A whistleblower lawsuit was filed against insurance company Humana over allegations that it participated in an alleged kickback scheme with Roche Diagnostics, a division of the pharmaceutical giant Hoffman-La Roche.

The whistleblower alleges that Roche and Humana, a major U.S. health insurance company based in Kentucky, had an arrangement in which Roche would dismiss debt that Humana owed Roche in exchange for Humana keeping Roche’s diabetes testing products and excluding any competing products.

According to the whistleblower lawsuit, Roche’s dismissal of Humana’s debt was inappropriate, and this agreement between the insurance and pharmaceutical giants constitutes what is known as a kickback scheme. Essentially, a kickback scheme is one in which a company agrees to do something illegal (illegally dismissing debt, according to this lawsuit) in exchange for something beneficial to the other company (in this case, using Roche’s products and not those of competitors).

The whistleblower lawsuit was filed by a former Roche Diagnostics employee in June 2014, and alleges that this kickback scheme agreement allowed Roche access to Humana’s insurance plan participants. According to the lawsuit, the kickback scheme came about because Humana had planned to cut Roche products from its Medicare plans’ formularies back in March 2013, but Roche had overpaid Humana $45 million in rebates.

At this point, the lawsuit alleges, Roche “recognized an opportunity to be placed back on Humana’s formularies.” The two companies came to an agreement where Humana would pay Roche back no more than $11 million to cover its overpayment debt, and also put the company’s diabetes products back on their formularies, simultaneously excluding competing brands from these formularies.

Roche attempted to have the kickback scheme lawsuit dismissed, but the U.S. District Court for the Northern District of Illinois tossed these motions.

Filing a Whistleblower Lawsuit

Lawsuits like this kickback scheme lawsuit are often brought to the attention of the government by whistleblowers—that is, individuals who have noticed fraud against the government and filed litigation on behalf of the government. The federal government may then choose to intervene in the lawsuit, and if the suit is successful the whistleblower is rewarded for their part in alerting the government.

Whistleblowers are often given 15 to 30 percent of any recovered funds, as an incentive award. In many cases, whistleblowers are employees of the company committing government fraud. Many whistleblower lawsuits end up bringing in millions in settlement money, so a whistleblower monetary reward can be significant.

A person considering becoming a whistleblower on behalf of the government may worry about being fired or otherwise retaliated against at work. However, there are regulations in place to protect whistleblowers from this kind of retaliation.

If you believe you have witnessed some kind of fraud by your current or former employer, such as a kickback scheme like this one, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) on behalf of the government under the False Claims Act. These kinds of lawsuits have been filed over Medicare billing fraud, fraud against other insurers, physician/hospital kickbacks, and many other types of government financial fraud.