Those of us who remember May 2011 when L. Lin Wood left Bryan Cave LLP and suddenly created a small law firm in less than three weeks. Why we all asked? As one poster here on Rose Speaks.com said, “Looks like he sees a way to make millions of dollars.” Yes but how?
Wood had agreed with attorney Marlan Wilbanks to leave Bryan Cave set up new offices and toss his hat into the Qui Tam Action against accusing dialysis providers DaVita, Inc. and
Gambro Healthcare, Inc. of deliberately wasting hundreds of millions of dollars of medications in order to fraudulently boost reimbursements from Medicare and Medicaid. That folks is illegal but the people involved in this suit, don’t have criminal charges pending they are involved in a Civil Federal Suit of “Qui Tam Action”.
What does that mean? Let’s start with the definition of “Qui Tam Action”.
Qui tam action (kwee tam) n. Latin for who as well, a lawsuit brought by a private citizen (popularly called a “whistle blower”) against a person or company who is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation, when there is a statute which provides for a penalty for such violations. Qui tam suits are brought for “the government as well as the plaintiff.” In a qui tam action the plaintiff (the person bringing the suit) will be entitled to a percentage of the recovery of the penalty (which may include large amounts for breach of contract) as a reward for exposing the wrong-doing and recovering funds for the government. Sometimes the federal or state government will intervene and become a party to the suit in order to guarantee success and be part of any negotiations and conduct of the case. This type of action is generally based on significant violations which involve fraudulent or criminal acts, and not technical violations and/or errors.
MEDICARE FRAUD!!!! In days of yesteryear “the federal or state government will intervene and become a party to the suit in order to guarantee success and be part of any negotiations and conduct of the case,” happened and “We the people” never knew what the hell was going on because the records were seal.
NO MORE until a case at least gets to this stage, now while our U. S. Congress is trying to cut benefits to those Americans who receive Medicare and/or Medicaid in services, doctors visits, in-patient care and on and on and on, these corporations have in the past been slapped in the past with a fine, and THE RECORDS SEALED. No more now we get to follow these cases and call our congressional representatives and ask them WTF??? Do they get contributions from these large corporations or perhaps it goes into the hole of the new “Super Pacs”, and in the vacuum we have no way of knowing which members of congress are aware, has been aware in the past and has done the old political trick of wink wink, don’t listen to what I say to the voter.
Here are the papers for you to read, and like me GET MAD AS HELL THIS IS GOING ON AND HAS BEEN FOR EONS, MEDICARE FRAUD IS NOT THE LITTLE OLD MAN OR WOMAN FIGHTING FOR PAYMENTS TO DOCTORS, MEDICARE FRAUD IS A PRIME EXAMPLE OF THIS CASE!!!!
Here is as close to a lay person description as we can get:
According to the suit, the companies designed multiple sets of directly conflicting internal protocols dictating how specific drugs should be administered based on how the costs for such drugs were reimbursed by the government. The suit also charges that these “dosing grids” were designed to increase volume rebates and discounts to the defendants from the manufacturers of the medications.
“The complaint makes clear that for years, DaVita has used different sets of rules to game the Medicare system and illegally inflate their government reimbursements at taxpayer and patient expense,” said L. Lin Wood, attorney for the whistle blowers.
“Taxpayers and patients should feel a sense of outrage when they read the complaint and learn how DaVita has become a multi-billion dollar business due in large part to corporate strategies and protocols focused on extracting every dollar possible from the government rather than on improving the care of chronically ill patients.”
The scheme centered on three drugs routinely administered to patients during dialysis: Venofer, an iron supplement; Zemplar, a vitamin D analog; and Epogen, a glycoprotein hormone also known as EPO.
In the case of Venofer and Zemplar, the government reimbursed the defendants for “necessary wastage,” such as medication that remained in a vial after the vial dose was administered. The internal protocols developed and mandated by DaVita and the others named in the suit were explicit about the vial sizes employees were required to use and whether vials could be entered with a needle more than once to extract the contents. According to the suit, these protocols were designed to maximize the amount of drug wasted because the government paid DaVita for the amount of drug administered to the dialysis patients and the amount intentionally wasted and thrown away.
For example, instead of using three 2 mcg vials to administer a 6 mcg dose of Zemplar with no waste, DaVita’s protocols required employees to use a 10 mcg vial. The patient received 6 mcgs, and the remaining 4 mcgs were discarded but still billed to the government. Medicare unknowingly paid DaVita for all 10 mcgs in the vial, including the 4 mcgs of wasted medication that ended up in DaVita’s trash cans thousands of times each week from 2003 through the end of 2010 at its hundreds of centers across the United States.
Reimbursement rules for Epogen, on the other hand, made clear that no waste would be
reimbursed. As a result, the DaVita dosing grids were formulated to guarantee that every
available drop of medication in every vial was used and billed for, including any excess
medication, or overfill, for which they had not paid.
On January 1, 2011, Medicare guidelines were changed to halt all payments for wasted drugs.
According to the suit, DaVita immediately put in place new protocols that effectively eliminated iron waste and significantly reduced Vitamin D waste.
“When the reimbursement rules changed on January 1, 2011, the protocols that mandated the
unnecessary waste of Venofer and Zemplar stopped as well.”
“This had nothing to do with a New Year’s resolution to be more efficient but had everything to do with how money drives corporate practices and protocols at DaVita.”
Denver-based DaVita, which is currently the second largest independent provider of dialysis services for second largest independent provider of dialysis services, acquired Gambro’s dialysis clinics in the U.S. in 2005. According to the suit, DaVita and Gambro engaged in similar fraudulent practices prior to the merger. Afterward, DaVita selectively implemented additional fraudulent practices at the clinics it acquired and adopted some of Gambro’s wrongful practices and procedures at its own legacy facilities.
The suit alleges that the post-merger goals of DaVita were to increase wastage whenever possible for Vitamin D and iron drugs where the government paid for the wastage while ensuring that there was no waste of EPO. To accomplish this goal, the suit provides evidence of totally contradictory internal protocols that were used on most, if not all, of the 100,000-plus patients who receive dialysis treatments at DaVita centers across the United States.
The suit was filed on behalf of the U.S. government under the False Claims Act in the United States District Court for the Northern District of Georgia by a former Gambro/DaVita clinic director, Daniel D. Barbir, R.N., and Alon J. Vainer, M.D., a nephrologist who served as Medical Director of Gambro and DaVita dialysis clinics in Georgia.
So if someone in your family is on Medicare, it is time to be angry, very angry and to began to ask some tough questions of our members of congress of how one company could be fined and just do it again, and again and again. Any of us would be heading to jail. Thank God for this doctor and nurse who took a stand for their patients.
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March 5, 2012
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