![]() We analyzed the interview transcripts using the constant comparative method of qualitative analysis. The interviews had a median duration of 40 minutes (interquartile range, 31 to 49) and addressed the whistle-blowers' motivations and experiences. We conducted individual, semistructured interviews with 26 (62%) of them. Using the unsealed complaints and settlement agreements, as well as direct approaches to attorneys involved in the litigation, we identified 42 whistle-blowers involved in these cases. Department of Justice helped us identify 17 federal qui tam cases against pharmaceutical manufacturers settled between January 2001 and March 2009 ( Table 1). ![]() Officials in the Civil Division of the U.S. Whistle-Blower–Initiated Federal Pharmaceutical Fraud Cases Settled between January 2001 and March 2009. Enforcement actions against pharmaceutical manufacturers have become the most lucrative type of health care fraud litigation on the basis of recovery amounts (average and gross). We conducted interviews with whistle-blowers who were key informants in recent prosecutions brought against pharmaceutical manufacturers. The goal of this study is to shed light on the motivations and experiences of whistle-blowers in cases of major health care fraud. Popular portrayals of whistle-blowers vary widely: some anecdotes paint them as heroes struggling against corporate greed, emphasizing the hardships and retaliation they must endure other accounts question their motives and the “excessive” rewards they receive. 6 Although such actions are touted as cost-effective 7 and may deter inappropriate behavior, 8 little is known about how well the qui tam process works.įrom their vantage point at the center of the process, whistle-blowers have valuable insights. From 1996 through 2005, qui tam actions led to more than $9 billion in recoveries. 5 Qui tam derives from the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning “who as well for the king as for himself sues in this matter.” If a qui tam action leads to a financial recovery, the whistle-blower stands to collect a portion of the award. 4Ĭurrently, 90% of health care fraud cases are “qui tam” actions in which whistle-blowers with direct knowledge of the alleged fraud initiate the litigation on behalf of the government. ![]() 1-3 A number of recent high-profile cases have uncovered suspect business practices and led to substantial recoveries in September 2009, for example, Pfizer paid $2.3 billion to settle allegations that it marketed its drugs illegally to physicians, leading to unnecessary payments by the government. Prosecution and prevention of health care fraud and abuse are essential to reducing U.S. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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