Call to conscience: Attorney General calling on whistleblowers to help cut fraud

May 20, 2010

The Indiana Attorney General has made a public invitation for individuals to become whistleblowers to help eliminate fraud in the health care industry.   Whistleblowers are people who reveal wrongdoing or malpractice in an organization.  It has become particularly visible in the area of publicly funded healthcare programs (such as Medicaid) where, in the last couple of years, at couple of large psychiatric drug manufacturers have become defendents in whistleblower lawsuits brought by individuals on behalf of the federal government.  One of those suits, which was filed by a former sales representative for a pharmaceutical company, exposed how the company had used fraudulent sales and marketing tactics to get the state to purchase their drugs.  The largest ever settlements in such cases involved psychiatric drugs. 

People reading this might wonder how they could blow the whistle.  As far as health care fraud is concerned, one of the most rampant areas of fraud is the psychiatric/mental health industry.  Though one of the smaller medical specialties, it is nonetheless over-represented in the area of fraud.  

Search for psychiatrists and other mental health practitioners convicted of fraud in Citizens Commission on Human Rights' convictions database.

The people who file whistleblower suits received 10 percent of the settlement.  The pharmaceutical company whistleblowers mentioned above got 10% of a $1 billion-plus settlement and probably won't have to work again for the rest of their lives.  When people see a wrong in their industry and become a whistleblower, they win, the government wins and the taxpayers win.

Text of article:

Whistleblowers Wanted To Help Cut Health Care Fraud

New Initiative Seeks Professionals With Inside Information

State investigators are asking whistleblowers to come forward in a new effort to prevent health care fraud.The Medicaid Fraud Control Unit of the attorney general's office is encouraging people to report companies if they are cheating taxpayers with unnecessary health care services or products, 6News' Rafael Sanchez reported."The vast majority of those cases is because someone has come forward and exposed wrongdoing," said Deputy Attorney General Tim McClure.

One major concern for the unit is known as off-label marketing. That's when a pharmaceutical company or its sales staff promote and sell a medicine to treat an illness without approval from the Food and Drug Administration.

In 2009, a whistleblower was credited for forcing Indianapolis-based Eli Lilly and Company to settle a multi-state lawsuit for $1.4 billion involving its drug Zyprexa, an anti-psychotic that the company had encouraged doctors to prescribe to treat schizophrenia and gambling addictions.Indiana has also received more than $5 million from AstraZeneca, Norvatis and Johnson & Johnson for the misrepresentation of medicines they produced.

McClure said that often the taxpayer-supported Medicaid program is billed for medicines that should not have been prescribed. He said he's looking for professionals with inside information.

"It could be a salesperson. It could be somebody in accounting for the company who doesn't think what's going on is right," he said. "This is one of the best ways to recover taxpayer dollars obtained illegally."The reward for whistleblowers is up 18 percent of any legal settlement reached with a business accused of violating the law.

While people who decide to become whistleblowers risk losing their job and being blackballed from their profession, officials said they believe they can encourage people to step forward with vital information.

"From what we've seen in the past, a lot of good people who can't abide with what their company is doing at personal risk, they come forward," McClure said.The state currently has 150 investigations against a number of companies due to whistleblowers.To become a whistleblower, a person must hire a private attorney. The case is sealed and then state and federal investigators can begin to look into the situation.

Source: "Whistleblowers Wanted To Help Cut Health Care Fraud," 6 News -- The Indy Channel, May 19, 2010


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