Healthcare Fraud

December 21, 2015

Fiscal Year 2015 and the False Claims Act: Reviewing Another Successful Year

Why do we spend so much time talking about the False Claims Act (“FCA” or “the Act”)? The short answer: It works. Through the FCA, our government fraud attorney is able to partner with private citizens to fight back against those who knowingly take money from government programs. A frightening amount of fraud occurs every year, much of it quite intentionally, including fraud targeting health care programs for the elderly, programs to aid the poor, military contract spending, and other important causes. However, we continue to have hope. The FCA is an excellent tool for fighting back, as illustrated by the recent government press release detailing the successes of the False Claims Act in 2015, and the honesty of ordinary citizens fuels its success.

FCA Results for FY2015

Earlier this month, the Department of Justice (“DOJ”) issued a press release with a title that speaks for itself: “Justice Department Recovers Over $3.5 Billion From False Claims Act Cases in Fiscal Year 2015.” This makes four consecutive years with FCA recoveries exceeding the $3.5 billion mark and brings the total recovered under the FCA from January 2009 through the end of Fiscal Year 2015 (“FY2015;” unless otherwise indicated “2015” also refers to Fiscal Year 2015) to $16.4 billion.

December 14, 2015

A Federal and State False Claims Act Spurs Possible Changes in Mental Health Services in Minnesota

by Gregory J. Brod

We spend a lot of time talking about the federal False Claims Act and for good reason; it is an important tool for fighting frauds that steal taxpayer money and leave some of our nation’s most vulnerable and worthy individuals unable to get the services they need or even directly endangered by the fraud. It is important to remember, however, that there are also powerful state laws that cover similar cases of fraud on state government. As a recent case shows, these laws not only allow for the potential return of money to already-underfunded state programs, but they can also prove powerful incentives for change.

Minnesota Group Accused of Fraud in Mental Health Arena

Earlier this month, The Star Tribune wrote about allegations of fraud in the provision of mental health services filed at both the state and federal level. According to the report, Complementary Support Services (“CSS”), a nonprofit organization based in Richfield, Minnesota, stands accused of improperly billing government assistance programs for mental health services. Specifically, the pending lawsuit alleges CSS billed for services provided to hundreds of patients without the supervision by a licensed mental health professional that the programs require. Additionally, the suit accuses the organization of padding bills by including time spent on paperwork, a lonelysenior practice prohibited under state law. Prosecutors further allege that CSS’s president, herself a licensed social worker, “batch signed” large numbers of documents and directed the practice be continued while she was out on leave, rather than giving the files the personal review required by law. The suit also accuses the company of encouraging fraudulent practices tying employees commissions to regional billings.

December 7, 2015

False Claim FAQ, Part Two: The Importance of Whistleblowers and Our Whistleblowers’ Law Firm

by Gregory J. Brod

In the previously published Part One of this FAQ (link provided below), we looked at the False Claims Act (“FCA” or “the Act”) and discussed its coverage and enforcement. This concluding section of the two-part series focuses on the role of whistleblowers in False Claims Act cases and how our False Claims Act whistleblowers’ attorney can help these honest people step forward to join the fight against fraud.

What happens after I file a whistleblower’s lawsuit?

Qui tam lawsuits (the legal term for suits filed by private citizens on the government’s behalf) under the FCA are filed under seal which essentially means they are kept secret. The claim and a written disclosure of the information on which it is based must be served on the appropriate U.S. Attorney and the Attorney General. From the time of filing, the government has 60 days to investigate the claim, although it can (and often does) ask for an extension if necessary. Notably, the defendant is not informed until this investigation is complete.

November 30, 2015

False Claims FAQ, Part One: Coverage and the Qui Tam Provision

by Gregory J. Brod

On a regular basis, we use this blog to discuss health care fraud, government contracts fraud, and a range of related issues that fall under the False Claims Act and similar pieces of legislation. In a two-part post, our government fraud whistleblower’s law firm is taking a step back to provide a broader look at this important law. Part One provides a general overview of the law and what it covers while Part Two (to be published in coming weeks) will look at how a suit unfolds and the importance of engaging a knowledgeable False Claims Act lawyer.

What does the False Claims Act (“FCA” or “the Act”) deal with?

In brief, the FCA is a federal law that provides remedies when an individual or entity files a fraudulent bill (the “claim”) with the federal government or one of its agencies. The FCA is not a “gotcha” statute and it does not apply in cases of genuine mistake. To be covered by the Act, the claim must be made knowingly and with deliberate ignorance or willful disregard for its false nature. While the FCA only applies to fraud on the federal government, many states have similar laws applicable to fraud on the state government.

November 16, 2015

Spotlight on Home Health Care Fraud: False Claims Threaten Those Needing Care, Medicare Fraud Attorney and Private Whistleblowers Take Action

by Gregory J. Brod

Fraud follows the money. If something is expensive, there is probably someone looking to steal it or profit from it. Given the ever-rising cost of health care, it is hardly surprising that health care fraud is a growing problem and that Medicare and other government health programs are frequent targets. Home health care services are among the priciest services covered by Medicare and, not surprisingly, home health fraud is a major threat to the Medicare system, Medicare beneficiaries, and to all Americans who seek any form of health care and/or all taxpayers. Our home health Medicare fraud law firm partners with the brave, honest individuals who step forward to share knowledge, fight fraud, and return wrongfully obtained money to the government.

The Background: Home Health Services Under Medicare

Medicare covers certain home health services for qualified beneficiaries. Eligible services include intermittent skilling nursing care and a range of additional services like physical, occupational, and speech therapy. Generally, these services are coordinated by a home health agency (“HHA”). Medicare’s home health benefit does not cover meal delivery, round-the-clock care, personal care, or help with cleaning and other homemaker services.

November 9, 2015

Cheat the System, Pay the Price: Pursuing Those Who Knowingly Violate Medicare Rules

by Gregory J. Brod

There are few topics that will get people talking (and, inevitably, complaining) like health insurance. The truth of the matter is that, in order to function efficiently and provide the best possible care to the largest possible audience, health insurance companies must have rules and guidelines. Perhaps the context where this principle is most important is when the insurer is Medicare. According to a government memo published in July marking the program’s 50^th year, Medicare currently covers 55 million beneficiaries, an increase of 3 million beneficiaries from just three years ago. While coverage rules are sometimes unpopular, they exist for a reason and organizations that repeatedly bill and collect money in violation of Medicare coverage rules put the system and all who rely on it in jeopardy. The government cannot examine every claim in depth making health care fraud whistleblowers critical to protecting the system, one of the many reasons we are proud to serve as a Medicare fraud whistleblower’s law firm.

Settlement Resolves Allegations 450+ Hospitals Violated Medicare Guidelines for Cardiac Devices

On October 30, the Department of Justice (“DOJ”) announced that it had reached 70 related settlements totaling over $250 million dollars resolving allegations that 457 hospitals (listed in a separate document) in 43 states violated Medicare rules related to implantable cardiac devices. Most of the hospitals were named as defendants in a lawsuit filed under the False Claims Act (“FCA”) which contains a special qui tam provision allowing private whistleblowers to file claims on the government’s behalf. In this case, the original suit was filed by a cardiac nurse and a health care reimbursement consultant. Pursuant to the FCA, the whistleblowers received over $38 million from the settlement. While some might suggest that amount seems excessive, as the legal news website Lawyers and Settlements notes, “when the depth and breadth of the alleged healthcare fraud is factored in, it soon becomes clear the contributions of the two lead plaintiffs were integral in what has been described as one of the largest examples of alleged healthcare fraud, in terms of the number of defendants, in the history of the False Claims Act (FCA).”

November 2, 2015

Health Care Fraud Attorney on the Importance of Treating Patients as Individuals with Individual Needs

by Gregory J. Brod

It’s something you learn in preschool, but sometimes it seems like a lesson modern medicine has forgotten – Everybody is unique (and that’s a good thing!). Medicine should be tailored to individual patient’s needs; after all, that’s why we go to the doctor individually rather than showing up with thirty others and being handed the same treatment as everyone else. Sometimes, however, companies forget this and often profit seems to be the motivating factor. Using overly generalized profiles to justify unnecessary, costly tests and/or treatments can be a form of health care fraud. The law empowers both patients and conscientious professionals to fight these misdeeds, wrongs that can be both costly and dangerous. As a whistleblowers’ law firm specializing in health care fraud, The Brod Law Firm can help. Together, we can bring an end to unnecessary billing based on general profiles and ensure medicine focuses on the individual.

Lab Company Settles Claims it Billed for Unnecessary, Generalized Services

On October 19, the United States Department of Justice (“DOJ”) issued a press release announcing the settlement of multiple False Claims Act lawsuits against Millennium Health, a company headquartered in California. Millennium agreed to pay $256 million to resolve claims they billed Medicare, Medicaid, and other federal programs for services that were not medically necessary and allegations they provided free items to medical practitioners in exchange for their use of company services. While the settlement resolves the legal claims in several whistleblower suits, Millennium did not admit any wrongdoing.

October 26, 2015

Health Care Fraud Lawyer on Pill Restocking and Other Pharmacy Fraud Schemes

by Gregory J. Brod

As consumers of health services, we rely on medical professionals to help us protect our own health and the health of others. The vast majority of medical professionals are dedicated to providing the best care possible. Sadly, however, there are some people who abuse the public’s trust, often risking the health and welfare of others for personal gain. Today’s post will focus on pharmacies and pharmacy fraud, a category that includes pill restocking schemes. These schemes may include Medicare fraud, Medicaid fraud, and/or fraud on private insurance providers. People who become aware of such schemes, including patients, pharmacy employees, and other medical professionals, can help fight back. As a pharmacy fraud law firm, we work with concerned citizens to stop these crimes and protect the health of innocent Americans.

Restitution Order in Alleged Pill Restocking Case

Last week, according to WZZM13, a federal judge handed down an order for restitution in a case that has already let to more than a dozen arrests. WZZM reports that, according to this ruling, the drug restocking scheme cost Medicare over $64 million and cost Medicaid $18.2 million with an additional $4.7 million lost by Blue Cross Blue Shield of Michigan. The ruling decrees that the CEO and six others must collectively pay $8.8 million, 10% of the total amount lost by public and private insurers due to the fraud.

September 28, 2015

Ensuring Health Care Decisions Based on Patients’ Best Interest, Not Provider Profits

by Gregory J. Brod

The relationship between health care and money is the crux of some of the biggest policy debates of our time. Still, while much is debated, there are also many principles that most Americans agree should hold true. One such maxim – Medical decisions should be based on the best interests of patients, not providers own financial well-being. This precept is reflected in several laws including the Anti-Kickback Statute and the Stark Act and enforcing these rules is one of the goals of our work as a whistleblowers’ law firm for health care fraud issues.

$115 Million Settlement Resolves Case Alleging Health System’s Bonuses Violated Law

Just last week, the Justice Department (“DOJ”) announced a major settlement in a health care fraud case involving allegations of improper financial relationships between health care providers and their referral sources. The lawsuit claimed that Adventist Health Systems, a healthcare organization with facilities in 10 states, billed for the services of employed providers who were paid bonuses that, contrary to law, were based on a formula that considered the value of the referrals to the hospital system. More specifically, the suit alleged that doctors received monetary bonuses tied to the number of tests and procedures they ordered. Adventist agreed to pay $115 million to settle these and other fraud allegations, but did not admit to any wrongdoing.

September 21, 2015

The Many Uses of the False Claims Act: Beyond Medicare Fraud and Military Contracts

by Gregory J. Brod

As a False Claims Act law firm, we are always interested to find out what people know about the law, a fundamental issue given the large role private citizens play in bring False Claims Act (“FCA” or “the Act”) lawsuits. One of the things we’ve learned is that even the people who are familiar with the law are surprised to learn the wide variety of contexts in which it can apply. Likewise, its many state counterparts are versatile tools for the fight against fraud.

Overview of the False Claims Act

The Legal Information Institute (“LII”) at Cornell University Law School explains that the FCA is a “[f]ederal statute setting criminal and civil penalties for falsely billing the government, over-representing the amount of a delivered product, or under-stating an obligation to the government.” Although not emphasized in the LII article, false claims only violate the Act if made knowingly, with deliberate ignorance, or willful disregard of the claim’s falsity (see The False Claims Act: A Primer published by the Department of Justice (“DOJ”)).