Former Blue Cross Blue Shield of North Dakota Medical Director Files Whistleblower Lawsuit, Alleges He Was Terminated for Coming Forward, Parker Waichman LLP Notes

The now-former Blue Cross Blue Shield of North Dakota medical director alleges the insurer engaged in illegal practices that hiked costs to millions of BCBS customers.

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“When a corporation endeavors to retaliate against whistleblowers, am indefensible work environment is created and the public suffers, as well.” said Gary Falkowitz, Managing Attorney at Parker Waichman LLP

Port Washington, NY (PRWEB) May 14, 2014

Parker Waichman LLP, a national law firm dedicated to protecting the rights of whistleblowers who have reported, or seek to report, employers engaged in illegal activities, announces that Blue Cross Blue Shield of North Dakota is the focus of a whistleblower lawsuit brought by the company’s former medical director, who alleges that the insurer engaged in illegal insurance practices. Former director of behavioral health for Noridian Mutual Insurance Company, Dr. Kenneth Fischer, also alleges that he was retaliated against for bringing the matter to the attention of his superiors, according to a May 8, 2014 report by WDAY News/ABCNews. Noridian Mutual Insurance Co. also does business as Blue Cross Blue Shield North Dakota. (http://www.wday.com/event/article/id/96733/)

According to Dr. Fischer’s allegations, Noridian Mutual Insurance Co. permitted some of its members to receive more benefits than other members on the same insurance plan. This was done by BCBS overpaying providers from employer accounts and not recovering those overpayments, according to the lawsuit. Dr. Fischer alleges that the practice may be costing members millions in increased premiums and other costs. The lawsuit was filed on May 6, 2014 in Cass County District Court on behalf of Dr. Kenneth Fischer and brought against Noridian Mutual Insurance Co., which also does business as Blue Cross Blue Shield North Dakota. (In Re: Dr. Kenneth Fischer vs. Noridian Mutual and Blue Cross Blue Shield North Dakota, filed on May 6, 2014, 09-2014-CV-01237)

Dr. Fischer, who was hired as the behavioral health medical director in January 2011, alleges he was terminated for reporting the insurer’s violations and described a “significant and widespread” pattern throughout BCBS, “later determined to infect the entire book of business of BCBSND,” according to the lawsuit, wrote The Bismarck Tribune on May 8, 2014. The lawsuit also lists the North Dakota Public Employees Retirement System and the Federal Employees’ Program as just two areas impacted by the allegedly illegal practices. (In Re: Dr. Kenneth Fischer vs. Noridian Mutual and Blue Cross Blue Shield North Dakota, filed on May 6, 2014, 09-2014-CV-01237)
(http://bismarcktribune.com/news/local/former-medical-director-files-whistleblower-suit-against-bcbs/article_460e67d8-d6fa-11e3-9b51-001a4bcf887a.html)

Lawsuit allegations include that Fischer had no insurance industry experience and did not understand what was occurring with BCBS’s business practices for several years. When he discovered the unethical practices he advised vice president of clinical excellence and quality, Jacquelyn Walsh, in 2012. It took several months, according to the lawsuit, wrote WDAY News/ABCNews for the two to meet and further discuss the alleged illegal insurance practices. Fischer insisted that action be taken or he would pursue the manner with higher levels, which he did with Senior Vice President Sharon Fletcher, who allegedly assured Fischer he acted appropriately and that she would hold Walsh accountable. Fischer soon learned that Walsh complained about Fischer to the firm’s human resources department. The matter was referred to an external law firm and, in a nearly four-hour meeting, Fischer discussed his concerns with the chief compliance officer at Noridian, according to the lawsuit, wrote WDay News/ABCNews. (http://www.wday.com/event/article/id/96733/)

Fischer alleged he advised the compliance officer of BCBS’s violations. BCBS allegedly put Fischer through a one-month mandatory market conduct exam with the Insurance Department and fired Fischer days later for allegedly failing to attend a meeting with his management team. Lawsuit allegations include that BCBS attempted to pressure Fischer into resigning by listing “unfiled and uninvestigated” charges against him as part of the external probe finalized approximately one week before the Insurance Company exam. The lawsuit alleges BCBS continued to retaliate against Fischer by damaging his reputation and denigrating him in the industry, according to the WDAY News/ABCNews report. (In Re: Dr. Kenneth Fischer vs. Noridian Mutual and Blue Cross Blue Shield North Dakota, filed on May 6, 2014, 09-2014-CV-01237) (http://www.wday.com/event/article/id/96733/)

Fischer alleges that thousands of previously denied claims were inappropriately paid; “place of service” coding was intentionally entered incorrectly by Walsh’s staff; 10 years of so-called “workarounds” were conducted that omitted behavioral health analyses and claims; some of Walsh’s direct staff was not subject to training or oversight; and some critical staff left with no procedures in place to recover lost knowledge, also according to the WDAY News/ABCNews report. (http://www.wday.com/event/article/id/96733/) “These violations, and others, could lead to repayments to employer groups and penalties in the millions of dollars and, in some cases, criminal liability,” the lawsuit says according to The Bismarck Tribune. (http://bismarcktribune.com/news/local/former-medical-director-files-whistleblower-suit-against-bcbs/article_460e67d8-d6fa-11e3-9b51-001a4bcf887a.html) (In Re: Dr. Kenneth Fischer vs. Noridian Mutual and Blue Cross Blue Shield North Dakota, filed on May 6, 2014, 09-2014-CV-01237)

“When insurers, which are meant to protect their members, engage in unethical conduct, a pattern emerges in which members are defrauded,” said Gary Falkowitz, Managing Attorney at Parker Waichman LLP. “When a corporation endeavors to retaliate against whistleblowers, am indefensible work environment is created and the public suffers, as well.”

Parker Waichman LLP supports whistleblower efforts to report illegal activities that may harm citizens. The firm continues to offer free legal evaluations to those individuals who believe their companies may be involved in wrongdoings. If you believe that your company is involved in illegal activities, or for more information, please visit the firm’s Whistleblower page at yourlawyer.com or call 1-800-LAW-INFO (1-800-529-4636). (http://www.yourlawyer.com/topics/overview/qui_tam)


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