Blood Money: One Man’s Bare-Knuckle Fight to Protect Taxpayers from Medical Fraud

Nothing gets the old blood to boiling like the state of our health care system and the ridiculous rules, regs, laws, and mishandling of the medical system by HMOs to PPOs, x-rays to blood draws. From pharmaceuticals to labs, it would seem there is nothing beyond the realm of untold millions in fraudulent practices—most of which go unprosecuted. Not undetected. Unprosecuted. Giant pharmaceuticals have millions to fight claims—apparently so do the giant lab corporations. Nevermind Medicare, Medicaid, or MediCal. They are merely fodder for some of the worse “pull-through” revenue schemes perpetrated on the taxpaying public.

Those who would dare fight the giants are the “Whistleblowers” or Qui-tam. The author is one such, who discovering his Hunter Laboratories could not compete with the pricing of the big boys, also discovered why. Blood Money is the chronology of his battle, a classic David vs Goliath. It’s a sad state of affairs and it requires years of patience and untold millions of dollars to battle.

Fraudulent claims were recognized as early as 1863, during the Civil War when Lincoln instituted the False Claims Statute, or Qui-tam, that quickly become known as “Lincoln’s Law.” It also quickly overwhelmed federal law enforcement officials—and is apparently still doing so—many states not electing to even open the can of worms. “Approximately 80% of recoveries involve healthcare fraud…”

The author called it taking on the “Blood Brothers” those giants that no one thought could be brought to their knees—“considered by Congress and DOJ as ‘too big to fail’ and their CEOs as ‘too big to jail’.” Part of the problem was Qui-tam’s rigid statute First-to-File rule” (to prevent copycat lawsuits).

The author goes on to discuss his battles in California, Michigan, New York, Nevada, and Virginia. Between the length of time stalled in legalistics, attorneys leave the firm, judges die, and it’s not uncommon to actually prolong into a seven or eight year struggle.

Some interesting notes along the way:

1. In a continuing effort to reduce costs, almost all generic drugs are now manufactured in India and China.
2. Is the target company growing ten times faster than (your) company?
3. Extended searches occur for (witness) LinkedIn employees.
4. If you are going to pursue a fight, better invest in a micro-shredder and a “burner” phone.
5. Find only the proven, experienced attorneys in Qui-tam.
6. Remember that in America, there are several other “multibillion-dollar companies who have settled multiple times.”

Quite the eye-opening exposé, one sure to force a long, piercing look at some of the major firms out there reaping billions in fraudulent practices, taking kick-backs, receiving some lovely inducement gifts.

It’s costing you and I. And most of us can’t do a thing about it.