April 15, 2014
Unlike most businesses that are forced to run efficiently or go out of business, the government realizes it can not count on its personnel to operate as responsibly as business personnel do - as there is often next to no feedback loop for inefficiency or accountablity as there is in a business - which loses capital, has to shut down programs and lay off people....government organizations struggle to really connect the personnel with the true health of their businesses, as their paychecks are not as dependent on it --- government can generally print more, and historically, problems are not near as significant when they exceed budget, especially when it can seem "for a good reason." So instead, the Health and Human Services Department has done as many of the government agencies are doing, and increasing the bounties paid by the government to it's employees in order to get them to report their fellow co-workers and on their organizations for fraud and abuse, to assist the government in identifying the rampant waste and abuse ongoing in their organizations.
Secretary Sebelius, the same woman connected with the Obama adminstrations embarassing blunders on the failed Obamacare insurance website, has announced that the new increases in rewards for individauls reporting Medicare fraud whose tips lead to recovery of funds would now receive as much as $9.9 million per incident. That is not as much as many other reward programs, such as those associated with the False Claims Act, but it is a step in the right direction and will motivate people to take the risks they need to report the fraud. She also announced that President Obama, who is agressively trying to clean up fraud, negligence and waste where he can in these government systems, is actively behind these proposals and is funding significant education campaigns for employees to help get the word out about the Senior Medicare Patrol (SMP) activities aimed at explaining to Medicare beneificiaries and employees alike how to identify, report and collect rewards surrounding these cases.
Over the last 3 years nearly $15BN has been recovered through these programs and in the HHS program specifically, claimants can receive up to 15% of the total reward or up to $9.9M. Compare this to a mere $1.8BN in 2008. The skyrocketing improvements have in large part to do with the administrations recognition that it needs more money, and with tax levels where they are, it sees recovery of it's own monies not used effectively as substantial arena in which to make more money relative to other areas where it can find more dollars for itself. And secondly, government is desiring to crack down on some of the abuses which are becoming more overt. One thing to keep in mind however is that it MAY BE BETTER to take some of these claims instead through the False Claims Act channels of reporting instead of through the HHS itself. Why? Because the typical reward varies by the discresion of the judge; but the amount can be anywhere from a LOW end of 15% to and upper end of 30% of the monies recovered by the government -- and their is no cap.
Bayer/GlaxoSmithKline (GSK) Case Example
Bayer and GSK sold relabled drugs to a Health Maintenance Organization at prices that were significantly below that which the HMO were reimbursed by the Medicaid programs. Additionally, Bayer and GSK attempted to conceal their activities in the process. For this, courts awarded the government $344 million in payments from the two companies back to the government. Additionally, the whistleblower who made this recovery possible for the US government by providing the necessary evidence to demonstrate the deception and concealment was awarded $34 million. These dollars went to his estate as he passed away during the process. Had he used the HHS process in which to report this crime versus the False Claims Act, he may have been capped at merely $9.9M of reward. OffRecord will do its best to find the highest rewarding channels for you to maximize the benefit you deserve for making these violations known and righting these wrongs.
Likewise, in another Medicare/Medicaid case that GlaxoSmithKline (GSK) was involved with, a whistleblower identified fraudulent lab billing practices where the government was ultimately being overbilled to the tune of $333M. This whistleblower, as Mr. Merena, was awared $52M.
As a third example, in 2010 a federal court via the False Claims Act lawsuit filed by two former pharmaceutical salesmen against their employer Johnson & Johnson subsidiary Ortho Biotech found the company guilty of promoting the sale and use of Topamax for a variety of psychiatric conditions other than those for which its use was approved by the Food and Drug Administration. This particularly violation is referred to as an "off-label" violation as the US government's FDA wants heavy payments in order to run its processes of validating that a drug is beneficial and safe before advocated by pharmaceutical companies. The judge also found that some of these uses were not "medically-accepted indications for which State Medicaid programs provided coverage" and that as a result "OMJPI knowingly caused false or fraudulent claims for Topamax to be submitted to, or caused purchase by, Medicaid." The judge in the case made the company responsible for payng the government and whistleblowers a total of $81M in the case -- of which the two salesment received over $9M in the reward process for reporting the crime and getting these monies returned to tax payers and the US government. More on this case can be read at: http://www.hhs.gov/news/press/2013pres/04/20130424a.html
HHS increasing the bounties on its reward programs should increase the interest from participants submitting claims to the Department, but relators may want to consider using other channels in which to make their reports and perhaps using OffRecord directly to assist them in protecting their identity in the process.