Experienced Mississippi Whistleblower Lawyer Explains How the Recent Digital Reality Supreme Court Case

Without a rich bounty program for whistleblowers and robust legal prohibitions against retaliation, it is unlikely that anyone would take the risks of reporting fraud—luckily, most whistleblower programs offer both. Clients here in Mississippi often ask me to walk them through a whistleblower claim, a process that usually begins with a description the definition of a whistleblower.

The United States Supreme Court issued a decision, Digital Reality v. Paul Somers, in February that has a dramatic effect on who qualifies as a whistleblower for the purposes of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010. I have discussed Dodd-Frank on this blog before; it is a law passed in the wake of the 2008 financial crisis aimed at reforming the finance industry. Interested in incentivizing whistleblowing Wall Street insiders, it offers a 10% to 30% reward to whistleblowers who report fraud and broad protections against retaliation.

The issue in Digital Reality was similar to questions many of my clients bring to me, specifically, “do I qualify as a whistleblower?” Paul Somers, the plaintiff in the case, alerted his supervisors to financial fraud and was subsequently fired. Normally, this sort of clear retaliation would be prohibited against whistleblowers. The question was whether Somers qualified as a whistleblower under Dodd-Frank.

Which Definition of “Whistleblower” Applies Under Dodd-Frank?

Dodd-Frank prohibits “retaliation based on the whistleblower’s attempts to report her concerns.”  Somers’ report to his supervisors would seem to fall neatly under this provision. However, Dodd-Frank goes on to state, that the prohibition against retaliation only applies to whistleblowers who:

  1. Provide information to the SEC,
  2. Who assist or testify in SEC investigations, and
  3. Who report (even internally) suspected violations of securities laws or regulations.

Even when the definition of “whistleblower” is further narrowed by the three categories above, it still seems like Somers’ internal report of suspected violations of securities laws should have satisfied category three.

Remember what I said earlier, that Dodd-Frank has two important parts, one pertaining to the reward program and the other pertaining to retaliation. Somers’ actions seem to meet the definition of a “whistleblower” in the above retaliation section. However, in the reward section of Dodd-Frank, the term is defined much more narrowly. Instead of three different ways to qualify as a whistleblower, it only has one.  This narrow definition states that a whistleblower is a person who provides information to the SEC regarding a securities fraud violation. Somers never did that.

The question before the Supreme Court in the Digital Reality case was which definition of whistleblower should apply—the three-pronged version or the single-pronged one. The court found that the narrowest definition applied, and because Paul Somers did not report his suspicions of fraud to the SEC, he could not enjoy Dodd-Frank’s protections from retaliation.

Dangerous Precedent for All

The Digital Reality decision is bad for whistleblowers, bad for the finance industry, and bad for the SEC.  The decision is clear—if you want a considerable reward, you must report fraud to the SEC, and if you do anything less, you will not have any retaliation protection. For the finance industry, this decision means that employees will now be incentivized to go the SEC to attain protections against retaliation, and the decision creates a disincentive to try to report and fix problems within a company before reporting problems externally. Because the SEC lacks the capacity to investigate every tip it gets, this decision means that a tremendous amount of fraud will go unregulated. In the end, the purpose of Dodd-Frank was to incentivize fraud whistleblowing—Mr. Somers should not be penalized for doing just that.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud in the finance industry? Are you considering filing a whistleblower case?

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains How HIPAA Affects Healthcare Industry Whistleblower Claims

Many of the whistleblower claims I see here in Mississippi involve the healthcare industry, especially referrals for unnecessary procedures and kickbacks for client referrals. Exposing this sort of fraud can be worth it to the whistleblower, but a question often arises, “how do you expose fraud involving medical patients without simultaneously violating HIPAA?” In simpler terms, how do you show that your employer defrauded a patient without violating their right to privacy regarding their medical records? Luckily, with the help of an experienced whistleblower attorney, you can find “safe harbors” in HIPAA that allow for some disclosure of patients’ records, so long as the disclosure is limited and only occurs in an effort to report fraud.

The Federal False Claims Act

The claim in this $111 million recover was brought under the Federal False Claims Act (31 U.S.C. §§ 3729-3733), a law that penalizes individuals and companies that are convicted of defrauding the government. The False Claims Act created during the Civil War and signed by Lincoln to root out companies that were taking financial advantage of the war effort.

HIPAA

Most people here know it as “HIPAA” and not it’s full name, the Health Insurance Portability and Accountability Act of 1996. HIPAA is a privacy law for entities that handle patient’s medical information, generally prohibiting using “protected health information” such as bills, medical files, or notes for anything other than treatment. Protected health information cannot be shared publicly. This is a problem in whistleblower cases, as the whistleblower often wants to use patients’ files or bills as evidence of fraud. Whistleblowers cannot move forward with a case on general allegations, specific instances of fraud must be provided, often with evidence. But patients’ bills and files normally cannot leave a medical institution and should not be shared publicly. So how does a whistleblower prove their case?

HIPAA’s “Safe Harbors”

In law, a “safe harbor” is a term describing an act that would normally violate the law but is instead allowed because of some higher purpose being achieved. Under federal regulation 45 C.F.R. sec. 164.502(j) linked below, a person may release protected health information if the person believes that his or her employer “has engaged in conduct that is unlawful or otherwise violates professional or clinical standards” or “that the care, services, or conditions . . . potentially [endanger] one or more patients, workers, or the public.” Thus, HIPAA protected health information may be shared in a False Claims Act case by an employee who believes that his or her employer is engaging in fraud.

HIPAA establishes another safe harbor at 45 C.F.R. sec. 164.514(a) & (b), also linked below, for releases of protected health information that is de-identified. To use this safe harbor, an employee must de-identify the protected health information in a way that blacks our or redacts any identifying information. This is not just names and addresses, but also information such as dates of discharge that could be used to deduce the patient’s identity.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in a health care context like the one described above? Are you considering filing a whistleblower case? The handling of protected health information under HIPAA is only one complexity to being a healthcare industry whistleblower.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Jonathan Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Discusses Massive Settlement Matter

Clients here in Mississippi often ask whether it is worth it financially to be a whistleblower. There certainly are risks involved, but in return for taking the substantial risks sometimes required to expose fraud, the whistleblower may receive a significant percentage of any funds the government recovers.  In May, the government recovered $111 million in a whistleblower case and the four individuals who bravely exposed that fraud are entitled to up to a third of that amount. Because of the significant size of this recovery, I am going to use it as an example in the following blog post.

The Federal False Claims Act

The claim in this $111 million recover was brought under the Federal False Claims Act (31 U.S.C. §§ 3729-3733), a law that penalizes individuals and companies that are convicted of defrauding the government. The False Claims Act created during the Civil War and signed by Lincoln to root out companies that were taking financial advantage of the war effort.

Health Care Fraud at the Center of this False Claims Act Case

The health care industry is increasingly at the center of False Claims Act cases, as the government, through programs such as Medicare and Tricare (health programs for low income and military individuals, respectively) are often paying the lion’s share of payments to healthcare companies. That was the case here, as the allegation was that a medical testing lab called Health Diagnostics Laboratory and a consulting company called Blue Wave Healthcare paid a kickback to doctors who sent patients to them for unnecessary testing. A “kickback” occurs when a private party, here a doctor, receives some payment or gift in exchange for steering a client or patient towards another provider. Kickbacks are prohibited under the False Claims Act; that federal law comes into play when the federal government is paying for patient’s care through a program such as Medicare or Tricare. In essence, the kickback defrauds the government by steering a patient towards a certain provider without regard to quality or price. Here, the fraud was made more serious by the fact that the treatments were not even necessary.

Four different whistleblowers brought claims against the companies regarding different illegal practices. This is also a bit unusual, as usually only the “first to file” is entitled to any settlement, not those who bring claims later. However, each whistleblower in this case brought unique claims to the government’s attention. The named plaintiff, or “relator” in whistleblower terms, was Scarlet Lutz, and her story is a good example of how someone can inadvertently become a whistleblower. Ms.Lutz was not looking for fraud and simply ran a billing company associated with the defendants. However, due to an anonymous tip, she became aware of billing practices suggesting that fraud was occurring. Like Ms. Lutz, all of the relators in this matter were external; the other three ran competing testing labs that lost business because they were not paying kickbacks.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in a health care context like the one described above? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

The experienced Mississippi Whistleblower Lawyer at Barrett Law can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains: Reporting Medicaid Kickback Fraud

The Department of Justice recently settled over 27 million dollars in Medicaid fraud cases. I’ve attached an article about it at the end this blog post that will likely interest anyone thinking about becoming a whistleblower. One of the most common forms of Medicaid fraud is “kickbacks,” where a medical professional receives added, unrecorded payments for performing specified therapies or for directing patients to a specific colleague. The drug company, medical device distributor, or another doctor usually pays the physician who prescribes the drug or performs the therapy “under the table” for the additional business.

If you have witnessed this sort of illegal kickbacks in your workplace, you may be able to become a “whistleblower” and report this illegal activity in return for a share of whatever funds the government recovers. In return for taking the substantial risks involved with exposing that fraud, the whistleblower may receive a substantial percentage of any funds the government recovers.  Whistleblowers here in Mississippi frequently recover millions of dollars.

The Federal False Claims Act

The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. Most of the cases I see here in Mississippi are filed under the False Claims Act.

Kickbacks in the Medicaid World

Physicians who receive kickbacks often rationalize them as simply a thank you for prescribing a treatment or procedure that they would have recommended otherwise. Another form of kickback occurs between physicians. When a patient requires a specific procedure, there are often many physicians that can perform it. If a physician improperly directs patients to a specific physician in return for financial payment, that is also an illegal kickback. A kickback is nothing more than a bribe. While the physician may later rationalize that they would have taken the same action without the kickback he or she was provided, that rationalization does nothing to diminish the illegality of the act.

These kickbacks are often handled very informally. They may be cash payments handed over outside of the medical setting. They may also be non-monetary, such as expensive bottles of wine, golf clubs, or vacation home use. All of this informality makes them hard to track.

If you are an employee in a medical clinic or hospital and witness kickbacks being paid to either steer patients towards certain treatment brands or certain specialists, you may be eligible to make a whistleblower claim. To be a successful whistleblower, you must be the “first to file” your claim, meaning that if another coworker reports the kickbacks before you, you will receive nothing. You can remain anonymous for a short period, but if the federal government decides to prosecute your case, your name will become public. As a result, you should be prepared for significant backlash for your actions. However, retaliation is prohibited under the False Claims Act, and retaliation has its own financial penalties for employers who take negative action against whistleblowers.

What Should You Do if You are Considering a Whistleblower Claim?

Are you witnessing kickbacks in your work environment? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case regarding kickbacks. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains: Hospice Care Medicaid Fraud

When people are in their final months of life they often go into hospice care. Hospice care is emotional support and pain management for patients with less than six months to live. The money to pay for hospice care is often paid through Medicare, a federal program.

Hospice is a fraught time for most families. Their loved one is about to die and they are often overwhelmed with the many tasks involved in caring for their loved one, dealing with health-related expenses, and the pain of impending loss. As a result, they do not closely watch expenses. Unfortunately, because of the high cost of medical care, this is a ripe moment for Medicare fraud. Because the patient has usually died by the time any discrepancy arises and the family is in no position to remember precisely what medication was given or therapy performed, it can be challenging to detect over-billing or billing for treatments that never occurred. This difficulty is compounded because the majority of hospice care happens in a patient’s home, where the standard controls present in a hospital environment may not be as robust.

If you have witnessed the sort of Medicaid fraud I described above, you may be able to file a False Claims Act whistleblower claim. The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. “Whistleblower” is a general term for a private citizen who wants to alert the government to fraudulent acts committed against the government. In return for taking the substantial risks involved with exposing that fraud, whistleblowers can recover 15% to 30% of whatever funds the federal government recovers, amounts that often reach well into the millions.

Fraud in the Hospice Environment

If you work in hospice, you know that it is medication-intensive. The United States and Mississippi are both suffering from the effects of an opioid epidemic. Given that the pain management aspects of hospice often involve opioids, there is a tremendous opportunity to steal or divert medications and resell them on the black market. Similarly, because the patient will likely die shortly after hospice, it is ripe for overbilling and billing for procedures that were not performed.

If you are contemplating becoming a whistleblower in the hospice context, you will likely need to gather a sizable amount of evidence to support your claim. Especially if you are reporting a medical provider’s practice of overbilling, keeping careful notes regarding what treatment did and did not occur will be vital.

To attain any reward as a whistleblower, you must be the “first to file.” You can remain anonymous for a short period, but if the federal government decides to prosecute your case, your name will become public. As a result, you should be prepared for significant backlash for your actions. However, retaliation is prohibited under the False Claims Act, and retaliation has its own financial penalties for employers who take adverse action against whistleblowers.

What Should You Do if You are Considering a Whistleblower Claim?

Do you have knowledge of fraud or other serious financial misconduct occurring in hospice care? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, relationships, and livelihood, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Jonathan Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgement and losing your career and livelihood. Call  today.

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Experienced Mississippi Whistleblower Lawyer Provides a False Claims Act Overview

Clients here in Mississippi often come to me with questions about becoming a whistleblower. But what is a whistleblower? “Whistleblower” is a general term for a private citizen who wants to alert the government to fraudulent acts committed against the government. In return for taking the substantial risks involved with exposing that fraud, the whistleblower may receive a significant percentage of any funds the government recovers. Whistleblowers frequently recover millions of dollars, and these significant payments often catch folks’ attention and imagination.

The Federal False Claims Act

The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. Most of the cases I see are filed under the False Claims Act. It is not a new law and was created during the Civil War to root out companies that were taking financial advantage of the war effort.

How Does the False Claims Act Work?

A private citizen that becomes of fraud and files a False Claims Act claim is technically called a “relator.” From a layperson’s perspective, a “relator” is the same thing as a “whistleblower.” A relator can bring many types of claims, but the most common are for overcharging the government for goods or services, falsely claiming that the products or services meet certain prescribed specifications, or improperly concealing government overpayments. These claims arise in a wide variety of fields, but are especially prevalent in defense contracting, government construction contracting, health care fraud, and fraudulently attaining government loans.

Once a whistleblower’s claim is filed with the federal government, several factors come into play. To have any hope of receiving a reward, your claim must be the first regarding the fraud in question; a second claim for the same conduct will receive nothing. Second, the facts alleged must describe with accuracy significant fraud against the government. Finally, the allegations must allege a serious financial loss. The federal government receives thousands of False Claims Act allegations every year from would-be whistleblowers, but only acts on a few. Having experienced whistleblower counsel by your side is crucial to make sure that your allegations stand out.

A whistleblower’s allegations are usually filed secretly, under seal. But if the government accepts the allegations for prosecution, the allegations will be unsealed, revealing the whistleblower’s identity. This can be a fraught process, as your associates or employer may now know that you are accusing them of fraud, but every whistleblower should be aware that retaliation is also prohibited under the False Claims Act, and that retaliation carries significant monetary penalties as well.

A successful prosecution results in 15% to 30% of recovered funds going to the whistleblower. Because these cases frequently recover many millions of dollars, that recovery may be tremendous.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in the government context? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, relationships, and livelihood, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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With the federal government settling its claim against disgraced cyclist Lance Armstrong today, clients are asking about his former teammate, Floyd Landis receiving $1.1 million dollars as a whistleblower.  Clients have asked me if this is a new law or process. On the contrary, President Abraham Lincoln created the False Claims Act during the Civil War in an attempt to incentivize whistleblowing against war profiteers who sought to defraud the government.  Under the False Claims Act, the government can attain treble damages against the person or corporation committing fraud in the pursuit of a government contract, meaning the penalty is three times the fraud itself. A whistleblower, the person who alerts the government to the fraud under the False Claims Act, is entitle to 15% to 30% of the government’s recovery. Given that government contracts are frequently many millions of dollars, the rewards for whistleblowers can be sizable.

The Challenges of Being a Whistleblower Under the False Claims Act

Many people walk into my office excited at the prospect of being a False Claims Act whistleblower.  But being a whistleblower is scary—it can be terrifying to become aware of fraud, especially when you are reporting fraud by your coworkers or those within your corporation. Choosing to expose that misconduct and to become a whistleblower means risking your livelihood, friendship with colleagues, and financial security. Once you become a whistleblower and an investigation into the fraud commences, there is a serious chance that you will feel the wrath of those you have exposed. Loss of employment, punitive or disciplinary action, and defamation are just some of the forms of retaliation that whistleblowers sometimes experience.

What are the Types of Fraud the False Claims Act Covers?

Clients often ask me what constitutes fraud under the False Claims Act? Fraud can take several forms. Imagine that your company contracts to supply car tires to the Army at a certain specification of resilience and puncture resistance. If your company sell the government knock-off versions of the promised tire, that is fraud. In that example, your company is promising one thing to the government and providing a substandard product at the same price.

Yet another type of fraud involves qualifications; many types of government contracts either require that the contractor has certain qualifications and certifications or that it meet certain demographic qualifications such as being minority or woman owned.  In this type of fraud, a whistleblower may not be claiming that the product or service sold to the government was shoddy, but that the corporation involved in the transaction actually had no business entering into it.

Similarly, bribery is another type of fraud.  If your company bribes government officials in an effort to obtain a government contract, it is violating the False Claims Act.  For the same reason as stated above, your company is entering a contract with the government that it has no right to.

What Should You Do if You are Considering a Whistleblower Claim?

Do you have knowledge of fraud or other serious financial misconduct occurring in the context of your employment? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. First, you need confidential advice regarding whether the conduct you have observed constitutes fraud and whether you are in a position to receive compensation based on a whistleblower tip. Evidence gathering, dealing with the federal government’s attorneys, important deadlines, and filing requirements make your representation both complex and time-sensitive. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgement and losing your career and livelihood. Call us today.

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Mississippi Whistleblower Lawyer Explains Lance Armstrong’s Corruption Exposed by a Whistleblower

As a whistleblower attorney, I am used to reading about cases where the settlement amount—sometimes an eight digit number—is the what is noteworthy about the case. Today’s settlement of the Lance Armstrong doping fraud case is not huge—he has to pay a $5 million dollar settlement—but his larger than life profile makes for a great False Claims Act example. Under the False Claims Act, the government can attain treble damages against the person or corporation committing fraud in the pursuit of a government contract, meaning the penalty is three times the fraud itself. A whistleblower, the person who alerts the government to the fraud under the False Claims Act, is entitle to 15% to 30% of the government’s recovery. Given that government contracts are frequently many millions of dollars, the rewards for whistleblowers can be sizable.

How Did Lance Armstrong’s Actions Violate the False Claims Act?

Fraud can take several forms. The form at issue in the Lance Armstrong case involved qualification to contract with the government. Many types of government contracts require that the contractor has certain qualifications and certifications. In some contracts, the contractor must meet certain demographic qualifications such as being minority or woman owned. Here, Lance Armstrong defrauded the government by indicating that he was not taking performance enhancing drugs when the government—the U.S. Post Office—contracted to sponsor his team .  In essence, he was just like any other fraudulent contractor who promises the government a certain product, here drug free cycling victories, and actually provides something of less value.

The whistleblower in this case, Armstrong’s teammate Floyd Landis, exposed Armstrong’s cheating. As a result, he receives $1.1 million of the $5 million dollars that the government recovered, along with $1.67 million dollars in legal fees.

Because this settlement under the False Claims Act is so newsworthy, I thought I’d provide the following National Public Radio article that describes it in a bit more depth.  The entire article can be downloaded by clicking on the link below.

Lance Armstrong To Pay U.S. Government $5 Million To Settle Fraud Claims

Lance Armstrong has agreed to pay the federal government $5 million to settle fraud allegations that could have resulted in a nearly $100 million penalty. The U.S. Postal Service, which had sponsored the disgraced cyclist’s team, argued that Armstrong defrauded taxpayers by accepting millions from the government agency while using performance-enhancing drugs during competition.

“A competitor who intentionally uses illegal PEDs not only deceives fellow competitors and fans, but also sponsors, who help make sporting competitions possible,” Chad Reader, acting attorney general for the Justice Department’s civil division, said in a statement. “This settlement demonstrates that those who cheat the government will be held accountable.”

During his time cycling, Armstrong famously won a record seven consecutive Tour de France titles after recovering from testicular cancer, six of which he won as a member of the USPS-sponsored team.

But he was dogged by suspicions of doping throughout his career — including from his former teammate, Floyd Landis, who sued him in 2010 under the False Claims Act. As Reuters explains, the federal law “lets whistle-blowers pursue fraud cases on behalf of the government, and obtain rewards if successful.”

What Should You Do if You are Considering a Whistleblower Claim?

Do you have knowledge of fraud or other serious financial misconduct occurring in the context of government contracting? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgement and losing your career and livelihood. Call us today.

Source:            https://www.npr.org/sections/thetwo-way/2018/04/19/604125474/lance-armstrong-to-pay-u-s-government-5-million-to-settle-fraud-claims

 

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Mississippi Whistleblower Lawyer Provides Example of the Possible Rewards of Insurance Industry Employees Participation in the IRS Whistleblower Program

One thing is certain—if there is money in an enterprise, fraud will follow. That is certainly true in the insurance industry, where increased regulation under the Affordable Care Act has tightened insurance companies’ bottom lines. And if there is fraud, there is an opportunity for whistleblowers to expose it, which comes with tremendous risk and tremendous potential reward. Choosing to expose that fraud and become a whistleblower means risking your livelihood, friendship with colleagues, and financial security.

But with risk comes reward. The following April 17, 2018 article excerpts demonstrate the potential reward of whistleblowing, so I thought it would be interesting to those considering becoming a whistleblower. The whistleblower in this health insurance case exposed $89 million dollars in unpaid federal taxes. If his case is successfully prosecuted by the U.S. government, he would be due 30 percent of that amount or $26.7 million dollars under the IRS Whistleblower Program. I have linked to the entire article at the end of this blog post and encourage you to read it.

California Insurer Faces Whistleblower Complaint Over Health Law Taxes

A federal whistleblower complaint alleges that a major California insurer failed to pay an estimated $89 million in taxes on premium revenue as required under the Affordable Care Act.

The complaint against Blue Shield of California focuses on the taxation of certain health plans that are funded by both an employer and insurer. It could spark more scrutiny by federal officials into whether all insurers are paying their fair share of taxes on premiums.

The ACA’s health insurance tax is one of several fees designed to help fund the health law. Employers’ self-funded plans are exempt from this ACA tax. But traditional plans, in which health insurers are fully responsible for paying medical claims in exchange for premiums, are subject to the tax.

At issue in this case is whether Blue Shield should have paid ACA taxes on hybrid, or “flex-funded,” plans, in which employers pay claims out of their own pocket up to a point and the insurance company covers the rest. Such plans account for a modest share of the insurance market.

The whistleblower in the Blue Shield complaint is Michael Johnson, a public policy director at the company until 2015, when he left and became an outspoken critic of the company.

“Blue Shield appears to have skipped out on $89 million in health reform taxes in 2016, and it’s poised to do the same every year going forward,” Johnson said.

In July 2016, the San Francisco-based insurer made a significant change to its annual tax filing required by the ACA, federal records show. Blue Shield amended its initial filing from three months earlier and made a 25 percent reduction in its reported premiums, or $3.1 billion less.

Johnson cited those public Internal Revenue Service filings and other information he learned as a Blue Shield employee in his Jan. 30 whistleblower complaint. He shared parts of his complaint with California Healthline.

Johnson worked at Blue Shield for 12 years before leaving in March 2015. Soon after, he launched a public campaign against Blue Shield, accusing the nonprofit of shortchanging the public by operating too much like its for-profit competitors. Blue Shield sued Johnson in 2015 for breach of contract, accusing him of disclosing confidential company information. Johnson is seeking to have the case dismissed in state court.

The IRS Whistleblower Office acknowledged receipt of Johnson’s complaint in a Feb. 22 letter and said “we will evaluate the information you provided to determine if an investigation is warranted and an award is appropriate.”

If the IRS uses the information provided by a whistleblower, it can award the person up to 30 percent of the additional taxes and penalties collected. A spokesman for the IRS declined to comment further, saying the agency can’t discuss specific cases.

What Should You Do if You are Considering a Whistleblower Claim?

Are you considering filing a whistleblower case? To attain your compensation, you will require the help of an experienced whistleblower attorney to decide whether the conduct you have observed constitutes fraud. Evidence gathering, dealing with the federal government’s attorneys, important deadlines, and filing requirements make your representation both complex and time-sensitive.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgement and losing your career and livelihood. Call us today.

Sources: https://californiahealthline.org/news/california-insurer-faces-whistleblower-complaint-over-health-law-taxes/

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Mississippi Whistleblower Lawyer Explains U.S. Corporations’ Increased Whistleblower Retaliation Statistics

Being a whistleblower is scary enough—it can be terrifying to become aware of fraud, especially when you are reporting fraud by your coworkers or those within your corporation. Choosing to expose that misconduct and to become a whistleblower means risking your livelihood, friendship with colleagues, and financial security. Once you become a whistleblower and an investigation into the fraud commences, there is a serious chance that you will feel the wrath of those you have exposed. Loss of employment, punitive or disciplinary action, and defamation are just some of the forms of retaliation that whistleblowers sometimes experience. Unfortunately, clients often come to me asking if they can be an “anonymous” whistleblower. In the short term, the answer may be yes. However, if your matter goes to investigation and prosecution, your employer will eventually know your identity.

It looks like times are getting even tougher for whistleblowers. A recent Wall Street Journal report based on a survey by the Ethics & Compliance Initiative indicates that retaliation against whistleblowers is rising, and the increase is dramatic. Since 2013, the rate of whistleblowers reporting misconduct has increased 5%; however, the rate of retaliation against whistleblowers doubled, or rose by 100%, in that same time.

As employees know, a company can have prohibitions and policies against retaliation, but they may have little or no effect unless the company’s leadership supports an ethical culture where those policies are taken seriously and enforced. Without that enforcement, retaliation can go on either subtle or explicit ways, which has a chilling effect on other employees’ future reporting. When employees see unethical behavior go unpunished or, worse, rewarded, the company is communicating that its policies are simply “lip service” to appease auditors and ethics watchdogs. Other employees witness the negative ramifications of whistleblowing and learn to keep their head down and mouth shut. Over time, this process repeats itself and the company’s culture of ethics erodes dramatically.

While there is plenty of troubling news in the Ethics & Compliance Initiative report, the news was not all bad. It also reported that there are some companies that are “creating cultures their employees think are strong and grounded in good values. About 21% said they work at a company with a strong culture, up from 18% in 2013.” Thus, approximately one fifth of employees feel that they are working for a company that takes ethics seriously. That is still far too low, but may be a glimmer of hope.

What Should You Do if You are Considering a Whistleblower Claim?

Do you have knowledge of fraud or other serious financial misconduct occurring in the context of your employment? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. First, you need confidential advice regarding whether the conduct you have observed constitutes fraud and whether you are in a position to receive compensation based on a whistleblower tip. Evidence gathering, dealing with the federal government’s attorneys, important deadlines, and filing requirements make your representation both complex and time-sensitive. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call our seasoned Mississippi Whistleblower Lawyer today to learn more about how he can make a difference for you.

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