such as Dowden, want to nail a competitor who's illegally tilting the playing field. Some want to take the money and run to Easy Street. Others are good citizens indignant that someone is ripping off public funds.

And then there's the disgruntled employee or vengeful ex-employee who knows where the bodies are buried and decides to hand the feds a shovel. …

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