Undercover: How I Went from Company Man to FBI Spy--And Exposed the Worst Healthcare Fraud in U.S. History

By John W. Schilling | Go to book overview

CHAPTER FOUR
The False Claims Act

It was 6 P.M. on Friday, February 10, 1995, and it surprised me when Mary Louise Cohen answered my call. I had expected to hear a recorded message. Quickly regaining my composure, I said I was calling because of the Wall Street Journal article. I launched into a quick version of my story, telling her I was a Medicare reimbursement supervisor at a major U.S. healthcare company.

I told her I believed that the company I worked for was cheating the U.S. government. I said that I had unearthed a long hidden cost reporting error and received no support when I sought to disclose it. I'd also found that my employer routinely prepared two separate cost reports. My company, I explained, ordered me to oversee the preparation of one cost report to file with Medicare that included expenses that I knew were not allowable under federal rules. In addition, I had to oversee the preparation of a second “Confidential” or “Reserve” report that more accurately reflected actual hospital expenses. I asked, “Do I have cause to file a whistleblower lawsuit?”

Cohen explained that she couldn't answer that question definitively yet. She explained that a qui tam case is filed under “seal,” allowing the government unhampered time to investigate the allegations. Under the False Claims Act, once the seal is lifted, the company would be prohibited from retaliating against the whistleblower. That's a relief, I thought.

“How could I possibly afford to retain your firm?” I asked.

She explained that if the law firm decided to take the case, it would be

-26-

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