Christopher Piacentile, CFE, knows the trials and tribulations of being a whistleblower all too well. Not only does he work regularly with whistleblowers at the Daniel J. Ocasio Whistleblower Law Group, he has been a whistleblower himself multiple times. He was the lead investigator for the Apria Healthcare fraud case which settled recently for $40.5 million. He hopes to continue fighting for whistleblowers and helping expose fraud in any way he can.

How did you first become passionate about fighting fraud?

My first whistleblower case was back in 1993 in the Durable Medical Equipment (DME) industry which led to a successful settlement. As a young sales representative in the medical industry, I saw firsthand how companies would go to great lengths to try and defraud Medicare — some subtly and some not so subtly. It seemed that every time that I took a new job for a medical company I discovered that they were cheating the government in some fashion. This is what led me to file several whistleblower cases early on in my career. It was never my intention to file several cases, but what was I to do when the fraud was so obvious to me? I believed I was doing the right thing and I still believe that today.

Fast forward 27 years later and I am a certified fraud examiner and certified FCPA expert, working with the Danial J. Ocasio Whistleblower Law Group which specializes in filing whistleblower cases. I work with our clients who are brave individuals who come forward to blow the whistle on fraud. My unique talent is reviewing their documents and finding secondary and tertiary allegations that the client didn’t even realize was a fraud. For me, figuring out fraud schemes is like solving a puzzle. My goal is to add value to my clients’ cases. It’s what I’m good at.

What steps led to your current role in the Daniel J. Ocasio Whistleblower Law Group?

Over the years, I had worked both independently and under contract for several whistleblowing organizations. Daniel Ocasio and I have worked together for the past several years on more than 130 cases. He is one of the brightest and hardest working false claims attorneys in this industry. We have filed some amazing cases together which are now beginning to come out from under government seal, like our Apria Healthcare case which settled recently for $40.5 million. You will be seeing more of our other cases in the next several months as settlements are announced.

You were the lead investigator in that Apria Healthcare case you mentioned. Can you tell us about that investigation and the steps you took from initial discovery to settlement?

This case was discovered in 2016, when I read an OIG report about an increase in the Medicare spending for non-invasive home ventilators (NIV). The report went on to say that there was a substantial increase in Medicare spending for the NIV billing code over the past few years. It was a 40-page report that was well-done, but it left out one piece of critical information: It never said why there was a substantial increase in NIV spending by Medicare from year to year. To me this report screamed “We are getting ripped off but we don’t know how.” I embarked on a mission to answer that question of how. It helped that I had an extensive DME background from basic sales to the economics associated with operating a DME company.

The investigation started with interviewing several individuals from the respiratory industry and asking them key questions surrounding their companies’ process for gaining NIV orders. It quickly came to light that there was an organized effort by Apria to take patients on lesser, more economical respiratory therapies (such as CPAP and BiPAP) and switch them to the more expensive NIV therapy. We learned that these patients switched to the more aggressive NIV therapy were knowingly non-compliant based upon internal documents.

Even though these patients showed little to no usage for months at a time, Apria still routinely billed Medicare each month. A typical NIV patient is worth $18,000 per year to a DME provider as opposed to $1,300 per year to a patient on the correct more economical equipment. It is usually greed or the desire to improve the bottom line that drive companies to commit fraud. This case involved numerous witness interviews, thousands of pages of document review and uncovering many well-hidden schemes. I am putting together a presentation for the ACFE where I will discuss all my investigative techniques used in cracking this case. The $40.5 million Apria settlement was a big win for the U.S. taxpayers and the whistleblowers involved.

In addition to working with whistleblowers, you personally have been a whistleblower and know first-hand the hardships that many whistleblowers face. What do you think organizations, governments and society as a whole can do to encourage more whistleblowers to come forward?

There are many hardships that whistleblowers face. The biggest question is always risk vs. reward. Just the thought of becoming a whistleblower can be both stressful and daunting. Weighing the potential reward of doing the right thing with the potential risk of whistleblowing is not something to be taken lightly.

My goal with any client is to help them make this decision. There are several factors and each case is unique to each client. This initial process is something that I take very seriously. The various whistleblower programs offer a variety of protections. My whistleblower clients will tell you that I am straight forward, down to earth, extremely knowledgeable and bring a level of calmness when walking them through the arduous but rewarding process of blowing the whistle. There is a free white paper about this subject on our website. I invite all who are interested about learning your rights and protections as a whistleblower to download it.

Do you have any advice for people on the fence about whether to blow the whistle?

Yes — call me. I work for a contingency law firm and there is never a charge to speak with me. All my calls are confidential and privileged because I work for a law firm.

How has being a CFE impacted your career?

I learned about becoming a CFE a few years back. I looked at the organization and found it to be extremely reputable with great leadership. My career has been impacted in a very positive way. Being certified by an accredited association immediately improves status and reputation. It tells people that your expertise is current because of the yearly certification requirements. People within the whistleblowing industry know me and my work but if you're an outsider or a potential whistleblower you may have never heard of me. Having that CFE at the end of my name means a lot to me.

What do you like most about being a member of the ACFE?

The ACFE is a well-run organization with more than 85,000 members worldwide and growing. The diverse selection of educational courses provided are second to none. I learn new things all the time while being kept up to date on hot topics relating to all types of fraud. Also, the ACFE is great for networking as it gives me access to certified members who can possibly help in one of my international investigations. I would like to mention that I am a member of the local Puerto Rico ACFE Chapter #61. What a wonderful group of dedicated certified fraud examiners in that local chapter! If you’re a CFE, I strongly encourage supporting the local chapters in every community.

When not fighting fraud, what do you like to do in your spare time?

I am a single father raising my two sons, now ages 18 and 20, for the last 12 years. I have done this alone so like most single parents, I have no spare time. I do try to sneak in a little Xbox with my sons once in a while. :)

ACFE membership is open to individuals of all job functions, industries and levels of experience who are interested in the prevention, detection and deterrence of fraud. If you want to level up your anti-fraud career, we can help.

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