Within hours of the U.S. government's
unprecedented release last week of a trove of Medicare billing data,
a small fraternity of lawyers who specialize in representing
whistleblowers in healthcare fraud cases began to mobilize.
These lawyers earn their living bringing cases on
behalf of employees at drug companies and healthcare providers who
believe their bosses or colleagues may be cheating the federal
Medicare system by bribing doctors to prescribe certain drugs, for
example, or inflating bills.
A whistleblower who prevails gets up to 30 percent of whatever the
government recovers, and 40 percent of that reward typically goes to
the whistleblower's lawyer.
Whistleblower cases can result in huge settlements, such as the $3
billion GlaxoSmithKline paid in 2012 to resolve claims that it
promoted drugs for unapproved uses and failed to report certain
Patrick Burns, co-director of Taxpayers Against Fraud, a nonprofit
advocacy group with around 400 whistleblower lawyers as members,
said that right after the release on Wednesday a handful of lawyers
asked him for help accessing the data, which is available online.
The 2012 data runs for 10 million lines and shows how many times
some 880,000 medical providers billed for a particular service, how
much they charged and whether that deviated from the national norm.
Burns said he sent the database link to the entire 400-lawyer group,
under the heading, "Have Fun!"
By Thursday, Pennsylvania lawyer Marc Raspanti was having a ball.
Raspanti said he spent six hours combing through the data. He has
several Medicare fraud lawsuits pending against pharmaceutical
companies alleging kickbacks to certain doctors.
Raspanti is analyzing the data, he said, to see if doctors are
prescribing an unusually high amount of the pharmaceutical company's
products. If so, he said, that could bolster allegations that
something is amiss.
In the past Raspanti had to rely on his clients' personal knowledge
of any suspect billings, he said, and then had to subpoena
government agencies for the supporting documents. "Now I have (the
data) at my fingertips." He said that has helped him on some cases,
which he declined to identify.
FOLLOWING THE RED FLAGS
The data could also help direct lawyers to additional targets or
potential witnesses in cases they have already filed, said Reuben
Guttman, a Washington, D.C., whistleblower lawyer who said he jumped
into the database soon after it was released.
For example, if a lawyer were representing a pharmaceutical sales
manager accusing his company of paying kickbacks to certain doctors,
the data could point to other providers using the company's products
who could serve as witnesses or be added as defendants if the
billings suggest wrongdoing.
"It could expand the case beyond a certain institution or
provider to multiple institutions or providers," said Chris Coffin,
a Louisiana lawyer who represents whistleblowers.
Other lawyers said the data could produce leads for new lawsuits.
When red flags emerge — a doctor bills Medicare an unusually high
amount for a particular drug, say — lawyers could investigate what
might explain the aberrant figure. That could turn up a possible
"You'd have to be able to see that there's (improper) influence
actually being exerted over healthcare decisions," said Michael Behn,
a Chicago whistleblower lawyer. "But there's the possibility this
data could lead to actual cases."
Consumer and press groups have been seeking the Medicare physician
data since Jimmy Carter was in the White House. In 1979, the
American Medical Association and the Florida Medical Association
convinced a judge to bar officials from releasing the data to
protect physicians' privacy. Last May, a judge lifted the ban.
AMA spokesman Robert Mills declined to comment on the digging by
lawyers and instead referred to the statement on Wednesday by AMA
President Ardis Dee Hoven.
"Releasing the data without context will likely lead to
inaccuracies, misinterpretations, false conclusions and other
unintended consequences," she said.
Indeed, data alone doesn't make a lawsuit. Lawyers still need a
client with inside knowledge of the alleged fraud. But employees in
physicians' offices or healthcare labs who suspect wrongdoing can
now see whether their employers' billings are out-of-line with the
rest of the industry.
And that could seriously stiffen some of their spines.
(Reporting by Terry Baynes; editing by Ted Botha, Eric Effron and