A Whistleblower in His Own Words

June 6, 2013

Clark Bolton
WellCare Whistleblower

By Angie Moreschi:

A first hand account of a whistleblower experience is not something you hear very often. Whistleblowers are a rare breed. They often come forward reluctantly, but are compelled to reject silence in order to expose wrongdoing and fraud against the government.

Clark Bolton is one of those rare few. He came forward as a whistleblower against insurance provider WellCare after uncovering evidence of Medicaid/Medicare fraud.  His case ultimately helped lead to a $137.5 million settlement. He shared his experience with CWN to offer insight into what it’s like to be a whistleblower.

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Does Your Doctor Get Money from Drug Companies?

May 30, 2013

It’s common practice for drug companies to compensate doctors as promotional speakers and advisers. The income some get can be quite substantial, creating potential conflicts of interest.  Critics worry that such substantial compensation can affect a doctor’s judgement on which drugs might be best for their patients.

The non-profit News Outlet ProPublica publishes an annual database that compiles payments from 15 pharmaceutical companies to doctors around the country. So far, more than $2 billion dollars in payments are accounted for since 2009. The Dollars for Docs database makes it very easy for you to search and find out if your doctor is receiving money from pharmaceutical companies.

Among the drug companies that gave the most from 2009 to 2012 were Pfizer at $538.2 million, GlaxoSmithKline at $238.6 million, and Merck at $224.3 million. Doctors from all over the country are recipients of drug company compensation, but the top earners were from just a handful of states– New York, Texas, California, Massachusetts, Pennsylvania and Tennessee.

Is your doctor on the list?  Click here to find out.

Protect Your Credit Card & Bank Account on Vacation

May 30, 2013

The summer travel season is here and that means scammers will be on the prowl trying to take advantage of tourists on vacation.  It’s important to be especially careful when using your credit card or ATM card on vacation.  Consumer Reports laid out some good advice on how to prevent a crook from stealing your ATM card password and how to protect yourself against unauthorized charges on your credit card.

The tips include inspecting an ATM for a false front and reporting any unauthorized charges immediately to limit your liability.  Click here to read more from Consumer Reports.

Protect Yourself

Creditcards.com recommends several other easy ways to protect your credit cards while traveling.

  1. Don’t pack all your cards.  No need to put them all at risk, just the one or two you know you’ll need.
  2. Watch your card.  Don’t leave purses or bags with credit cards unattended.
  3. Don’t use debit cards on vacation.  Stick with credit cards which offer more protection
  4. Check your card activity.  This will help you to learn quickly if someone has skimmed your card or made unauthorized charges.
  5. Create text alerts.  If your credit cards is stolen, activate text alerts on all your credit cards. That way anytime something is posted to your account, you get a text on your phone.
  6. Lock it up.  If you don’t need your credit card for the day, lock it up in your hotel room safe.


Nurse’s Allegations about Medicare Lead to $7.3 Million Settlement

May 23, 2013

A nurse’s allegations about excessive charges to Medicare led to a $7.3 million settlement between a Plano, Texas-based firm and the U.S. Justice Department.

Whistleblower Laura Davis’ complaint involved charges for Epogen, an anemia drug used to treat dialysis patients. A “qui tam” whistleblower lawsuit filed on her behalf in Baltimore alleged that Dialysis Corporation of America billed Medicare and other government healthcare programs for more Epogen than was used.

Epogen is an intravenous medication that is used to treat anemia, a common condition afflicting patients with end-stage renal disease. Epogen vials contain a small amount of medication in excess of the labeled amount, known as “overfill,” to compensate for medication that may remain in the vial after extraction and in the syringe upon administration.

The United States contends that from January 2004 through May 2011, DCA billed for 10-11% overfill whenever it administered Epogen. However, because of the types of syringes DCA used, the United States alleges that DCA was not able to withdraw and administer 10-11% overfill every time it administered Epogen to patients, and thus submitted false claims to Medicare that overstated the amount of Epogen that it was actually providing.

Dialsysis Corporation was acquired by U.S. Renal Care, which is headquartered in Plano, in June 2010.

Click here to read more from The Dallas Morning News.

Can You Trust Generic Drugs?

May 15, 2013

Many patients have come to accept generic drugs as a way to save costs when their insurance won’t cover name brands.  It seems like a reasonable alternative, but a recent whistleblower case calls into question whether the booming use of generics can be properly regulated by the Food and Drug Administration.

Generic drug maker Ranbaxy plead guilty to federal drug safety violations and will pay $500 million in fines to settle claims that it sold sub-par drugs and made false statements to the FDA about its two manufacturing plants in India.  The United States contends that Ranbaxy manufactured, distributed, and sold drugs whose strength, purity, or quality differed from the drug’s specifications or that were not manufactured according to the FDA-approved formulation. The Justice Department said it is the largest drug safety settlement to date with a generic drug manufacturer.

Many Generic Drugs Made Overseas

The global market for generics is estimated to be $242 billion and growing. Fortune Magazine examined the dark side of the generics boom in a recent article.  In Dirty Medicine, Fortune reports  more than 80% of active pharmaceutical ingredients for all U.S. drugs now come from overseas, as do 40% of finished pills and capsules.

When you consider just how much of America’s generic drug supply comes from factories outside of the U.S., the Ranbaxy case is cause for concern.  It puts the FDA in a difficult position when it comes to policing facilities that produce the generic drugs Americans are increasingly ingesting.

Fortune reports, as our dependence on generic drugs from overseas has grown, so have questions about their oversight and safety. A report by the Government Accountability Office found that in 2009, regulators inspected only 11% of foreign drug manufacturing plants, while they inspected 40% of domestic ones.

Here is an excerpt of the Fortune report:

Fortune’s investigation yields the first comprehensive picture of how one under-policed and far-flung generics company operated. It is not a tale of cutting corners or lax manufacturing practices but one of outright fraud, in which the company knowingly sold substandard drugs around the world — including in the U.S. — while working to deceive regulators. The impact on patients will likely never be known. But it is clear that millions of people worldwide got medicine of dubious quality from Ranbaxy.

Click here to read more.



Learn to Save Money on Medical Costs

May 15, 2013

There’s often no rhyme or reason when it comes to what hospitals charge for medical procedures.  They can pretty much charge whatever they want to and do just that.  The evidence comes in the form of widely varying rates charged for the same procedure in the same geographic area.  ABC News examined the issue of inexplicable medical costs, while trying to help one family figure out how to save money on a tonsillectomy for their little boy.  Click here to watch.

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Why are the Rich So Rich, while Everyone Else Struggles?

May 10, 2013

Ordinary working Americans don’t seem to have as much of a chance anymore at striking it rich.  Over the past three decades, income disparity between the wealthy and middle class has exploded.  That makes it much harder for average people to pursue the American dream and nearly impossible for the poor.  Upward mobility in the United States is lagging far behind upward mobility in other industrialized countries.  If you’re feeling it, it’s not your imagination.  Click here to learn more and watch this fascinating documentary which is part of the “Why Poverty?” series: “Park Avenue: money, power and the American Dream”

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Nursing Home Chain Accused of Overbilling for Excess Care

May 9, 2013

Every year, Americans spend hundreds of billions of dollars on unnecessary medical tests and treatments.  Often times, that care goes to the elderly and all taxpayers end up paying for it through Medicare. CBS News has been investigating Life Care Centers of America, one of the largest nursing home chains in the country, for allegedly over-billing Medicare for unnecessary patient rehab.  Click here to watch this investigative report by CBS reporter Jeff Glore.

Medicare’s Pay & Chase Phenomenon

May 3, 2013

Forget about drug-dealing, Medicare fraud is becoming America’s new get rich quick scheme of choice.  Why? Because it’s easy money, with little threat of prosecution. An article in the Broward Palm Beach New Times explains the crime is so widespread, prosecutors don’t even bother going after anyone unless they’ve stolen $500,000 or more.

Reporter Chris Parker rode along with agents, driving by strip mall after strip mall packed with pop-up medical clinics that authorities say game the system. First , the money comes fast and easy. Medicare generally pays invoices first and pursues criminals later, only after time-consuming audits. It’s a phenomenon that’s become known as “pay and chase” by insiders.

The sheer volume of offenders makes going after the bad guys overwhelming, and the bad guys know it. Click here to read more about the onslaught of Medicare fraud in the New Times report on how Medicare fraud has become big business in South Florida.

Employees within these clinics and even big hospitals are generally the whistle-blowers who come forward to expose the fraud. Authorities depend on these citizens to stop the systemic fraud that’s ripping off taxpayers. Click here to learn more from the James Hoyer Law Firm about how and why to become a whistle-blower if you have inside knowledge about fraud against the government.




Do Non-Profit Hospitals Give as Much as They Get?

April 30, 2013

Many hospitals in your community no doubt enjoy tax exempt status because they are designated as non-profit.  But what does that really mean?  It’s not that they don’t make a profit, because they most likely do. The difference is these corporations are supposed to give back to their communities. Reporter Marni Jameson took a fascinating look at the issue in a front page story in the Orlando Sentinel.  Click here to learn more about what she discovered.

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