Health Care whistleblower

Whistleblowing is good for our health. Not necessarily the whistleblower’s health. But, while we’ve been watching the battle over whistleblower protection in Washington, insiders have been busy flagging health fraud.

As a result, there are patients out there who may have been spared unnecessary spine surgery or viscosupplementation injections. As a bonus, the rest of us won’t have to pay for them through Medicare.

In its October announcement of a $7.1 million settlement with the now defunct Osteo Relief Institutes, the Department of Justice (DOJ) describes viscosupplementation as a treatment for osteoarthritis “in which a doctor injects a gel-like fluid into a patient’s knee joint to act as a lubricant and to supplement the natural properties of joint fluid.”

But the clinic didn’t quite get it right, according to the DOJ.


Continue Reading Healthcare whistleblowers have your back, and your knees

Medicine is a profession with high ethical standards. At the same time, there is much money to be made. Bad players find ways to siphon some of the nearly $600 billion we spend on Medicare each year. So, both the health care industry and its regulators constantly struggle with how to cope with the kickbacks, conflicts of interest and billing for unnecessary care.

Illustration by Nora Valdez

Last year, $2.5 billion of the $2.8 billion in Department of Justice False Claim Act recoveries involved the health care industry. In 2019, whistleblowers working with the DOJ included hospital administrators, sales representatives, home health care workers, physicians and patients.

Now, they may have more muscle. Maria Durant, a partner with the firm Hogan and Lovells, told a group of lawyers gathered in Boston last week there has been a major shift in the way courts interpret the validity of medical opinion. She spoke at a conference on health care law held Thursday by the Boston Bar Association. 
Continue Reading Can medical opinions be false claims? Now they can, as two whistleblower cases suggest a shift.

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians across the nation, the federal government charged in a lawsuit filed this spring.

In addition, Wheeling paid an obstetrician-gynecologist a salary as high as $1.3 million a year, so much that her department bled money, according to a related lawsuit by a whistleblowing executive. The hospital paid a cardiothoracic surgeon $770,000 and let him take 12 weeks off each year even though his cardiac team also routinely ran in the red, that lawsuit said.

Despite the losses from these stratospheric salaries and perks, the recruitment efforts had a golden lining for Wheeling, the government asserts. Specialists in fields like labor and delivery, pain management and cardiology reliably referred patients for tests, procedures and other services Wheeling offered, earning the hospital millions of dollars, the lawsuit said.
Continue Reading Kaiser Health News: Hospitals Accused Of Paying Doctors Large Kickbacks In Quest For Patients