EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski Podcast Por arte de portada

EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski

EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski

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 Alright, first off, let me calm down any attorneys right outta the gate here. We will not be talking about—at all—the legal activity that is currently ongoing that my guest today, Ann Lewandowski, is involved with. The suit mostly on our radar today is the one where an EBC (employee benefit consultant) allegedly had 61% of their revenue coming from pocketing their clients’ pharma rebates and using said clients’ pharma rebates to fund their executive bonus pool. Doing all this, not transparently (ie, none of their clients were aware that this was going on), it was not disclosed as per the Consolidated Appropriations Act of 2021. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, these EBCs’ clients were (one would assume) plan sponsors, like self-insured employers, of course. This pocketing of the rebates amounted to allegedly $27 million. Nice executive bonus poll they got there, I guess, would be one comment. Anyway, allegedly when the whistleblower—who happened to be, at the time, this employee benefit consultant’s compliance officer—when he, you know, did his thing and sounded the alarm and said, “Hey, gang. Consolidated Appropriations Act. We gotta disclose this compensation we are earning from, you know, pocketing our clients’ pharma rebates and all that. It’s the law of the land.” Well, a couple things went down at that point, but yeah … EBC executive team winds up ultimately firing their compliance officer (ie, the whistleblower). We gotta be opaque as hell, I believe is the alleged quote. So, this case has all the things. It’s a violation allegedly of the CAA (Consolidated Appropriations Act) legislation. It’s got retaliation. It’s got self-dealing. It’s got a lot of WTHs per mile, as they say … allegedly. Right about now, I am going to mention that Peter Hayes last week on this podcast (EP475) talked about how regulations like the CAA are a major force colliding with two other major forces: transparency and public outrage. So, three major forces combining to shake up the status quo. And maybe this whole pharma rebates getting disappeared case is a great example of this actually allegedly happening. We got all three of these forces—outrage, transparency, and regulations—revealing (allegedly) one giant swirl cone of cluster f’ery that could certainly inspire even the most uninspired plan sponsor to take a serious look into their brokers or PBMs (pharmacy benefit managers) or TPAs (third-party administrators) or other vendors. At least do some level of auditing there. So, there’s that. But also, to me, the big takeaway circles back once again to this trust touchstone that, again, keeps coming up in lots of Relentless Health Value episodes lately. And it’s just a really big reminder that trust isn’t just for patients and their doctors, and it’s not just for clinicians and their administrators or leadership. It’s also for plan sponsors and their advisors. Although distrust is the problem with everybody else I just mentioned, in this particular instance, the problem isn’t a lack of trust. It’s often too much of it. Plan sponsors often really trust their longtime EBCs or TPAs, and yeah … sometimes it’s warranted. Sometimes it’s not. Brutally not. Kimberly Carleson the other day, she wrote, “$14.5 million is being returned to self-funded health plans after the Department of Labor found that … the TPA had been pocketing undisclosed markups.” She continues, “But your premiums are still rising today because behavior like this hasn’t stopped. This isn’t just about one TPA [or one EBC]. It’s a warning shot.” So, yeah, this whole goings-on with this pharma rebates disappearing lawsuit is a warning shot on several levels. One is just how many millions of dollars can go missing on its way from point A to members’ wallets. But another level of warning shot is more personally self-interested in nature because the thing about whistleblowing is that it’s only possible when there is a scent of illegal activity wafting in the air. And if that bad smell turns out to be verifiable by the DOJ or DOL or courts of law, at that point, personally, you can either be the whistleblower or be on the other side of the table. And being on the other side of the table could mean millions of dollars in fines or even jail time. We talk about that generic drug manufacturer collusion whistleblower case a little bit later on in the show today, where the CEOs are facing possible prison and there’s millions of dollars in fines also, just BTW. So, all of this and more comes up today in my conversation with Ann Lewandowski. I mean, if you had the chance to talk about whistleblowing with a whistleblower, you would’ve done the same thing in my shoes, right? Talk about whistleblowing with someone who has made the decision to be one ...
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