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Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

Posted  March 20, 2020

On March 16, 2019, STAT published an article by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman about a new kind of whistleblower emerging: the data-driven whistleblower.

The article, Data analysts: a new kind of whistleblower to ‘catch a rogue’?, discusses different courts’ reaction to False Claims Act cases brought by Integra Med Analytics, a “forensic analysis firm that studies publicly available Medicare data to sniff out irregularities for potential fraud.”  Unlike whistleblowers who are individuals with firsthand knowledge of fraud, data analyst whistleblowers base their claims on statistics and numbers, starting from the outside, then looking in.  As Shnell and Voldman write:

“Using an outside-looking-in approach,” Integra brought False Claims Act cases in California and Texas, charging the defendants with healthcare fraud in the form of “Medicare upcoding – claiming higher Medicare reimbursement by mischaracterizing the health status of some patients the defendants treated. In each case, Integra based its allegations primarily on statistical aberrations in the defendants’ publicly available Medicare claims data, suggesting (but not directly evidencing) defendants’ wrongdoing.”

Defendants claim that the cases are barred because they are based on public information, and we have previously written about the reactions of different courts to these arguments.  As Schnell and Voldman write in Stat, both the California and Texas cases are now on appeal, before the 9th Circuit and the 5th Circuit.  “Whatever happens,” they conclude, “the groundwork has been laid for a new kind of whistleblower and for a broader challenge to the traditional concept of what it means to be a whistleblower.  The benefit of encouraging corporate and government insiders to speak truth to power has been proven over and over. But in this data-driven age, it is not just the insiders that have something to offer.”

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Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Public Disclosure and Public Information, Upcoding,


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