From: hound23x@gmail.com   
      
   Whistleblowers Integral to the Fight against Medical and Health Care Fraud   
      
   March 1, 2015, 11:30:00AM. By Gordon Gibb	   
   Sacramento, CA: As generous as they are, "sugar daddies" often get taken to   
   the cleaners. For them, money is no object. When someone in a position of   
   influence can invent reasons for a man of means to part with his cash, well,   
   so much the better. It is    
   with this parallel that we illustrate what happens when Medicaid and Medicare   
   (and others), backed by government funding, are allegedly bilked by   
   opportunistic entities out to bill the system for billions of dollars worth of   
   unnecessary procedures. It's    
   medical fraud by any other name.   
      
   Whistleblowers Integral to the Fight against Medical and Health Care   
   FraudThere are countless examples...   
      
   A scheme, whereby spinal surgeries and procedures that were not medically   
   necessary were performed with implements not approved by the US Food and Drug   
   Administration (FDA), is one such case. This allegedly involved the   
   implantation of surgical screws    
   and rods into patients that also lacked FDA approval. Along with a vast array   
   of kickbacks, it is alleged that procedures were billed to government and   
   insurance funders at inflated rates (State of California v. Gardens Regional   
   (Tri-City), Pacific    
   Hospital of Long Beach, Michael Drobot, et al, Los Angeles County Superior   
   Court, Case No. BC534466).   
      
   Another example of such behavior culminated in the largest settlement under   
   the False Claims Act (FCA) in the history of the state of California, together   
   with the largest single-state FCA settlement ever recorded in the US. In that   
   case, the two largest    
   medical labs in the state were alleged to have routinely billed California's   
   state "Medi-Cal" program much higher fees than others were charged, in spite   
   of state law requiring the lowest fees billed to Medi-Cal. That case settled   
   for $241 million in    
   2011 (State of California ex rel. Hunter Laboratories v. Quest Diagnostics   
   Inc., et al. Sacramento County Superior Court).   
      
   The point of all this remains the important role of the whistleblower - often   
   a current or former employee - who has witnessed such unfair and unlawful   
   behavior, and files a Qui Tam lawsuit on behalf of a government entity who may   
   or may not join the    
   lawsuit later. The Whistleblower Act protects a whistleblower from retaliation   
   and honors his or her honesty and right to expose injustice and unlawful   
   practices. In the event of a conviction or settlement, the Qui Tam   
   whistleblower can share in the    
   settlement proceeds in exchange for leading the charge against unjust activity   
   that not only serves as an injustice to taxpayers, but also a reason for   
   insurance carriers to raise their rates needlessly due to inflated payouts.   
      
   In spite of previous litigation, there appears to be no hesitancy on the part   
   of some organizations to attempt to line their pockets through unjust means.   
   Any employee or individual who witnesses an injustice is encouraged to seek   
   the advice of a    
   qualified attorney. You could be providing a valuable service, and rewarded   
   for your efforts to boot. Such injustices can take on many forms, including   
   billings for services not performed or complex procedures not medically   
   necessary, or kickbacks,    
   discriminatory billing... the list goes on.   
      
   Healthcare and medical fraud is everywhere. That said, the average American   
   may be surprised to know how much capacity he has to stop it...   
      
      
      
   http://www.lawyersandsettlements.com/articles/healthcare-fraud/m   
   dicaid-medicare-us-food-drug-administration-fda-20481.html#.VPkKLMt6jqD   
      
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