A “Whistle blower” is usually an employee or former employee who reports a financial violation of the law by his or her employer or former employer who has ripped off, cheated, or defrauded the government. Often, but not always a whistle blower is a low paid employee, billing clerk, CNA, claims processor, secretary, medical assistant, data entry or coder, insurance clerk, registered medical assistant, physical therapist, dental hygienist, even a nurse or doctor. An attorney will initially bring a “secret action” in United States District Court, where the matter may quietly resolve.

You May have a Potential Whistle Blower Case if your employer or former employer has done or is doing any of the following:

  • Medicare Advantage Plan(s) knowingly improperly denying claims
  • Defrauding Medicare
  • Treatments without regardless of real need
  • Excessive “TOI” (Tendon Origin Injections)
  • Excessive “TPI” (Triger Point Injections) mislabeled as tendon injections
  • Unnecessary injections to patients then mislabeling the injection during billing
  • Health care fraud
  • Schemes to rip off insurance benefits
  • Billing Medicare for services not provided
  • Using false billing codes
  • Fake or false prescriptions
  • Diagnosing conditions/diseases and billing for care not provided
  • Defrauding the United States Government
  • Billing for medication not provided
  • Billing for high priced items and giving low priced items to patients/customers
  • Billing for services or care not provided
  • Managers dictating how much therapy a patient receives instead of the therapist
  • Improperly denying claims to increase profit
  • Knowingly overcharging premiums to increase profit
  • Billing for unreasonable/unnecessary treatment
  • Overcharging premiums to increase profits
  • Increasing profits by various schemes that are not true
  • Nursing Homes charging for things not done
  • Billing for services not provided

WHISTLE BLOWER REWARDS – Getting Paid for Blowing the Whistle

Whistle blower rewards are paid for reporting fraud against the government such as Medicare fraud or military fraud. Congress authorized the government to pay the whistle blower a percentage of the money the government collects based upon the whistle blowers information.

Often a case settles with no litigation.

You must hire an attorney and file a “secret” qui tam civil suit that sets out the fraud upon the Government. We need very specific and detailed information of the fraud. . You need an attorney with experience filing Whistle blower cases lawsuits. Attorney Aldred has this experience.

Employees are protected

Current employees are protected under state and federal laws barring discrimination or retaliation against a whistle blower.

The False Claims Act allows an everyday employee who discovers wrongdoing to sue on behalf of the government in order to recover lost public funding.

Affordable Care Act. 29 U.S.C. §218C (ACA) Protects employees who report violations including but not limited to discrimination based on an individual's receipt of health insurance subsidies, the denial of coverage based on a preexisting condition, or an insurer's failure to rebate a portion of an excess premium.

Consumer Financial Protection Act (CFPA). [12 U.S.C. §5567]. Protects employees for blowing the whistle on reasonably perceived violations of any provision of the Title X of the Dodd-Frank Wall Street Reform and Consumer Protection Act or any other provision of law that is subject to the jurisdiction of the Bureau of Consumer Financial, Protection, or any rule, order, standard, or prohibition prescribed by the Bureau.

Sarbanes-Oxley Act (SOX). [18 U.S.C. §1514A] Protects employees of certain companies who report alleged mail, wire, bank or securities fraud; violations of the SEC rules and regulations; or violation of federal laws related to fraud against shareholders. The Act covers employees of publicly traded companies and their subsidiaries, as well as employees of nationally-recognized statistical rating organizations. 29 CFR 1980

Consumer Product Safety Improvement Act (CPSIA). [15 U.S.C. §2087] Protects employees who report to their employer, the federal government, or a state attorney general reasonably perceived violations of any statute or regulation within the jurisdiction of the Consumer Safety Product Safety Commission (CPSC).

FDA Food Safety Modernization Act (FSMA) [21 U.S.C. 399d]. Protects employees of food manufacturers, distributors, packers, and transporters from reporting a violation of the Food, Drug, and Cosmetic Act, or a regulation promulgated under the Act. Employees are also protected from retaliation for refusing to participate in a practice that violates the Act.

Some examples of Whistle Blower Cases (as reported by ABC News):

1. UBS: $104 million; September 2012 The IRS award to Bradley Birkenfeld made him the most richly rewarded whistle blower to date.

2. Pfizer: $102 million; September 2009 A group of 10 for Pfizer employees, including original whistle blower John Kopchinski, were awarded $102 million for having exposed the illegal promotion of the arthritis drug Bextra.

3. HCA: $100 million; December 2000 Two whistle blowers shared a $100 million reward, after they told the FBI that the healthcare provider was regularly overbilling Medicare. Their tips led to government raids of 35 HCA locations in 1997, and to HCA's payment of a landmark fine.

4. GlaxoSmithKline: $94 million; July 2012 Whistle blowing complaints filed by Cheryl Eckard, who alleged manufacturing faults at one of Glaxo's plants. Glaxo, without admitting wrongdoing, agreed to pay fines to settle civil allegations.

5. Abbott Laboratories: $84 million; August 2012 Whistle blowers stand to receive some $84 million under the False Claims Act in a settlement by Abbott concerning off-label promotions of its anti-seizure drug Depakote.

6. Bank of America: $25 million; March 2012 whistle blower Kyle Lagow alleged underwriting and mortgage fraud involving subsidiary Countrywide Financial, and Lagow was awarded $14.5 million.

7. Tenet: $8.1 million; January 2004 Two whistle blowers responsible for having told the FBI they believed physicians at a Tenet hospital were performing unnecessary cardiac procedures, shared a reward of $8.1 million. of a $54 million settlement—a record amount for a fraud allegation involving a single hospital, according to Modern Healthcare. Tenet did not admit any wrongdoing.

If you are an employee or former employee who knows of inappropriate or unethical billing or financial activity by your employer you should speak with attorney Aldred IMMEDIATELY! Do not talk to anyone else, especially a co-employee or your employer.

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