Thursday, September 13, 2012

I Want To Report Fraud !

Sherry Hunt never expected to be a senior manager at a Wall Street bank. She was a country girl, raised in rural Michigan by a dad who taught her to fish and a mom who showed her how to find wild mushrooms. She listened to Marty Robbins and Buck Owens on the radio and came to believe that God has a bigger plan, that everything happens for a reason.

On the day Jim Lenox got his last injection, the frail 54-year-old cancer patient was waiting to be discharged from the Baltimore Washington Medical Center. He’d put on his black leather coat. Then a nurse said he needed another dose of anemia drugs.

His wife, Sherry, thought that seemed odd, because his blood readings had been close to normal, but Lenox trusted the doctors. After the nurse pumped the drug into his left shoulder, the former repairman for Washington Gas said he felt good enough to play basketball.

Those who have been injured by the diabetic drug Avandia saw a bit of justice recently.

Pharmaceutical behemoth Glaxo-Smith-Kline was ordered by the U.S. Department of Justice to pay out $1 billion in criminal fines and $2 billion in civil penalties for fraud. In this case, the fraud consisted of aggressive marketing tactics, encouraging doctors to prescribe Avandia and two other drugs for unapproved uses.

It is not unusual for physicians to prescribe medications to treat conditions other than those for which they were developed. This practice is known as “off-label use.” A common example of off-label use is taking aspirin as a blood-thinner (actually an anti-coagulant). Another example of off-label use is to prescribe the anti-depressant Zoloft for the treatment of premature ejaculation in men. This practice is completely legal in most countries of the world, including the U.S.

So – where and how did GSK run afoul of the law?

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There are several examples of how companies and individuals defraud the government. The following are covered under the False Claims Act:

  • Kickbacks: Paying doctors or public officials for patients, referrals, prescriptions or government-funded contracts or studies.
  • Self-referral Violations: Doctors referring patients to medical facilities in which they have a financial interest.
  • “Up-coding”: Healthcare providers billing health insurance companies for higher-paying services or equipment that the actual service or equipment provided.
  • Medically Unnecessary Tests or Services: Patients being subjected to unnecessary tests or services.
  • Over-Utilization of Medical Equipment or Treatments
  • Use of Unqualified Personnel: Untrained or Unauthorized practice of medicine
  • Failure to Provide Services: “Billing Fraud,” charging for services not performed or billing more than one for the same service
  • Overpricing for drugs, devices and equipment
  • Off-label Marketing of Drugs: Selling drugs for unapproved uses
  • Phantom Patients: Billing the government or health insurance companies for patients that do not exist
  • Phantom Supplies: Billing government or health insurance companies for supplies that were never used.
  • Phantom Prescriptions: Billing for prescriptions that never get used or dispensed
  • Fabricated Invoices
  • Fraudulent Referrals

Law Topics> Cause of Injuries> Federal Civil False Claims Act & Qui Tam Law (Whistleblower Litigation)

If a person is in the business of committing fraud, one of the most lucrative targets is the United States government. For hundreds of years, individuals and corporations have been successful in defrauding the most powerful government in the world. With hundreds of transactions and partnerships being made every day, it is difficult for the government to keep a watchful eye on every sale or purchase it directs. Benjamin Franklin knew this all too well when he said, "There is no kind of dishonesty into which otherwise good people more easily and frequently fall than that of defrauding the government." Read more »

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