Introduction and Episode Overview
[00:00:00] Stacey Richter: Episode 476. "Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower." Today I speak with Ann Lewandowski.
[00:00:27] Stacey Richter: Alright. First off, let me calm down. Any attorneys right outta the gate here.
The Pharma Rebates Whistleblower Case
[00:00:32] Stacey Richter: 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, i.e., none of their clients were aware that this was going on. It was not disclosed as per the consolidated Appropriations Act of 2021.
To listen to this episode or read the show notes with the mentioned links, visit the episode page.
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 i.e. 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 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 or TPAs or other vendors. At least do some level of auditing there.
So there's that.
The Impact of Trust in Healthcare
[00:03:14] Stacey Richter: 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 an 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.
Understanding Whistleblowing
[00:05:28] Stacey Richter: 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 herself.
And it is a truly difficult choice. It takes just such firm conviction and commitment to doing the right thing. As Ann has written, she wrote, "Whenever someone sees what appears to be illegal actions without saying something, it means people are protecting the status quo."
The problem, as Ann wrote, that the penalty that can arise for whistleblowing is real. So we need more voices so that those speaking up cannot be silenced. In other words, this is me paraphrasing. It's hard as heck to be a whistleblower, which we discuss and we also get into how to make the choice to whistle blow, how to do it safely. Basically, you know what to consider there, but also not to get into a damned if you do, damned if you don't territory.
Because the risk of choosing not to whistleblow if you see illegal activity is also real. There are plenty of cases, again, referring back to that generic collusion case is just one of them. There are plenty of cases where a whistle got blown by someone and others on the team face the penalties of that.
[00:06:47] James Gelfand: Hi, this is James Gelfand, president and CEO of the ERISA Industry Committee. If you love the Relentless Health Value podcast as much as I do and you want to help support the program, be sure to follow and leave for review on Apple Podcast or Spotify. Thanks so much for listening.
[00:07:03] Stacey Richter: Alright. Let me land this plane by saying in sum, don't forget, there's upsides whistleblowing. Like you get a percentage of the dollars recouped. Also, you're in the clear because no one else is gonna blow the whistle first, and then you find yourself on the wrong side of the table. But for sure there's downsides.
Today as aforementioned, I am speaking with Ann Lewandowski. Ann Lewandowski is a nationally recognized award-winning healthcare executive with extensive experience. Most listeners probably know her last name at the very least, from the Lewandowski versus Johnson and Johnson case that came out last year.
Ann does a lot of work with plan sponsors and others. Links to Ann's work and websites are in the show notes.
There will be another show, it's gonna be a summer short with Ann Lewandowski, where we're gonna dig in on pharma rebates. More kind of, I'd say, the less intuitive ins and outs afoot there.
My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Ann Lewandowski, welcome to Relentless Health Value.
[00:08:08] Ann Lewandowski: Thanks, Stacey. I'm so pleased to be here.
[00:08:10] Stacey Richter: There was just a whistleblower lawsuit that was filed. It's a pretty well known term, whistleblower, but just what's the short on? What's a whistleblower?
[00:08:22] Ann Lewandowski: So a whistleblower is somebody who comes forward, publicly, right? You can do it internally as well, but typically once you become an actual whistleblower, you've gone to an external source and said. There's some sort of activity that doesn't feel right and allege some sort of wrongdoing within the company.
[00:08:45] Stacey Richter: Within the company they work for most of the time.
[00:08:47] Ann Lewandowski: Yeah. I took a couple classes on compliance and healthcare compliance and what the company would say is you're airing their dirty laundry in public. The government would say, you're doing the right thing and making sure all the laws are followed and people are doing things legally.
So those are sort of the two different perspectives that you'll find.
Deep Dive into the Whistleblower Lawsuit
[00:09:05] Stacey Richter: So let's talk about this actual lawsuit, which is a whistleblower lawsuit. What is going on very specifically in this one, which by the way, has to do with rebates.
[00:09:15] Ann Lewandowski: This entire complaint, and it's, it's pretty long. And this person was very committed. He was in a compliance role. In a compliance role, you are really trying to check the boxes and make sure that your company is doing the right thing. You start to see this tension between his role in compliance and some of the other executive officers. He is trying to say, let's be consistent with the Consolidated Appropriations Act and disclose to our plan sponsors the rebates that we get.
[00:09:46] Stacey Richter: It was an employee benefit consultant that this individual worked for in a compliance role, on behalf of their plan sponsor client. They were collecting from the PBMs, the pharmaceutical rebates.
[00:09:58] Ann Lewandowski: They also had a third-party administrator. My understanding is this really centers on the actions of the third-party administrator portion of the benefits consulting group.
Essentially, he's being the Jiminy Cricket, of the company is saying, Hey guys. There is this new law, the Consolidated Appropriations Act, it's the law of the land. It's requiring these disclosures. We need to release our rebate information. Then you see pushback from within the company saying, We're not gonna do that.
It represents approximately 61% of our revenue.
[00:10:36] Stacey Richter: Whoa. Wait, wait. So there was an employee benefit consultant. Where 61% of their revenue was effectively keeping some percentage of their plan sponsor, employer clients, pharmaceutical rebates.
[00:10:49] Ann Lewandowski: It gets worse actually, Stacey. According to the allegations, not only was this more than 50% of their revenue. It was also allocated for their executive bonus pool.
[00:11:01] Stacey Richter: Their executive bonus. Okay, so they're keeping, without disclosing as required by the Consolidated Appropriations Act.
[00:11:09] Ann Lewandowski: Alright. Yep.
[00:11:09] Stacey Richter: They're keeping the rebate or some portion of it and using it to pay a bonus to the people who are deciding to keep the rebate and not disclose it.
[00:11:20] Ann Lewandowski: Yeah. Say the first lawyer I ran this by an old mass tort guy. He wrote the book literally on, on torts and you know, basically torts are bad behavior in civil contracts.
And he was just like, Ann you've gotta be kidding me. This is like classic self-dealing. And I was like, I wish I could tell you I was kidding, but I'm not. I think no matter who you are when you're purchasing something, you really don't want your vendors to be self-dealing.
This Jiminy Cricket compliance person keeps trying to get his company to see, we have to at least tell people.
[00:12:00] Stacey Richter: Well, he's the compliance person, so this is really on him, like this is his job.
[00:12:05] Ann Lewandowski: Absolutely. He eventually does disclose to a plan sponsor, like these are rebates, and he was fired. So you have not only the whistleblower portion of coming forward and saying there is this bad behavior.
This group was not potentially complying with the Consolidated Appropriations Act of 2021. But when I tried to do the right thing, they actually retaliated against me and terminated my position.
Now, I think there's a really interesting question that's going to come up here, and that's according to the Department of Labor's 401k guidance, if you request a vendor disclosure and the vendor does not disclose, then you can't contract with them because essentially you're in this position with or not acting potentially legally.
So I think the real question for me that I is gonna be very interesting is what happened to those clients that asked for disclosure and didn't get it.
[00:13:05] Stacey Richter: Because basically what you're saying is if they asked and this entity was just like, nah. Then it's on the plan sponsor as a fiduciary of their plan to be like, whoa. This doesn't smell right, like this does not pass the sniff test. I'm gonna fire this vendor who clearly we've got some trust issues with them.
[00:13:27] Ann Lewandowski: Yeah. The question is, does that raise a trust issue? Right. Because often these are very, very trusted relationships.
But the DOLs crystal, crystal clear in the 401k space. A plan sponsor can choose to continue the contract until it's done, but it cannot decide to have a new contract, right. And that's probably because the DOL is pretty reasonable but you know, if you're having trouble getting these disclosures, then you know, you're put on notice and you need to start taking those steps to get a compliant vendor.
[00:14:00] Stacey Richter: Well, I guess for this particular case, I'm not exactly sure whether they did a 5500 like filled one out and just these rebates weren't on it. So if the plan sponsor went back and said, oh, I need my 5500, and the this EBC was like, sure, here you go. And it was just missing stuff. That's different than if the plan sponsors asking for 5500 and the EBC was like, nah, don't think so.
[00:14:22] Ann Lewandowski: Yes, and, the disclosure requirements are actually, you can tell what the compensation is for, and you need to have it for total compensation. For example, you are coming to me and I'm, I'm EBC here, and I'm like, oh, I get money for PEPM. I get a prescription fee, I get an audit fee, I have rebate dollars, and I put zero there, then I've lied.
But if I just say, I may get some third-party compensation from these pharmaceutical companies, or PBM that I think is questionable. And I think we're going to see that come up more and more as, is that an appropriate disclosure?
[00:15:05] Stacey Richter: This is something actually that AJ Loiacono talked about when he was on the pod. He's just like, you need your own template. For these 5500 forms, which are the disclosure forms that the Consolidated Appropriations Act, the CAA requires plan sponsors to get. And, the point that AJ made is use your own template. Don't take your employee benefit consultants because, and now I'm understanding exactly why with three underlines, because your employee benefit consultant, if they are up to no good, potentially they may just put this kind of squishy language.
Paul Holmes talked about this also on a show a while back, where if you've got "May from time to time, take marketing and third party", blah, blah, blah, like they're gonna have a statement on like that, which basically covers them.
Whereas if you're doing your own template, you put a line item like black and white quantitatively, how much are you taking from rebates? Answer the question. Because then that company has a hard choice to make. If they are doing things which they're not disclosing, they have to choose whether they're gonna disclose or actively in black and white lie.
[00:16:07] Ann Lewandowski: What I would say is, find a good ERISA attorney. Get that initial template, run it by them, make sure that they're very comfortable with it. Not being an ERISA attorney, I can't offer guidance, but there are some that are better. And then I think what I've heard from a very good friend is the disclosure she receives is a slide that says we may receive third-party compensation. Deal with it, kind of to your point, right.
And that to me does not feel adequate. But again, I'm not an ERISA attorney. So I would say if that's the situation you're in, definitely explore it. Look for good examples out there.
Legal and Compliance Insights
[00:16:46] Ann Lewandowski: We talk about defensive medicine a lot, and this starts to feel like defensive health plan.
Like are you checking all the boxes and making sure that things are really in line before you decide to move forward with this vendor?
[00:17:01] Stacey Richter: There's a lot of money at play here. It wasn't just a couple of bucks. It was, as you said, 61% of that employee benefit consultant's revenue. And I think it was like $27 million. Was it?
[00:17:13] Ann Lewandowski: It's a lot of money.
[00:17:15] Stacey Richter: If they had been disclosing it, that's one thing. If you're not disclosing it, and then you've got plan sponsors who are trusting, that just showcases this pervasive. One of the things I've been keeping an eye on lately is just the number like Matt Ohrt just wrote the other day, a post that was something like Healthcare has lost its soul.
Dr. Eric Bricker wrote about just the profit motives and the lack of spirit in healthcare. Michelle Bernabe wrote a post about how healthcare has lost its heart.
We're talking about old or sick or disabled people's lives, and it's come down to trying to maximize financial transactions often at best, at worst, doing it in ways that call forth a whistleblower.
[00:17:59] Ann Lewandowski: I was thinking of Matt, as you were think is saying all that, right, and Matt and I are both in Wisconsin. We see each other quite a bit and I consider him a very good friend. And the thing that I love that he says is have a trusted partnership. The challenge is many people think their partnership is based on trust.
And, they're not verifying. I think that's really where, you know, we need to have this trust and verify or, practice defensive plan sponsorship so that everybody is really safe. And you do actually have that transparency that does lead to trust.
[00:18:39] Stacey Richter: Trust, but verify. What's that one, Deming? I think it was Edward Deming: "In God, we trust everyone else bring data."
[00:18:46] Ann Lewandowski: Yeah, exactly.
[00:18:47] Stacey Richter: And it's a really tangled web because there could be EBCs (employee benefit consultants), where there's corporate to corporate deals, which an individual consultant may not know about. Like if two companies at the corporate level make a deal. Of course ultimately it could mean that the EBC or the TPA (third-party administrator) is incented to make recommendations that may or may not be in the plan sponsor's best interest.
Like you often hear about PBMs, you know, kind of backing up the truck and dumping money on some EBC executive suite's doorsteps. It's not directly connected with any particular book of business. It's just kind of a corporate to corporate understanding. But then of course it does become kind of odd when you see almost every single one of any given EBCs clients advised to use that particular PBM.
So it, I don't know how possible it is for any given plan sponsor to get ahead of some of this gamesmanship. But at the same time, being naive that this is going on is kind of not an option these days.
[00:19:48] Ann Lewandowski: Some of these big companies, they have, I don't think a hyperbole to say that they have platoons of lawyers. Perhaps we will get to the point, and Jennifer Stanley’s a really good friend of mine and she's like, Hey, what are the best contracts in the world? These are the oil leases down in Dallas. Because every single word in those contracts has been litigated.
And I could see a world where that's the case for healthcare, too. But right now we're sort of in this infancy stage there, and there are like act like a five-year-old, right? Like, ask the questions, why, why?
One of the things I'm trying to bring to the market are things that are, sort of this trust and verify. I have a, sort of schema, a risk map of. Hey, have you gotten all of these things? At least check the box right. Or my data analytics partner has a data map that plan sponsors can start visualizing that data. Where's the spend going? What's happening here? As you collect more data and data that we verify, that happens in other areas of purchasing.
And we've just not quite done that level of due diligence on our health plan side yet.
[00:20:58] Stacey Richter: That is cogent advice for plan sponsors. To do everything that you just said, ensuring you're verifying. It's not like this is the first day at the rodeo, right? Like as you said there you have a map that plan sponsors could take advantage of.
It's really important to be doing that right now to play, as you said, it's not defensive medicine, it's like defensive plan sponsoring relative to this case that we're talking about where the allegedly this employee benefit consultant was pocketing, you know, the 61% of their revenue was coming from their clients unknowingly. Right. In an unreported way.
In brief, what's the status there? What's happening right now?
[00:21:39] Ann Lewandowski: Interestingly enough, this was originally filed in a Maryland state court, and it's actually been removed to federal court because it deals with ERISA, which is a federal law. The Department of Labor has also taken an interest in this and is working with plaintiff's counsel.
It will be very interesting to see how the Department of Labor works with plaintiff's counsel and starts to analyze and look at this case. I am watching that piece really, really closely.
[00:22:07] Stacey Richter: And plaintiff is the whistleblower, the compliance person.
[00:22:11] Ann Lewandowski: Yeah.
[00:22:12] Stacey Richter: What do you think makes someone become a whistleblower. Like, there's a difference between, ugh, my company, you know, dot, dot, dot. And I complain over beers and deciding to take this step. Like, what goes through your head?
[00:22:27] Ann Lewandowski: It goes back to that quote that you see the results of somebody's decisions, but you don't see the choices that they had. And I think in this case, in just the brief rereading of the complaint, this guy was in a really difficult spot.
He knew he had to disclose. And his job was threatened if he did disclose and followed the legal requirements. He was in an absolutely no-win situation where he followed all of the right paths, and I think that's, all of the people that I've talked to that have concerns about their company have typically followed the right ways of dealing with them before going public.
And at some point you realize I'm not getting anywhere. I could be personally liable. That's the Department of Justice's sentencing guidelines that were updated in 2016 is it's not just the company that can be liable. Individuals within that company who have knowledge of wrongdoing can be prosecuted.
[00:23:30] Stacey Richter: So there was another really famous, actually whistleblower lawsuit that you and I had been talking about earlier with the generic drug manufacturers where, I mean it is a hundred, it's like a quarter billion dollars or something like that where it's price fix and colluding, all kinds of things.
There was a whistleblower that brought that case and there are CEOs of these, there's people in these companies that are being personally, you know, who sat at that table doing the actual colluding and like they're facing jail time.
[00:23:59] Ann Lewandowski: Potentially. Yeah. So there's this thing called Qui Tam lawsuit, and this goes back to the Civil War.
And the government saying, if you're overcharging the government, we want to give people who are doing the right thing, basically a slice of the pie, a slice of the recovery. Depending on the knowledge and level of sophistication with the DOJ, if you come forward with wrongdoing at your company, and say, by the way, Medicare, Medicaid, whatever was overcharged, and I can prove it, you can actually bring your own lawsuit.
And the Department of Justice can choose to either bring it up or not. But then, you get a portion of that. So it's really it, this incentive to come forward and whistleblow. Many people, they think of all the negative facts that you know, oh, I'm never gonna be employed again.
Oh, this is gonna crash my career or what. They don't think, wow, like, I could actually be okay coming forward because of this provision now. Qui Tam lawsuits are being challenged as constitutional or not. Maybe I'll have to come back and give you an update on that a little bit later.
[00:25:08] Stacey Richter: I think the point that you're making is you can get people in these companies that are being put in a really untenable position.
You use the rock in the hard place metaphor. It's like either, if you just do as you're told and somebody else whistleblows, you're on the wrong side of that interrogation table, right? Because like now you're a party to this wrongdoing. Whereas if you do whistleblow, then as you said, there's a lot of thoughts to be thought through.
[00:25:37] Ann Lewandowski: I have this theory that compliance is sort of an organization's immune system. You can tell a lot by how compliance responds. Either you are embraced and you're treated like a vaccine or some sort of assistance, and they're really gonna inoculate themselves against this, any sort of bad behavior, and maybe you even get a bonus or a reward for coming forward. Even if it's not a big thing.
Or as you see in this case, you become a total target and you are basically swarmed like an invader and tried to be eliminated.
[00:26:12] Stacey Richter: You're saying you can tell a lot about a company and the moral compass of a company by what happens when someone who works there raises their hand and says, We are doing something noncompliant right now.
Because there's two choices as you just said. One choice is, holy cow, thank you so much for bringing this to our attention. Let's fix this. And all of a sudden processes there, there is activity being taken to fix whatever it is.
Or alternatively, exactly like in this particular case, you get fired for bringing it up and or you get yelled at in meetings and there's some crazy quotes in this particular case about what happened to this guy in meetings and stuff. So two ways to go.
[00:26:55] Ann Lewandowski: There's more subtlety usually. Here are some things that might be concerning. We really act within the gray. And we really explore the gray and go right up into that black or red line. Any verbal instruction not to comply or go to compliance would be a huge red flag.
Refusal to meet with legal or compliance when you've identified or raised a concern or needing to go to your immediate supervisor or their supervisor to get approval to do that. And then if you're in compliance, any attempt to keep you from reporting to the board or board chair or these people who are ultimately responsible for the company, those are all things that I would, I would document and definitely push back on.
I always return to the advice that I received in my first job in public service, which is, document as much as you can and never depend on others to protect you.
[00:27:53] Stacey Richter: Kind of a cold, hard dose of water. A document what you can, but don't expect others to protect you. That advice, it just, it feels very, uh, yeah.
[00:28:03] Ann Lewandowski: Part of my Masters of Legal Studies is in compliance, and so conducting these investigations, one of the things that I really want employees to understand, because I did not understand this, is the issue of a corporate Miranda Rights, and this is called an Upjohn warning.
If the company has identified wrongdoing, like in the case of the generic manufacturers. You'll be brought in. You'll meet with their lawyers, and you'll receive what's called an Upjohn warning, which says, these lawyers do not represent you. They represent the company and at any time the company may waive privilege of anything you've said in order to mitigate their potential liability.
That is critical for every employee to understand that the company itself holds that privilege and the ability to say to the Department of Justice, Oh, we didn't do this. This is just one bad actor that went against policy and procedure. I really want people to understand that.
[00:29:03] Stacey Richter: As you just said, there's no attorney client privilege that's going on here because these aren't your attorneys.
[00:29:11] Ann Lewandowski: No, they are not. And that is an unfortunate state of fact, but always keep that in mind when your emails can be disclosed. They tell you this. I don't think people expect it, but just remember, you very much work for them.
Final Thoughts and Conclusion
[00:29:28] Stacey Richter: So whistleblower advice. One of the reasons why I was looking forward to having this conversation with you, Ann Lewandowski, is because there's just so much going on in the healthcare industry that if you stick your head up and look around, you can see, and this is anything from just odd and suboptimal on one end of the spectrum to legal, but pretty unpalatable in the middle, right?
There's this whole gray area in the middle to on the other side, just like illegal. If you are talking to somebody who's looking around and seeing any of these kinds of things, or maybe is a little unclear what they are seeing, what's your advice?
[00:30:13] Ann Lewandowski: The first thing that you have to square with yourself is, we all have to live with the consequences of our decisions, and we have to look at ourselves in the mirror. We have to be able to pay our mortgage. Tell our spouse, kids, family, dog, whatever it is that we feel we're making the right choice. And balancing all of that is not easy, right?
That, I think, is probably one of the deepest, most personal decisions we can make. But I think if what you are feeling is discomfort, I have learned that you have to trust your gut and really trust it. It's not hyperbole to say, I would reach out to a lawyer and run it by them. Right. You know, I find that it's typically worth the $500 and to say to somebody with the legal training to do the analysis and say, this is where you're gonna have trouble, you need to protect yourself.
Because, if you look at these CEOs, right, like these are 10 million or more dollar fines that they're now facing. Imagine they had spent the personal money to go to a lawyer and say: Hey, how does this look? Like, am I gonna get in trouble? And so I think again, it's that thoughtfulness. It's that defensiveness to make sure that you really are on the right side of things.
[00:31:33] Stacey Richter: It sounds like you've got two pieces of advice here. Mainly one of them is we all have to live with the choices that we choose to make. There was a show with Dr. John Lee about cognitive dissonance that I think is relevant. Like there's so much going on in the healthcare industry which is very upsetting and listeners of this show are probably more familiar than most. Sorry about that.
And we do not live in an ideal world here, so there's always gonna be stuff that we don't agree with and that we can see is not benefiting patients or not being done in an ideal way.
However, there's a difference between if that bad stuff is legal. Or not legal. And when it's not legal, your advice is step one, as you just said, document.
Document, because you're gonna need to protect yourself. Like there's illegal stuff that's going on in your vicinity, and somebody else could wind up whistleblowing. And then as we said, you're gonna be on the wrong side of the table there. So document your stuff and go to a lawyer.
[00:32:29] Ann Lewandowski: Yeah. I mean, you need somebody with that legal training to really answer the question, is this legal or not?
And, as we already covered, right, legal counsel for the company, works for the company their job is to defend their client. So I do think it's a very reasonable step to go to your own lawyer and say, what do you think of this? Here are sort of the set of facts. I'm concerned. Am I gonna be okay? That's a hard thing to do, but then you can get that very clear legal advice from somebody who knows.
[00:33:02] Stacey Richter: That I think that's probably very sound, especially if you are working for one of those companies. We talked about, there's two kinds of companies. I mean, there's a lot kinds of companies in the, in the middle, as you said, like a lot of times things are done a little bit more subtly.
But like you are working there for a while. You can tell whether you're working for a company that's really trying hard to do the right thing or a department. Sometimes it's not all at the corporate level, like it could definitely, there's different cultures even within different branches of an organization or whatnot.
[00:33:31] Ann Lewandowski: Another red flag would be, well, so and so said the wrong thing, and they're not able to move up, or they've been sort of blackballed within the company. That would be another pretty major red flag that I would be very concerned to hear.
[00:33:44] Stacey Richter: I bet everybody listening right now knows what kind of company they work for. Like you've been there for any amount of time. There's just any number of things. They're probably tiny little things, but they all add up to, if I see something wrong, I'm not gonna say anything.
And if that's someone's innate, like I know that that's the right thing to do. It's not gonna go well. Then, okay, we know what kind of company that we work for.
The next question is, is it unpalatable or is it illegal? If it's illegal, then there's some choices that need to be made. If it's not illegal, it's just unpalatable, then it becomes more of a personal question. How do we wanna deal with that so that we can feel good about what we're doing?
[00:34:22] Ann Lewandowski: I think it is really hard, right? Because when you get back to the Department of Justice sentencing guidelines. You are required to have not just a compliance program, but an effective compliance program.
Having this negative response to compliance is within itself a really big red flag. I think there is very much a gray continuum of what is the tone at the top? Are we embracing compliance or are we shunting it off? Which is within itself a very big problem.
[00:34:54] Stacey Richter: Ann Lewandowski, if someone is interested in learning more about your work or the plan sponsor compliance roadmap that you had mentioned earlier, where would you direct them?
[00:35:03] Ann Lewandowski: Reach out to me on LinkedIn, or you could reach out to me at ann@patientvalueinsights or patientvalueinsights.com
[00:35:11] Stacey Richter: And we will put all of these links in these show notes. Ann Lewandowski, thank you so much for being on Relentless Health Value today.
[00:35:17] Ann Lewandowski: Thanks, Stacey. It's been such a pleasure to join you.
[00:35:20] Dr. Vivian Ho: Hi, I am Dr. Vivian Ho. I'm a health economist at Rice University and Baylor College of Medicine. I listen to Relentless Health Value religiously because this is the show for those who are part of the tribe that wants to improve the quality of healthcare, improve access to care, and make it affordable. So make sure that you subscribe to the newsletter and subscribe to the podcast and keep up with every episode.