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

An EBC Allegedly Pocketed $27 Million of Client Pharma Rebates. Here's What Happened Next. An employee benefit consultant where 61% of revenue allegedly came from keeping clients' pharma rebates — undisclosed, in violation of the Consolidated Appropriations Act of 2021, funneled into the executive bonus pool. When the compliance officer raised the alarm and eventually disclosed to a plan sponsor, he was fired. That firing is what made this a whistleblower case. Stacey Richter speaks with Ann Lewandowski — nationally recognized healthcare executive and whistleblower known for Lewandowski v. Johnson & Johnson — about the pharma rebates case, what it means for plan sponsors, and what to do if you are an employee watching something like this unfold. WHAT YOU'LL LEARN ✅ The anatomy of the case: an EBC's TPA arm allegedly kept client pharma rebates — 61% of revenue — without disclosing them as required by the CAA, funneled them into the executive bonus pool, and fired the compliance officer who tried to make the disclosures; originally filed in Maryland state court, moved to federal court because it involves ERISA, with the Department of Labor now working alongside plaintiff's counsel ✅ Why Form 5500 disclosure templates matter: a vague statement like "may from time to time receive third-party compensation" satisfies the letter of the law while hiding everything; Ann's advice is to use your own template with black-and-white line items so the vendor either discloses or actively lies ✅ What a qui tam lawsuit is: qui tam provisions allow private individuals to sue on behalf of the government and collect a portion of the recovery — the upside most employees don't think about when weighing whether to come forward ✅ The Upjohn warning: when a company's lawyers interview employees about potential wrongdoing, those lawyers represent the company, not the employee — the company can waive privilege and share what was said with the DOJ; every employee must understand this before speaking ✅ Ann's practical advice: document everything, don't depend on others to protect you, and consult an ERISA attorney — the DOJ's 2016 sentencing guidelines mean individuals with knowledge of wrongdoing can be personally prosecuted, not just the company ✅ Compliance as the organizational immune system: you can tell everything about a company by whether it treats a concern raised by the compliance officer as a vaccine or an invader to be eliminated WHY THIS MATTERS Trust but verify — and as W. Edwards Deming put it, in God we trust, all others must bring data. For plan sponsors, this is a guide to defensive plan sponsorship. For employees watching the wrong things happen around them: the risk of not whistleblowing, of being on the wrong side of the table when someone else does, is just as real as the risk of coming forward. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP476 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 00:00 Introduction 08:10 What does it mean to be a whistleblower? 09:05 What's happening in the current whistleblower case about pharma rebates? 14:24 What are the disclosure requirements, and how does this affect contracts in healthcare? 15:05 EP379 with AJ Loiacono. 15:11 The 5500 form. 15:36 EP397 with Paul Holmes. 16:46 Why having a "defensive health plan" is important. 17:31 Matt Ohrt's post about healthcare's soul. 17:42 Michelle Bernabe's post about how healthcare has lost its heart. 18:15 Why "trust and verify" is important when building contracts and relationships in healthcare. 18:42 Quote by W. Edwards Deming. 21:35 How has this case moved from state to federal court? 23:30 Whistleblower case on generic drug collusion. 24:01 What is a qui tam lawsuit? 28:08 What is an Upjohn warning and the issue of corporate Miranda rights? 30:01 What is Ann's advice to employees who might be whistleblowers? 31:41 EP438 with John Lee, MD. 33:31 What are some red flags that employees should look for to understand what kind of company they work for?