A recent news article in the New York Times, “The Bounty Hunter of Wall Street,” featured Andrew Left, an “activist” short seller who receives leaked documents and other intelligence about publicly-traded companies from confidential sources. Armed with this information, short sellers leak negative information to the press. When the information negatively impacts the target company’s stock price, the short sellers make millions.
As the article states, short sellers use inside information related to potential wrongdoing by publicly-traded health care companies, including pharmacy benefit managers (PBMs). PBMs are involved in literally every prescription that is dispensed, nationwide, every day. They play a critical role in the Medicare prescription drug program, Medicare Part D. The PBM industry is also one of the most opaque segments of the healthcare arena. It will take someone with access to drug data received by the PBM and drug data generated by the PBM to shed light on the inner workings of this multi-billion dollar industry.
Like PBMs, virtually every healthcare company earns significant revenues from billings to government funded programs, most notably Medicare and Medicaid. There are significant federal dollars spent on the federal employees health benefits program (FEHBP), and the healthcare programs for our military, including Tricare. A major portion of state budgets are also dedicated to funding healthcare for state and county employees.
However, there is a more appropriate use for inside information related to potential wrongdoing by publicly-traded or privately held healthcare companies, including PBMs. When the inside information is related to potential healthcare fraud (or other government contractor fraud), the taxpayers who contribute their hard-earned money to federal and state treasuries, and the person who assists in that endeavor by providing needed information, should be benefitting from that information – not wealthy short sellers.
There are programs that reward insiders who assist in ferreting out wrongdoing and returning fraudulent profits to federal and state governments. Those with knowledge of potential wrongdoing by any company that profits from federal or state government funds would do well to seek competent counsel who specializes in bringing cases under the federal False Claims Act, analogous state false claims acts, or the private insurance whistleblower statutes of California and Illinois. All of these statutes provide the relator, a person who is the source of such information, with share of the recovery (from 15 to 30%, and in the case of the California statute, potentially higher), in recognition of the whistleblower’s efforts.
Pamela Coyle Brecht has been invited to speak at this winter’s ACI’s False Claims and Qui Tam Enforcement program, taking place on January 27-28th at the Park Lane Hotel in NYC. This advanced forum on False Claims and Qui Tam Enforcement is designed to provide up-to-date guidance and analysis from the most respected false claims… Read more »Read More
Pietragallo Gordon Alfano Bosick & Raspanti, LLP is recognized in the 2018 annual list of “Top 100” verdicts, released by VerdictSearch and ALM. The firm’s record breaking $51,208,578 verdict in Lutz v. Health Diagnostics Laboratory, Inc. is ranked as #39 on this year’s list of highest verdicts throughout the nation and comes in at #2… Read more »Read More
Joseph L. Gordon will be presenting “OSHA’s Ten Most Common Violations – An Insider’s Perspective on Easy Solutions to Overlooked Hazards” at The Pennsylvania State Council of SHRM’s 2019 State Conference in State College, PA. Joe will be a co-presenter with Nicholas DeJesse, an Assistant Regional Administrator with OSHA. For more information, including how to attend… Read more »Read More
Marc Stephen Raspanti will be speaking at a False Claims Act Enforcement Roundtable on September 19, 2019 from 4:00-6:30pm in Miami, Florida. This event is being co-hosted by Pietragallo, Morgan Lewis, the Women’s White Collar Defense Association, and the American Bar Association’s Qui Tam Subcommittee for a False Claims Act/Qui Tam Roundtable, “Florida Style.” The discussion… Read more »Read More