Whistleblower Success Stories

Whistleblowers who file qui tam lawsuits have multiple allegations about fraud and retaliation. Some of these cases are summarized for your review. These particular cases deal with Medicaid fraud allegations. The attorneys at Berg & Androphy have many cases currently under seal and being evaluated by the federal and state governments. The whistleblower cases include multiple topics involving fraud. Unlike many qui tam firms, Berg & Androphy is a trial firm, and will litigate cases even if the government declines to intervene. Of course, each case will be evaluated based on the particular facts of each case, and a final and independent determination will be made by our firm about whether to proceed without government assistance.

WHISTLEBLOWER CASE SUMMARY: CHILDREN’S PHYSICIAN SERVICES OF SOUTH TEXAS, DRISCOLL GENETIC SERVICES, CENTER FOR GENETIC SERVICES AND RADIOLOGY ASSOCIATES MEDICAID FRAUD SETTLEMENT

Children’s Physician Services of South Texas, Driscoll Genetic Services, Center for Genetic Services, and Radiology Associates agreed to pay $2.3 million to settle civil allegations that they engaged in false or fraudulent conduct by double-billing the Texas Medicaid program, TRICARE, and the Federal Employee Health Benefit Program for the professional reading and interpretation of genetic ultrasounds.

UNITED STATES EX REL. v. BAYLOR UNIVERSITY MEDICAL CENTER, ET. AL.

Baylor University Medical Center, Baylor Health Care System, and HealthTexas Provider Network agreed to settle civil charges that they engaged in false or fraudulent conduct. The false/fraudulent conduct involved improperly billing federal healthcare programs for robotic stereotactic treatment delivery. The billing was performed without corroboration of direct physician supervision. In addition, overbilling for services associated with stereotactic procedures was performed without the necessary documentation in the medical record or claims were recorded as duplicates for services already performed and paid in conjunction with other services.

UNITED STATES OF AMERICA EX REL. JOSEPH FALTAOUS v. ELI LILLY ET. AL.

Joe Faltaous worked as a Neuroscience Sales Specialist for Eli Lilly for two years before  resigning after expressing concerns about Eli Lilly’s practices.  Faltaous complained of Lilly’s illegal marketing, promotion and sale of Zyprexa to children and in higher-than-recommended dosages to adults. He also complained that as part of the marketing and promotional schemes, Lilly encouraged physicians by means of monetary payments. While employed by Lilly, Faltaous’s performance was stellar.  Faltaous’s educational achievements are equally impressive. He received a B.A. in Business Economics from California State University, and completed a marketing internship as a consultant for Columbia University. He later earned a Masters of Public Administration in Health and Hospital Administration from the Robert F. Wagner Graduate School of Public Service at New York University. The Wagner school is ranked first in the nation by U.S. News & World Report.

WHISTLEBLOWER CASE SUMMARY: ED BOGART v. KING/MONARCH

As director of national accounts, Ed Bogart managed King/Monarch’s contracts department, which involved setting prices, government reporting, and working with Pharmacy Benefits Managers (PBMs). Soon after he was hired, Bogart complained to his superiors about the company’s underreporting activities. After making his complaints, Bogart claimed that he was excluded from meetings, unjustly criticized, and suffered negative employment consequences.

WHISTLEBLOWER CASE SUMMARY: DAVID FOSTER v. WARNER-LAMBERT CO.

In July 1998, David Foster was promoted by Parke-Davis to the position of National Account Manager for accounts in Texas and Louisiana. In this position, Foster was responsible for selling pharmaceuticals to managed care organizations in those states. Soon after Foster began this position, he became aware of several attempts by his supervisor and other employees to improperly influence decision makers at managed care organizations in exchange for better formulary status.

As a result of voicing his concerns regarding illegal conduct to his supervisor and a number of other persons in the company, Foster suffered negative employment consequences.

UNITED STATES OF AMERICA EX REL. PALLARES v. AMERICAN GROCERS INC., ET AL

Delma Pallares, who rejected offers to be put in the witness protection program, worked for American Grocers as a logistics manager and general merchandise manager from 1996 through 2003.  She gained extensive knowledge of the daily operations of American Grocers, including how the food products were invoiced, valued, and weighed prior to shipping and, according to the complaint, how the company and its employees changed expiration dates and forged accompanying documentation.  Ms. Pallares’s efforts in locating persuasive evidence led to this successful prosecution and enabled the U.S. government to intervene.  Without her knowledge, the alleged schemes would have gone unnoticed and she and the U.S. government would not have received $13.2 million of the total settlement.

UNITED STATES OF AMERICA EX REL. SHEILA BELL-MESSIER v. ROTECH HEALTHCARE, INC., ET. AL.

During her employment with ROTECH, Sheila Bell-Messier oversaw the operations of the company in twelve states. From 1995 to 2002, Bell-Messier’s responsibility grew from overseeing twelve locations to 220 locations nationwide. During this time she was the number one profit maker in the country. Bell-Messier took over the Medicare billing because of her great track record and success with cost efficiency. Bell-Messier later determined, however, that a significant percentage of patient files were not in compliance because they lacked the correct documentation. Bell-Messier also discovered that there was improper testing of oxygen patients. Bell-Messier instructed her billing department to “shut down the billing.” Compliance officers came to Texarkana. When they arrived, Bell-Messier told them the results of her audit. They informed her that they knew that they were significantly out of compliance. Bell-Messier told them that she “was not going to Medicare prison for ROTECH,” and refused to restart the billing.

Bell-Messier was told that ROTECH was in the middle of a settlement agreement with the government and could not do anything that might send the government a “red flag” (i.e. allow the government to recoup) and cost ROTECH more money.

After her settlement, she sent the following edited letter regarding her experience with partner Sarah Frazier.

Notice

This website is designed to provide general information only. This information is not and should not be construed to be legal advice. The transmission of the information found on this website also does not result in the formation of a lawyer-client relationship.

You should be aware that qui tam claims are subject to a Statute of Limitations. The area of limitations periods is complex. There are also first to file rules, public disclosure bars, original source issues, and varying limitations in pursuing retaliation claims. If you wish to pursue your claims, you should promptly seek the opinion of an attorney regarding the merits of your qui tam claim and the applicable statute of limitations.