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Archive for the ‘Whistle Blower’ Category

To Be or Not to Be (a Whistle Blower) that Is the Question

Thursday, July 7th, 2011

A follow up blog to a post concerning a nurse who was jailed and fined for reporting a doctor… It looks like justice was served in the end.

An Unfair Complaint

A Texas nurse is waiting to stand trial. For what you might ask… Illegal prescription use? Theft? Wrongful death? How about none of the above? Anne Mitchell is facing trial because she is a whistle blower and the doctor in question protested to the sheriff in the small Texas town that he was being harassed and defamed for no reason.

Mitchell wrote an anonymous letter complaining about Dr. Arafiles practices and “mishaps” – including a failed skin graft performed without surgical privileges, suturing a rubber tip to a patient’s crushed finger for protection and a large affinity to herbal supplements which he sold as a side business – to the medical board.

This “anonymous” letter was brought to the attention of Dr. Arafiles who immediately filed a complaint to his friend the sheriff who then issued a search warrant to seize the nurse’s computer and found the letter.

Mitchell had worked for the hospital system for over 20 years. She is a much respected member of the nursing community. She loved her job and only wanted the best for patients. She was doing what every nurse should do – report wrongdoing and highly questionable (on numerous occasions) practices performed by Dr. Arafiles.

Mitchell was charged of misuse of official information, a third-degree felony punishable by prison time and was also fired from her job at the hospital.

A Just Outcome

A jury found Mitchell not guilty. Karma also reared her ugly head, with Dr. Arafiles, the sheriff, and a hospital administrator faced criminal charges in connection with the prosecution and with the firing of Mitchell. The defendants agreed to pay Mitchell and another nurse who was fired as well $375,000 a piece for the wrongful firing.

The state medical board also charged Dr. Arafiles with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.

Following Dr. Arafiles’ hearing, the board gave the doctor the choice of 2 remedial education programs for physicians along with 8 hours of continuing medication education in medical record-keeping and another 8 hours in evaluating and treating thyroid disease. He has also been put on probation for 4 years and fined $5,000.

Final Lesson

Putting whistle blowers in prison would seem to be a deterrent to those in the future that witness wrongdoing. While there are certainly those that “blow their whistle” in hopes to receiving a grand payday, there are also concerned individuals that do the right thing and report the wrongdoings and injustices they witness.

We have laws in place to protect whistle blowers from retaliation. These laws are necessary to protect individuals who do the right thing and are not afraid of being call “tattletales.”

The whole point of protecting whistle blowers is to give people an incentive to report. Without an incentive we can expect fraud, theft etc. to only increase in the healthcare system.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Most Wanted Healthcare Fugitive List

Wednesday, February 9th, 2011

And cue… “Bad boys, bad boys, whatcha gonna do, whatcha gonna do when they come for you?”

The Office of Inspector General (OIG) of the Department of Health & Human Services launched a Most Wanted Fugitives List for those criminals wanted by authorities on charges of healthcare fraud and abuse. This most wanted list is a tool to bring attention to the fugitives and their crimes against the healthcare system.

The list on the OIG website includes photos, profiles, and a list of crimes of each featured fugitive. The 10 individuals on the list have allegedly cost taxpayers more than $124 million in fraud. In all, OIG is seeking more than 170 fugitives on charges related to healthcare fraud and abuse.

Included on the Most Wanted Fugitives List:

1. Eduardo Moreno

Moreno allegedly stole hundreds of thousands of dollars from the Medicare program, submitting false and fraudulent claims for durable medical equipment (DME) “and related health care benefits, items and services” that were medically unnecessary.

Moreno was a sneaky fraudster, using a “straw owner” and other methods to hide the money and property he obtained. (A straw owner is an individual who maintains the appearance of owning property in order to disguise the identity of the real owner.)

2. Leonard Nwafor

Nwafor billed Medicare for $1.1 million and collected $525,000 in fraudulent claims for such durable medical equipment (DME) as motorized wheelchairs, scooters, and hospital beds for beneficiaries. This investigation was led by the Medicare Fraud Strike Force, including OIG investigators, which was created to identify and prosecute fraudulent DME companies and laboratories in the Greater Los Angeles area.

The website also provides you with the opportunity to report any of the fugitives or any other individuals believed to have committed healthcare fraud. The site also includes a toll free number.

Take a look at the fugitives and spread the word! These are the individuals causing healthcare costs to increase and benefits to decrease.

Healthcare Fraud Roundup

Thursday, October 14th, 2010

What are the fraudsters doing these days? Well, according to reports, NOT getting away with healthcare fraud. The government is in hot pursuit of those that are bilking the system.

Some recent arrests include:

A Michigan podiatrist was accused of filing more than $800,000 in fraudulent claims. The doctor billed insurance providers for surgical procedures performed after falsely diagnosing patients with foot infections.

A New York surgeon was charged with stealing $3.5 million from insurance companies. The Department of Health & Human Services also investigated his billing patterns and found he had allegedly billed for multiple hemorrhoidectomies, office visits and examinations on the same day for the same patient on multiple occasions.

A Chicago-area cardiologist was ordered to pay $20 million and sentenced to 5 years in prison for defrauding both private and public insurers. The whistle blower on the case was another physician who worked in the same office.

Two West Virginia internists were sentenced to one year and one day of prison time after admitting to their involvement in a pill mill scheme. The local pharmacy where the prescriptions were sent by the physicians sold more hydrocodone in 2006 than all but 21 retail pharmacies in the country.

A California pathologist was sentenced to 25 years in prison for prescription fraud. He wrote fraudulent prescriptions for oxycodone in exchange for cash. In some cases the prescriptions were for minors under the age of 21.

In Miami a massage clinic owner was convicted of Medicare fraud. The owner was charged with submitting false claims for physical therapy services that were never given and occupational therapy services that Medicare does not cover.

Healthcare fraud is prevalent, but we’re finding ways to stop the bad guys.

All Eyes on Compliance with New Whistleblower Laws

Thursday, September 23rd, 2010

With the new laws and incentives reported in the Patient Protection and Affordable Care Act, we are seeing more whistleblowers come forth alleging healthcare fraud. Currently, 90% of health care fraud cases are whistleblower cases — often in which the behavior of the “ethically challenged” directly poses risks to public health.

Regardless of whether whistleblowers are concerned citizens, disgruntled employees or senior executives with a “lottery mentality”, hospitals and other healthcare companies must have strong compliance programs in place to stop fraudulent activity — such as improperly billing Medicare and Medicaid and kickbacks to doctors. A list of healthcare companies that have signed corporate integrity agreements with the OIG can be found here.

With the new incentives, hospitals and other healthcare companies are even more susceptible to whistleblowers. Now is the time to review your current compliance program and develop the necessary internal controls to protect your organization from committing fraud. Below are 4 simple but important considerations to keep in mind when evaluating compliance programs:

1. Periodic comprehensive fraud risk assessments are conducted.
2. Standards of conduct for employees are written and distributed.
3. Educational and training programs are offered to all employees.
4. Audits are conducted to monitor compliance and identify problem areas.

The effectiveness of whistleblowers is also an integral part of the effort to combat healthcare fraud. The first thing people need to do when encountering fraudulent activity in their workplace is to make sure that they understand the reporting framework and seek appropriate legal counsel. As an expert witness, I have seen first-hand the enormous complexity of whistleblower suits.

New Whistleblower Lawsuit Restrictions

Friday, April 2nd, 2010

“Blowing the whistle” on a former healthcare employer can lead to lottery like payouts. Recent whistleblowers are earning millions of dollars for their fraud reporting. Here are some highlights:

1. Pfizer whistleblower earns $51.5 million reward – with Pfizer having to pay $2.3 billion in penalties.
2. $2 million awarded to two New Yorkers for speaking out against their former nursing home employer – $24 million was paid back to the state.
3. A registered nurse received $4.9 million for her help in a Medicare fraud case that netted the U.S. Government $24 million.

However a recent Supreme Court ruling could change the nature of whistleblower lawsuits and the big individual payouts. The court has placed limits on existing whistleblower lawsuits claiming that local governments have misused federal money. The court voted 7 – 2 to hold that a technical, though important aspect of the federal whistleblower law applies to local governments. There is a section of the law that prohibits whistleblower lawsuits when public disclosure occurs through a court hearing, a news report or congressional/administrative audit. Read full article here.

It makes sense that once allegations are disclosed publicly, lawsuits are harder to file. If that wasn’t the case, people could hear about something on the news and head to the courthouse to file a claim. On the other hand, we need to make sure that people are still willing to file these claims against current or former employers who are guilty of wrongdoing. A previous post discussing two Texas nurses who are on trial for bringing claims against a doctor is a perfect example of what we are doing to NOT encourage people to stand up for what is right.

Whistle blower to stand trial for reporting doctor

Saturday, February 27th, 2010

A Texas nurse is waiting to stand trial. For what you might ask… Illegal prescription use? Theft? Wrongful death? How about none of the above? Anne Mitchell is facing trial because she is a whistle blower and the doctor in question protested to the sheriff in the small Texas town that he was being harassed and defamed for no reason.

Mitchell wrote an anonymous letter complaining about Dr. Arafiles practices and “mishaps” – including a failed skin graft performed without surgical privileges, suturing a rubber tip to a patient’s crushed finger for protection and a large affinity to herbal supplements which he sold as a side business – to the medical board.

This “anonymous” letter was brought to the attention of Dr. Arafiles who immediately filed a complaint to his friend the sheriff who then issued a search warrant to seize the nurse’s computer and found the letter.

Mitchell had worked for the hospital system for over 20 years. She is a much respected member of the nursing community. She loved her job and only wanted the best for patients. She was doing what every nurse should do – report wrongdoing and highly questionable (on numerous occasions) practices performed by Dr. Arafiles.

Putting whistle blowers in prison would seem to be a deterrent to those in the future that witness wrongdoing. While there are certainly those that “blow their whistle” in hopes to receiving a grand payday, there are also concerned individuals that do the right thing and report the wrongdoings and injustices they witness.

The whole point of protecting whistle blowers is to give people an incentive to report. Without an incentive we can expect fraud, theft etc. to only increase in the already failing healthcare system.

Read full article here.