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Martin Kenney: Healthcare scams (sadly) aren’t a new story

The FCPA Blog flagged a case recently where a Florida medical assistant who filed a whistleblower suit was awarded $3.2 million as part of a False Claims Act settlement. The medical assistant alleged that the cancer-care practice where she worked had submitted Medicare and other government claims for medically unnecessary tests.

I am not decrying the FCPA Blog’s reporting of the story, nor the fact that the whistleblower was awarded a significant sum for her efforts. No, the crux of my observation relates more to the fact that none of us will be surprised that a medical company is charging for unnecessary tests, simply to enhance their profits. These sort of scams have been going on for years.

One of my investigators, a former UK police officer, tells of arresting UK National Health Service (NHS) dentists, opticians and pharmacists who had bolstered their earnings by any number of underhanded tactics. The dentists had either conducted treatments that were not required, or claimed for tooth fillings and extractions that had simply never taken place. The optician, meanwhile, had claimed for a supplementary payment for dealing with very young children. The anomaly in this instance wasn’t the cut-off age, but a subjective measurement called ‘Pupillary Distance’, which gave the unscrupulous optician leeway to mislead the NHS.

The funnier (or sadder) tale he tells in regard of individual stupidity, though, is that of a pharmacist who was claiming for tubs of 500 paracetamol tablets that he was allegedly providing to people on a monthly basis. Paracetamol is used as pain reliever and a fever reducer.

When my colleague took a statement from an expert witness provided by the NHS, she explained that if any of the patients concerned consumed the 16 or so paracetamol tablets per day as claimed, they’d very soon be dead. That the supposed recipients were all still alive and well (plus had no knowledge of the tubs of paracetamol they were allegedly being given) made for a straightforward conviction for fraud. Scams of this nature cost the NHS millions of pounds every year, money that has to be supplemented somehow, normally via cuts to other NHS services or increased taxes.

My fellow attorneys out there who specialize in medical negligence claims will no doubt confirm that there are unscrupulous medical professionals, who are conducting unnecessary treatments on patients in order to make money. This is not only frightening but amounts to an assault on the recipient who would never have signed the consent form had they known they were being misled.

That the whistleblower described in the FCPA Blog’s post received more than $3 million shows just how  serious the problem can be.

The case discussed in the post shows again why whistleblowing is not only a good thing, but it is also vitally important when we are talking about people’s welfare.


Martin Kenney is Managing Partner of Martin Kenney & Co., Solicitors, a specialist investigative and asset recovery practice focused on multi-jurisdictional fraud cases |@MKSolicitors.

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1 Comment

  1. My dear friend Martin Kenney has learned the benefits of whistleblowing! Most of our whistleblowers don't come forward because of the money, they come forward only after trying to stop and wrongdoing internally. Only when no one listens – or they face retaliation – do they become whistleblowers.

    Hopefully the constant press coverage and stories in the blogsphere will get others to come forward. Despite having done this type work for years (and after having put over $100 million in our clients pockets), most people still don't know how to report fraud and corruption.

    Thank you Martin and thank you to the FCPA Blog for getting the word out.

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