Articles Posted in healthcare whistleblower protections

The U.S. Food and Drug Administration approved Xofluza (baloxavir marboxil) for the treatment of acute uncomplicated influenza (flu) in patients 12 years of age and older who have been symptomatic for no more than 48 hours. “This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option,” said FDA Commissioner Scott Gottlieb, M.D. “While there are several FDA-approved antiviral drugs to treat flu, they’re not a substitute for yearly vaccination. Flu season is already well underway, and the U.S. Centers for Disease Control and Prevention recommends getting vaccinated by the end of October, as seasonal flu vaccine is one of the most effective and safest ways to protect yourself, your family and your community from the flu and serious flu-related complications, which can result in hospitalizations. Yearly vaccination is the primary means of preventing and controlling flu outbreaks.”

Flu is a contagious respiratory illness caused by influenza viruses. When patients with the flu are treated within 48 hours of becoming sick, antiviral drugs can reduce symptoms and duration of the illness.

“When treatment is started within 48 hours of becoming sick with flu symptoms, antiviral drugs can lessen symptoms and shorten the time patients feel sick,” said Debra Birnkrant, M.D., director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research. “Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs.”

Brand named drugs cost the Medicare prescription drug program Part D double the cost for the same drugs sold in developing countries.  Medicaid and the VA are permitted to negotiate drug prices,. Medicare is not. Medicare is a much larger program but is is barred from negotiating prices by laws made by Congress!. Medicare Part D pays  73 percent more than Medicaid and 80 percent more than the VA for the same brand-name drugs.

Congress has yielded to lobbiest and as a result we, the taxpayers lose billions. Yes billions. Paul Ryan, speak up! The pharmaceutical industry is at the  very top of  contributors to our Senators and Representatives.

Time to put a stop to it. Everyone speak up.

George L. Piro,  owner and operator of a home health care agency was sentenced today to 106 months in prison for his participation in a $30 million Medicare fraud scheme. Ramon Regueira, 66, owner of Nation’s Best Care Home Health Corp. (Nation’s Best), a Florida home health care agency, pleaded guilty to one count of conspiracy to commit health care fraud on Nov. 13, 2014.  In addition to the prison sentence, U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida ordered Regueira to pay $21 million in restitution, both jointly and severally with his co-conspirator.

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Atiq Durrani MD charged Medicare $11 million for surgical procedures called anterior lumbar fusions from 2010 to 2013 and a detailed review has resulted in charges by the United States that those surgeries were unnecessary for the patients.

The doctor has been charged with healthcare fraud and making false statements following his recent arrest. According to news reports, he has also been named in nearly 150 medical malpractice lawsuits filed by former neck and back patients. His privileges at a major hospital have been taken away.

Jeffrey Newman represents whistleblowers


This month the government unveiled a scheme by two companies Omnicare and IVAX, which was uncovered when whistleblowers came forward to file lawsuits.The settlements WHICH RESULTED IN OVER $112 million returned to the givernment are based on five separate whistle blower lawsuits filed by private individuals and consolidated in U.S. District Court in Massachusetts under state and federal false claims statutes. The states and the federal government alleged that Omnicare and IVAX engaged in several unlawful kickback schemes:

* Omnicare solicited and received $8 million for agreeing to purchase $50 million in generic drugs from IVAX Pharmaceuticals and to push nursing home patients to use the drugs.

* Omnicare paid $50 million to certain nursing home chains in exchange for 15-year contracts to refer nursing home patients to Omnicare for the patients’ drug purchases.

Protecting yourself or your parents from Medicare Fraud is not difficult once you know what to look for. Last year, the Department of Justice recovered a billion dollars in health care fraud, in good part as a result of whistleblowers like you.  Whistleblowers are entitled to a percentage of what the government recovers .  Here are some tips on fraudulent schemes:
*Be suspicious of doctors, health care providers or suppliers that tell you 1) the equipment or service is free,  it won’t cost you anything and they only need your Medicare number for their records; 2)medicare wants you to have an item or service ; 3) The more tests they provider the cheapter the test; 4) be suspicious of doctors who use pressure or scare tactics to get you to take diagnostic tests or who offer non-medical transportation or housekeeping as a Medicare-approved service.
Only you can watch out for these kinds of  government fraud. Be vigilant  and report such activity. You should read your bills from all healthcare providers including hospitals, nursing homes, clinics and physicians. You have a legal right to a complete breakdown of all charges for services and goods. Medicare fraud is a frequent occurence. If you become aware of healthcare fraud and wish to be a whistleblower contact competent legal counsel who can review your claim with care.

New anti-retaliation whistleblower rights have been put into place by Congress for hospital employees who challenge breakdowns in the provision of medical care. This is intended to help prevent government fraud/Medicare Fraud.The Patient Protection and Affordable Care Act signed into law include such rights as:

*Protections for refusing to violate law or public or private whistleblowing disclosures;

*Reinstatement, compensatory damages, attorneys fees and other relief necessary to “make whole” whistleblowers who win their case;