Before joining our team at LawMD, Dr. Mitchell Nudelman spent over 10 years working for CIGNA’s wholly-owned medical review company, IntraCorp. While he was there, he realized the company was making false claims in California, Delaware, Florida, Nevada, and Tennessee.
IntraCorp did not perform correctly under its contracts and fraudulently represented its manner of performing utilization review (UR) services. As a result of these cost-mitigating practices, the company profited by hundreds of millions of dollars while an uncounted number of health plan members and their children were injured by interrupted care.
Rather than stand by, Dr. Nudelman put his job at risk and spoke out against his employer. He was formally dismissed while he continued to pursue a qui tam action against his employer as a federal whistleblower.
What Are Utilization Review Services?
Also referred to as UR services or utilization management, utilization review is the process in which a health insurance company reviews your request for medical treatment. Essentially, UR allows your insurer to decide whether or not they will cover your medical care. Because UR is an intrusion into the traditional doctor-patient relationship, fraudulent activity in this process can directly affect the care a patient receives.
For example, imagine you have appendicitis. Your doctor recommends you have your appendix removed in a routine surgery and you submit the request to your insurance provider. Your insurer then submits your request to a medical review company that considers it under utilization review.
If this company decides your surgery is nonessential, your insurance company will not only refuse to cover it but also share a professional medical opinion that the procedure is unnecessary. As a result, you might forgo the procedure altogether. Without the surgery, your appendix could burst, causing you to face countless health complications, and you would have a difficult time pursuing justice against your powerful insurance company, who will almost certainly try to confuse you by implicating your physician, the medical review company, and even your decision to not have the surgery.
By speaking out against CIGNA and IntraCorp for similar practices, Dr. Nudelman sacrificed his livelihood and saved future patients from the fate outlined above.
What Is a Whistleblower?
A whistleblower, in their simplest sense, is someone who reports large-scale wrongdoings to an individual organization who can rectify the wrongdoing. After Dr. Nudelman reported the UR fraud to his employer, he was fired, so he took the next step and reported the problem to the federal government under the False Claims Act. The qui tam doctrine offers federal protections and rewards to whistleblowers who adhere to the proper procedures and help the government achieve legal remedies, but that’s not why Dr. Nudelman spoke up.
When asked about his status as a whistleblower, Dr. Nudelman stated:
“While I did not become a millionaire or recover near what we should have, I did surely manage to save a good number of lives and injuries to patients who were being subjected to fraudulent UR activities.”
Continuing His Work
By pursuing justice on behalf of patients injured by medical malpractice, Dr. Mitchell Nudelman is continuing his important work at LawMD.
Receiving medical care requires a great deal of trust, and all providers have a duty to keep you safe from harm whenever possible.
If you’ve been injured by the negligence of a health care professional, Dr. Nudelman and the rest of our experienced attorneys can help.
In addition to being award-winning legal professionals, the majority of our team has worked as medical doctors. We understand what you are facing and how to help you recover.
Call us at (888) 695-2963, schedule a free consultation, and begin building your case today!