Cryptocurrency Whistleblower

Healthcare Fraud

• A healthcare provider paid $195 million to settle allegations that the company encouraged physicians to prescribe highly addictive opioid painkillers for unapproved purposes. (The painkillers were approved for cancer patients only, but the company was encouraging prescriptions for non-cancer patients.)

• A company paid $500 million to resolve various claims including that it promoted the use of its drug product to physicians who “were writing prescriptions … that were unsafe, ineffective, and medically unnecessary.”

• A healthcare operator paid $48 million to resolve allegations that some patient admissions to its facilities were not medically necessary and that some of its facilities provided inaccurate information to Medicare to maintain their status as “inpatient rehabilitation facilities” – a designation that enabled the operator to earn a higher rate of reimbursement from Medicare.

• A major pharma company paid $625 million to resolve allegations that it improperly repackaged potentially contaminated oncology-supportive injectable drugs.

• A medical device manufacturer paid $33.2 million to resolve allegations that it sold a materially unreliable testing device that was intended to help doctors and nurses diagnose drug overdoses, assess acute coronary syndrome, and identify other serious conditions

• Two of America’s most respected pharmaceutical companies paid more than $233 million to resolve various claims that they set up bogus schemes – including funneling money through a non-profit foundation to pay patients’ co-pays – to improperly inflate the price of drugs paid by Medicare in some cases by as much as 40%.

• A major provider of electronic medical records paid $155 million to resolve charges that it misrepresented what its software could do, and then paying kickbacks to customers to promote the product.

• A major hospital system paid $731 million to resolve claims that it ordered medical tests that were not necessary, up-coded various charges, and misrepresented its advertising expenses as “community education” in order to get the government to pay for non-reimbursable expenses.

• A major drug company paid $2.2 billion to resolve charges that it illegally marketed off-label uses of three drugs.

• A major nursing home chain paid $145 million to resolve a complaint that it provided unnecessary rehab services.

The most common types of healthcare fraud include:

• billing for services that were never rendered;

• upcoding;

• performing medically unnecessary services;

• misrepresenting treatments not covered by insurance as covered treatments;

• falsifying patients’ diagnoses and medical records to justify tests, surgeries or other procedures that aren’t medically necessary; and

• “unbundling” or billing for each step of a procedure as if they are separate procedures.

Research Fraud

• A major university paid $112.5 million to settle allegations that it falsified research data in grant applications.

• A major pharmaceutical company paid $3 billion to resolve charges that it illegally promoted nine different prescription drugs, paid kickbacks to doctors to prescribe the medications, and falsified scientific research and articles.

Contracting Fraud

• A company and its subsidiary paid $66 million to resolve claims that the fiber they used to produce their supposedly bullet-proof vests for law enforcement agencies was so weak and defective that it could not stop a bullet 50% of the time.

• A company responsible for servicing American Navy ships in foreign ports inflated its invoices, resulting in a $20 million fine.

• An aluminum manufacturer paid $34.6 million to resolve claims that it falsified critical testing data about the consistency and reliability of its products, resulting in two failed rocket launches by NASA.

• A Kuwaiti company paid $95 million to resolve claims that it overcharged the Department of Defense for the fruits and vegetables it provided to American troops stationed in Iraq.

• A major engineering and construction company agreed to pay $125 million to resolve allegations that it provided deficient materials, services, and testing involving nuclear waste.

Oversight Fraud

• One of the largest, most-respected accounting firms paid $149 million for failing to properly audit a participant in an important government mortgage program.

• A home mortgage company was found liable by a jury for $92 million in damages for issuing improperly issuing mortgages to unqualified applicants who then quickly defaulted on the loans.

• One of the largest banks in America – along with two financial institution subsidiaries – agreed to pay $16.65 billion to resolve charges that it engaged in fraudulent practices in the issuance and marketing of collateralized debt obligations involving home mortgages.

• Another major bank paid $641 million to settle allegations that it issued FHA and Veterans Affairs insured home loans to people who then defaulted; and the government paid the bank insurance money on mortgages that should never have been approved.