Fighting Healthcare Fraud Via Whistleblowers | Jonathan Tycko, Attorney

Jonathan Tycko , a seasoned attorney, has made a name for himself in the legal arena for his exemplary work representing whistleblowers in qui tam lawsuits, particularly in the healthcare industry. In the labyrinthine world of healthcare fraud, pharmacists and pharmacy owners, often on the frontlines, may find themselves unaware of fraudulent activities or even inadvertently participating. This article, and accompanying podcast episode, aims to enlighten readers about the role of whistleblowers in combating healthcare fraud, the legal parameters governing such actions, and how pharmacists and pharmacy owners can contribute to upholding integrity in the industry.

Understanding Qui Tam Lawsuits

Qui tam lawsuits, derived from a Latin phrase meaning "he who sues in this matter for the king as well as for himself," are suits brought by private citizens on behalf of the government, primarily governed by the False Claims Act. The act considers defrauding the government, including government-funded programs like Medicare and Medicaid, unlawful.

Whistleblowers are instrumental in exposing these fraudulent activities. They can be current or former employees or even individuals from other industries who unearth illegal activities. While firsthand involvement in the illegal conduct is common, anyone with information, as long as they are not the fraud's mastermind, can come forward.

However, the road to becoming a whistleblower isn't easy. They often wrestle with mixed emotions, grappling with worries about potential job loss or blacklisting, alongside anger and a strong sense of justice. These brave individuals, risking their security to protect taxpayer and government funds, often seek legal guidance from attorneys like Jonathan Tycko.

Pursuit of Justice, Not Destruction

A common misconception is that whistleblower cases aim to dismantle entire companies. The Department of Justice, however, seeks settlements that allow businesses to continue operation, primarily focusing on stopping the illegal conduct, ensuring compliance, and recovering funds. This is especially crucial in the healthcare industry, where the government's priority is to maintain necessary medical services while addressing fraudulent activities.

The Pharmacist's Role and Anti-Kickback Statute

In this complex legal landscape, pharmacists may inadvertently engage in activities violating healthcare regulations. One such regulation is the anti-kickback statute, prohibiting inducements for referrals to services billed to government-funded healthcare programs. It's essential for pharmacists and pharmacy owners to familiarize themselves with such regulations to maintain compliance and avoid unintentional non-compliant practices.

The Law and Its Shortcomings

When asked about potential amendments to existing whistleblower laws, Tycko commended the False Claims Act's efficacy since its inception in 1986. Nevertheless, he expressed concerns about the lengthy resolution times for cases, during which ongoing fraud may persist. A push for more resources or expedited judicial proceedings could alleviate this concern.

While he confirmed that individuals could face incarceration for clear and intentional fraud, Tycko acknowledged that the system sometimes ensnares smaller players, while those with plausible deniability escape punishment.

As technology advances, new areas of potential fraud, like telemedicine or data security, emerge. This necessitates ongoing efforts to adapt laws and combat creative fraud exploitation tactics.

In conclusion, the role of whistleblowers, supported by dedicated attorneys like Jonathan Tycko, is integral in fighting healthcare fraud. Pharmacists and pharmacy owners, with their unique industry insights, can play a significant role in identifying and reporting potential fraudulent activities, thereby upholding industry integrity and safeguarding public funds

The Business of Pharmacy Podcast™ is an interesting and entertaining weekly podcast discussion on the business of pharmacy. Hosted by Mike Koelzer, an independent pharmacist in Grand Rapids, Michigan, each episode covers a new topic relevant to pharmacists and pharmacy owners. Listen to a new episode every Monday morning.