When companies and individuals in the healthcare industry prioritize profit over well-being, their unethical and sometimes illegal actions can hurt many people and defraud the federal and state governments. This is especially true when their actions involve opioids.
Fortunately, individuals who know about these illegal or unethical actions may be able to file a sealed complaint in federal court and potentially obtain a portion of any recovery. Taking this brave step can save lives and promote justice. Here is a guide to help you through the challenging but vital journey of whistleblowing.
What forms could this misconduct take?
Misconduct can occur at any stage of prescribing and distributing opioids and is a major issue. Such misconduct not only breaks legal standards but also damages public trust in the healthcare system. Examples of illegal activities include:
- Marketing opioids for uses not approved by regulatory groups.
- Offering or receiving bribes or kickbacks for prescribing or distributing opioids.
- Pharmacies making false claims to insurance companies or government health programs for opioids they did not provide.
- Pharmacies making multiple claims for prescriptions they filled only once.
- Pharmacies charging for more expensive drugs while dispensing cheaper ones.
- Producing opioids without following the safety and compliance standards set by regulatory agencies.
- Distributing large amounts of opioids to areas or providers that do not have a medical need for them.
- Altering patient records or creating fake patient profiles to get or prescribe opioids.
- Prescribing opioids in doses or for durations that do not match medical guidelines or patient needs.
- Not reporting serious side effects of opioids to the authorities as required.
- Filling prescriptions that are not medically necessary.
- Doctors making clinical decisions based on their own financial interests instead of patient welfare.
Accusations of misconduct can involve a variety of parties. For example, large companies like Rite Aid Corporation and Sentynl Therapeutics Inc. have settled opioid-related claims in 2024. However, a claim could also involve small businesses or individuals.
Why are whistleblowers important?
Whistleblowers who expose fraud against the government healthcare plans and other illegal activities have an important part in protecting public health and finances. By coming forward, you can stop harmful practices that might otherwise continue unchecked. This can limit the risk that addiction and overdose pose to the public. It can slow the depletion of funds supporting government healthcare plans including Medicare and Medicaid by returning funds to the government which were obtained through false claims. Reporting can also significantly contribute to the fight against the opioid crisis.
Take the first steps of the whistleblowing process.
First, it wise to consult with a lawyer with experience in whistleblower cases. An attorney can help you identify the relevant laws and channels for your case. They can also help you take steps to protect yourself and strengthen your claim. Their guidance will reduce the risk of mistakes and help you navigate the reporting process with confidence.
Indeed, the False Claims Act requires that a formal complaint be filed in federal court under seal by an attorney on behalf of the government.
Take steps to understand the protections and benefits available to whistleblowers. The protections available to you depend on the laws involved. For example, the False Claims Act protects those who report fraud against government programs. Whistleblowers may be able to stay anonymous, and an employer cannot fire a whistleblower for their actions. Whistleblowers can also receive a reward of 15 to 30 percent of the funds collected in the claim.
Gathering solid evidence of misconduct is crucial. It is wise to consult legal counsel about gathering documents and other data. For example, legal provisions provide exceptions to HIPAA when sharing personal medical or pharmaceutical records with your attorney, so you will want to discuss this carefully.
Document everything you can. This includes emails, letters internal reports and records of meetings. Make copies of important documents. Keep your records organized and secure. This evidence can support your claim and increase the likelihood of success.
Whistleblowers are crucial in the fight against the opioid crisis. When someone bravely reports misconduct, they hold individuals and businesses responsible for their illegal actions and support public health and safety in the process. And, many whistleblowers have been awarded significant sums of money from the government’s recoveries in these cases.