The Department of Justice (DOJ) relies heavily on whistleblowers to help identify fraudsters who cheat the government. More than 80% of the cases the DOJ pursues have been initiated by whistleblowers.

Many experts agree that whistleblowers are among the most powerful weapons the government (and the American taxpayer) has in an effort to expose cheaters.

Who Are Whistleblowers?

Whistleblowers can be anyone.

Nurses and medical administrators. Procurement clerks. Mortgage banking personnel. Defense contractor machinists, suppliers, manufacturers, and distribution companies. Construction companies and their subcontractors. Retirees.

We believe whistleblowers are courageous citizens who put themselves on the line to expose fraud against their country and the American taxpayer. It is not easy to come forward. But those who have success stand to obtain from 15% to 30% of whatever the government recovers from those who cheat.

 

Could You Be a Whistleblower?

If you have firsthand knowledge of fraud against the U.S. or state governments and can provide supporting evidence, you could potentially serve as a whistleblower and file a qui tam lawsuit.

Of the $2.8 billion the government recovered in 2018, whistleblowers received nearly $400 million in reward money.

Attorney Gary Jackson has handled a variety of whistleblower/qui tam cases in different industries for clients who felt a duty to expose fraud. Here are a few of the most recent cases Gary has worked on*.

Misrepresenting Drug Costs

A lawsuit was brought against a major drug store chain's pharmacy in what became one of the first False Claims Act settlements involving Medicare's Prescription Drug Program, known as Part D. The company agreed to pay the government** to resolve allegations that it made false submissions to the Centers for Medicare & Medicaid Services (CMS).

The lawsuit alleged that the pharmacy misrepresented the cost of prescription drugs on the CMS online tool called the Medicare Prescription Drug Plan Finder (Plan Finder). Seniors use the Plan Finder to compare pricing and benefits of various Medicare Part D plans.

The whistleblowers, upon reviewing their Explanation of Benefits (EOB) statement, noticed a significant discrepancy in prescription drug pricing. Their EOB showed that the pharmacy charged more for prescriptions than what they found listed on the Medicare Plan Finder tool.

The higher prices that the whistleblowers had paid depleted their Medicare benefits prematurely, forcing them to pay more money out of pocket.

They brought a successful whistleblower claim under the False Claims Act and shared a percentage of the government's rewards**.

Fraudulent Billing for Compromised Medications

A pharmacist who worked at a major big-box retail chain brought a qui tam claim under the False Claims Act for allegedly improperly transporting a store-brand medication, which caused it to be compromised by uncontrolled temperature extremes during transport.

The pharmacist alleged that for years, the chain consistently and routinely failed to store and handle this medication in accordance with manufacturer and FDA regulations. As a consequence, allegations claimed that the chain had been dispensing a drug that the FDA and Centers for Medicare and Medicaid Services (CMS) considered to be "adulterated" potentially endangering the lives of the medication users. Still, the chain sought payment from government programs, including Medicare, Medicaid, and TRICARE.

The medication is supposed to be kept within a certain temperature range from the time of manufacture through final sale to customers. However, the pharmacist alleged that the medication was exposed to temperature extremes during transportation, despite knowing of the drug manufacturer's protocol for maintaining a safe temperature.

By failing to follow and maintain proper shipping and storage practices, allegations were that the chain was unable to certify to government payors that the medication had been stored and handled in accordance with manufacturer and FDA requirements, that it was fully potent and contained the dosage strength according to the labeling, and that it was safe to use.

As a result of the chain's alleged failure to maintain the recommended temperature control, the whistleblower claim alleged the pharmacies sold a drug that was considered to be adulterated and submitted claims for payment of this product.

Billing for Services Not Received, and Other Improprieties

An employee of a medical clinic in North Carolina brought a qui tam claim against the clinic alleging that, for several years, it submitted false claims against the government through improper and fraudulent billing. Allegations were that defendants submitted false and/or fraudulent claims to Medicare, Medicaid, and TRICARE by unbundling, billing for medically unnecessary services, and billing for services requiring direct physician supervision when, in fact, there was none. In 2015, a settlement agreement** was reached between the clinic, the State of North Carolina, and the federal government.

Falsifying Documents, and Other Healthcare Deviations

An employee of a healthcare company filed a federal False Claims Act suit alleging company owners knowingly defrauded the United States and the State of North Carolina for several years, by engaging in numerous fraudulent billing practices, including knowingly falsifying documents when billing Medicare, Medicaid, TRICARE, and the Veteran's Administration. Specific allegations included:

  • Billing for unauthorized hours and tasks that were not Medicaid-approved
  • Missing signatures and other vital and required information
  • Deviations of care that were not properly documented
  • Personal tasks billed for but which were not completed

The employee estimated that fraudulent billing over this period amounted to a total of nearly $100 million.

Violations of Student Loan & Grant Terms

In 2016, a university agreed to pay several million** to resolve allegations that it violated the False Claims Act in connection with a federal grant and with regard to receiving and disbursing Title IV federal student aid funds.

A whistleblower complaint filed by former students of a college alleged that the college received grant funds from a federal program despite failing to comply with the conditions of the grant. Additional allegations were that the college improperly awarded, disbursed, and received Title IV student loan funds.

Misrepresenting Source and Quality of Medical Products

A medical manufacturer obtained a contract from the North Carolina Department of Health and Human Services to produce and distribute medical products.

Whistleblowers who worked at the company brought a claim alleging that the company lied to the State of North Carolina during contract negotiations by promising to create local jobs at its manufacturing plant when, instead, it sent those jobs overseas.

The whistleblowers also alleged that the company had been misidentifying and falsifying some of their product labels. Ultimately the company lost its contract with the State of North Carolina.

Sham Companies & Kickbacks to Land DOD Construction Jobs

For several years, a large construction company allegedly set up "sham" small companies and veteran-owned businesses to win large multi-million dollar military construction contracts. The DOD often requires that large contractors use small- and minority-owned businesses as sub-contractors on DOD jobs, in efforts to help them compete on these massive lucrative bids. The large construction company and its sham companies made hundreds of millions of dollars allegedly fooling the government for several years. A whistleblower, who was employed on one of these large construction jobs became aware of this scheme and blew the whistle.

It is further alleged that the construction company and its sham companies gave kickbacks in regard to a military base project as well as other military construction projects.

 

* Cases handled prior to joining the Law Offices of James Scott Farrin.
** Each case is unique and must be evaluated on its own merits. Prior results do not guarantee a similar outcome.

NC Whistleblower/Qui Tam Attorneys Offer Free Case Evaluation

If you suspect fraud against the federal or state government, let's talk. We are here to help put you at ease as we try to help you determine — confidentially and discretely — if you should move forward with a whistleblower/qui tam claim. We appreciate the struggle you may be facing. That is why we have a You-First policy in place. We will try to help protect you regardless of your involvement.

Contact us or call 1-844-520-2889.

If we decide to take your case and you don't get a reward for reporting fraud, you owe us nothing.

Prefer we contact you?(100% confidential)
Submission of any information to Farrin.com does not constitute an attorney-client relationship. Our attorneys are licensed to practice law in North Carolina.