Today’s riddle: why would the government take the defendant’s side against the whistleblower in a False Claims Act qui tam case? Why would the government challenge the whistleblower’s claim that two defendants violated the Stark Law, insisting instead that they met a Stark exception? A Georgia federal …
Retaliation Claim Survives Though False Claim Act Claim Is False
March 28, 2016 Leave a Comment
Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans. When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving all preauthorization requests for durable medical equipment. She complained that the …
Most Imaginative Whistleblower Claim of the Month
March 18, 2016 Leave a Comment
Vicki Sheldon is the hands-down favorite to claim this month’s Most Imaginative Whistleblower Claim award. Vicki’s at-the-time husband Duane was employed at Kettering Health Network (KHN). Duane had an affair with another KHN employee, and the two of them impermissibly accessed Vicki’s medical records. …
A Grossly Negligent Claim Isn’t a False Claim
March 16, 2016 Leave a Comment
You have to feel sorry for whistleblower Darilyn Johnson. The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her basic FCA case. Darilyn could prove that when the allergy clinic filled out its Medicare …
Was Whistleblowing a Reason for Firing or the Reason?
January 26, 2016 Leave a Comment
The outcome of a physician whistleblower’s retaliation claim against his former medical group turns on the question whether whistleblowing was a reason or the reason he was fired. If it was a reason, he loses. If it was the reason, he wins. Dr. Donald Helfer was an anesthesiologist and shareholder with …
Broward Health Wins Most-Illegal-Physician-Comp
September 16, 2015 Leave a Comment
Okay, there’s not really a Most-Illegal-Physician-Compensation Prize. But if there were, Florida’s North Broward Hospital District would have won in a walk. That’s why the district has agreed to pay the government $69.5 million to settle charges that it violated the Stark Law, the Anti-Kickback Statute …