Whistleblowers and Qui Tam Lawsuits

January 11, 2016

The False Claims Act and the Health Care Fraud Fight in 2016

The False Claims Act (“FCA” or “the Act”) is one of the most important tools we have in the fight against health care fraud and other frauds on the federal government. When an organization or individual knowingly takes more money from the government than the law allows or otherwise submits a false claim to the government, the FCA allows the government to recover triple damages plus an appropriate penalty. Examples of false claims include overcharging Medicare for medical treatment and supplying the military with goods that don’t meet contractual requirements. The Act has a special qui tam provision that allows individuals to act as whistleblowers and bring claims on the government’s behalf, a critical tool because fraud is difficult to uncover without help. Although the law provides whistleblowers with a substantial reward for their time and effort if their case leads to a recovery via either a settlement or judgment, most whistleblowers are motivated by a desire to do the right thing and our government fraud law firm is proud to help them.

Recently, we’ve looked back on the success of the FCA in 2015. Today, we look ahead at what 2016 may hold in the health care fraud arena, the sector responsible for the largest share of FCA recoveries in 2015. Becker’s Hospital Review, a leading journal for the health care industry, identifies the following five trends expected to fuel FCA recoveries in the coming year[1]:

Extrapolation – Extrapolation involves examining a sample of payment claims and applying the information learned to all similar claims filed by the same organization. This is a useful shortcut in cases alleging large-scale fraud. Defendants have contested (and will likely to continue to fight) the use of extrapolation claiming it unfairly lowers the government’s burden of proof, but courts have largely ruled in the government’s favor.

January 4, 2016

A Closer Look: Health Care Fraud Recoveries in 2015

by Gregory J. Brod

In Fiscal Year 2015, the government, often with the assistance of private whistleblowers, recovered more than $3.5 billion using the False Claims Act to target companies and individuals who attempted to commit fraud and steal money from federal government programs. We took a broad look at these recoveries a couple of weeks back, today we take a narrower focus: health care fraud. We believe that looking at these cases can help people understand what sort of actions violate the FCA and encourage them to contact our whistleblowers’ law firm. As the 2015 numbers show, the FCA works and individuals can play a major role in the fight against fraud targeting Medicare, Medicaid, and other vital government health care programs.

$1.9 Billion Recovered in Health Care Fraud False Claims Act Cases in 2015

According to the Department of Justice’s press release announcing the successes under the FCA in FY2015, $1.9 billion of the $3.5 billion recovered on behalf of the federal government last year came from the health care industry. This makes the total health care fraud dollars recovered via the FCA since January 2009 nearly $16.5 billion. Importantly, these numbers are limited to federal dollars returned to federal programs. Quite often, health care fraud prosecutions include additional charges involving state programs and can include recoveries on behalf of these programs as well, especially when cases involve Medicaid which is a joint federal/state venture.

December 28, 2015

Looking at the State Side of Government Fraud Claims: Washington Examines its Medicaid Fraud False Claims Act

by Gregory J. Brod

Last week, we looked at the recoveries made on behalf of the federal government using the False Claims Act (“FCA”) in 2015. While informative, those numbers don’t tell the whole story. Many states have their own versions of the FCA. These statutes are particularly important in the Medicaid fraud arena since Medicaid is a state and federal partnership so fraud typically involves both federal and state funds. Today, our government fraud law firm looks at one such statute, Washington’s Medicaid Fraud False Claims Act (“WFCA”). Each state’s laws are unique, but this review can help readers understand the importance of state claims in this arena.

Washington’s Legislative Auditor Reviews the State False Claims Act, Recommends Reauthorization

In 2015, with the WFCA set to expire on June 30, 2016, the healthcash state’s Legislative Auditor undertook to study the statute, its results, and recommend or counsel against reauthorization. As the resulting report (Proposed Final Report issued 12/16/15) explains, government can investigate possible Medicaid fraud via federal (civil and/or criminal) investigations, state criminal investigations, and state civil investigations. Absent reauthorization, Washington would lose the authority for the final category. Additionally, if the federal government is investigating a case that also involved fraud on Washington state, the state can only participate in the case and any recovery if it has a state FCA that (like the WFCA) meets certain standards set forth in the federal law.

December 21, 2015

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

by Gregory J. Brod

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 23, 2015

As the Holidays Approach, Defense Contractor Settles Suit Alleging It Overcharged for Produce

by Gregory J. Brod

As we prepare for our upcoming holiday feasts, our thoughts go out to those who are serving our country and are unable to be with their families for the holidays. We give thanks to them and to their families and hope they all get to enjoy a special meal wherever they may be. In an ironic twist, one of the latest settlements in the government contracts fraud arena involves a company that agreed to supply produce to our servicepersons. The allegations are yet another reminder of the very real impact of government fraud, which takes money from taxpayer-funded coffers and, in the case of defense contract fraud, depletes funds needed for our nation’s defense and the protection of those who serve. We believe those who blow the whistle on government fraud are, like the men and women in the military, true Americans and our defense contract fraud law firm is proud to help.

DOJ Alleges California Company Overcharged for Produce, Violated Defense Contract, and Obstructed Investigation

Earlier this month, the Department of Justice (“DOJ”) announced that Coast Produce Company (“Coast”), a California company, agreed to pay $4 million to resolve contract fraud allegations. The settlement applies to both civil and criminal lawsuits alleging False Claims Act (“FCA”) violations and claims Coast obstructed a federal investigation. Coast also agreed to institute measures to ensure future compliance. It is important to note that Coast did not admit wrongdoing and the claims in the various suits remain allegations only.

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).”