Whistleblowers and Qui Tam Lawsuits

August 10, 2015

Major Ruling on Medicaid Overpayments is a Victory in the Fight Against Health Care Fraud

gavel2 A decision handed down by a federal court in New York last week further evidences the government’s commitment to fighting health care fraud. The court finds the clock begins to run on the duty to return Medicaid and Medicare overpayments (also known as reverse false claims) when the provider is put on notice that an overpayment likely occurred, rejecting the defendants’ position that the period only begins when an overpayment is conclusively proven. Our health care fraud whistleblowers’ law firm applauds the decision fight back against health care fraud.

Understanding Motions to Dismiss

Before turning to the substance of the ruling, it is worth taking a brief look at legal procedure. When a complaint is filed, the defendant typically responds with an answer, a paragraph-by-paragraph response. If the defense believes the claim is entirely without legal merit, they may file a motion to dismiss instead. One basis is Federal Rule of Civil Procedure 12(b)(6) whereby the defendant asserts the complaint should be dismissed for “failure to state a claim upon which relief can be granted.” In essence, the defendant asserts that even if everything the plaintiff alleges is true, there is no actionable violation of law.

August 3, 2015

Spotlight on Government Contracting Fraud: False Data Fuels Fraud in Program Providing Work Opportunities for the Disabled

by Gregory J. Brod

This week, CNN reported on rampant abuse in the federally-funded programs that help provide job opportunities for the severely disabled. Sadly, the current investigations are just the latest chapter in a series of problems with fraud and abuse in this area. If the allegations are true, this is yet another example of scammers taking taxpayer money and using it to line their own pockets rather than to support the noble cause for which it was marked. Fraud in AbilityOne and other government programs is a serious issue and our government contract fraud law firm works with honest whistleblowers to root out these frauds and return funds to these important initiatives.

DoJ Joins Other Agencies Investigating Work Program for the Disabled

CNN reported last week that the Department of Justice (“DoJ”) has joined several other government offices investigating allegations of fraud involving AbilityOne, the leading federally-funded program helping the blind and severely disabled find work, and SourceAmerica, the nonprofit agency that manages the program. AbilityOne uses some $3 billion of taxpayer money annually to fund contracts nationwide. In order to hold an AbilityOne contract, blind and/or seriously disabled individuals unable to hold another job must perform 75% or more of the company’s work.

July 27, 2015

Medi-Cal Fraud Targeting Drug Rehab Clinics

by Gregory J. Brod

As a health care fraud law firm, we work with private whistleblowers nationwide to protect taxpayer money and ensure the health of millions of Americans. Often, scammers who defraud the federal system also target state health care programs. We work to fight this type of fraud too, recognizing that these systems are also vital to the health and well-being of countless individuals. While we can handle health care fraud matters across the country, we have particularly strong ties to California and Florida. In today’s post, we look at a problem plaguing California – Medi-Cal fraud involving drug treatment clinics.

Director Apologizes for Medi-Cal Fraud

Last September, The Center for Investigative Reporting (“CIR”) reported on legislative hearings in which Toby Douglas, the director of Medi-Cal, apologized for systemic problems involving the failure to effectively monitor taxpayer-funded drug rehabilitation programs. In the course of those hearings, it became clear that the agency knew about widespread sham billing by “rogue clinics” as early as 2007. In 2014, the agency temporarily suspended 73 clinics and 101 other counseling sites, locations that had bilked Medi-Cal out of more than $36 million in the previous fiscal year alone. At the time of the report, there were at least 64 on-going fraud investigations looking into these scams.

July 20, 2015

Whistleblowers’ Law Firm Alert: For-Profit Schools Committing Federal Student Aid Fraud

by Gregory J. Brod

For-profit schools provide an education to many students who might otherwise be unable to attend post-secondary school. However, these schools have a dual mission: a commitment to educating students and a commitment to earning money for investors and shareholders. While many, perhaps most, are ethical and education-oriented, some for-profit schools misuse federal student aid funds perpetuating scams that hurt the government and students alike. Today, our false claims act law firm looks at federal student loan fraud and reminds readers of the importance of whistleblowers in all government fraud cases.

Education Affiliates Pays $13 Million to Resolve False Claims Allegations

On June 24, the U.S. Department of Justice (“DOJ”) announced that Education Affiliates (“EA”) agreed to pay $13 million to settle False Claims Act (“FCA”) claims against the for-profit institution. EA operates 50 campuses providing post-secondary training in a range of fields in five states. The suits were brought by five whistleblowers who will share approximately $1.8million under the FCA’s qui tam provisions. EA denies any wrongdoing.

July 13, 2015

Health Care Fraud Spotlight: Kickbacks and Other Fraud in Nursing Home Pharmacy Services

by Gregory J. Brod

Few things are more important that health. We all worry about it, especially when we think about our senior years. In addition to worrying about our physical and mental well-being, many of us are plagued by questions like “Will I be able to afford the health care that I need?” Medicare and Medicaid exist to ease these concerns, but they are struggling. As an experienced health care fraud law firm, we know that fraud is a big part of the problem. Nursing home fraud and other forms of Medicare/Medicaid fraud deplete already limited resources and impede the quality of care as (so-called) professionals place profit over people’s health. Scammers target lucrative arenas so it is no surprise that our firm is seeing repeated cases of Medicaid and Medicare fraud involving nursing home pharmacy providers.

Tentative Settlement in Case Alleging Pharmacy Accepted Kickbacks in Exchange for Promoting Drug

According to Modern Healthcare, Omnicare, the country’s largest provider of pharmacy services for long-term care facilities, reached a tentative agreement with the federal government to settle accusations it accepted millions of dollars in illegal kickbacks from Abbott Laboratories. According to the government, Abbott paid kickbacks in exchange for Omnicare promoting the drug Depakote as treatment for behavioral disturbances in dementia patients. The FDA has not approved Depakote for that purpose. Nonetheless, Omnicare purportedly promoted the off-label use and had its pharmacists review patient charts and recommend the drug to doctors. In return, Abbott allegedly paid kickbacks in a range of different disguises from “educational funding” and grants to tickets to sporting events and money used to fund corporate meetings.

July 6, 2015

A Startling Example of Health Care Fraud Involving False Cancer Diagnoses (and a Castle!)

by Gregory J. Brod

One of the reasons we write about health care fraud is to make people aware of the true cost of these schemes. These crimes are ultimately financial in nature, with scammers stealing billions (not a typo!) each year from government programs that are already operating on strained budgets. As if stealing money that is supposed to go towards ensuring the health of some of our nation’s most deserving (including military families and seniors) isn’t bad enough, these crimes also have a direct impact on individual beneficiaries. The broad, sometimes life-threatening impact of these crimes is why we urge private citizens to join the fight against health care fraud and why we are proud to serve as a law firm for health care fraud whistleblowers.

A Scheme Founded Upon False Cancer Diagnoses and Other Lies Told by a Michigan Doctor

A case from 2014 stands out as a particularly egregious example of how scammers put individuals at risk, ignoring the duties of the health care profession and risking people’s lives for profit. The FBI’s news article paints the picture:

June 29, 2015

Spotlight on Government Contracts Fraud: The Threat of Government Set-Aside Fraud

by Gregory J. Brod

It shouldn’t surprise us anymore, but it’s the type of fraud that surprises anyone who believes in supporting the American dream. We’ve seen it before and, sadly, we know we’ll see it again – people taking advantage of programs intended to help small businesses succeed, especially businesses run by our country’s veterans and/or historically disadvantaged groups. We take solace in the people we work with, those who step forward and say, “This isn’t right.” As a law firm for whistleblowers in defense contract fraud cases, we rely on honest individuals to help us fight government set-aside fraud and we are committed to protecting their interests, including ensuring they receive due compensation if their time, effort, and information leads to the recovery of government funds.

Four Charged With SBA Fraud

Last week, the Justice Department announced an indictment formally charging four individuals with defrauding Small Business Administration grant programs to obtain $24 million in unlawful profits. The SBA operates programs that help businesses owned and controlled by disabled veterans and socially or economically disadvantaged individuals compete for government contracts. In order to qualify, the business must be unconditionally owned and controlled by a qualified individual.

June 15, 2015

Focusing on the Victims: Medicare Fraud, Mental Health, and a Partial Hospitalization Program Scam

by Gregory J. Brod

Who are the victims of Medicare fraud? As a law firm specializing in health care fraud matters, we understand that question requires a multi-part answer. At the broadest level, Medicare fraud is theft and the target is a taxpayer-funded government program, meaning every U.S. taxpayer is a victim. Narrowing the focus a bit, Medicare fraud depletes an already strained budget and thus it jeopardizes the health and well-being of all Medicare beneficiaries. Medicare fraud also has more specific victims, individuals who are treated as mere pawns by the scammers. A recent case involving mental health benefit fraud in Texas brings these individual victims to the forefront of our minds.

Medicare and Mental Health

Medicare recognizes that true health involves both physical and mental well-being. In order to understand the Texas case, it is helpful to understand a bit about Medicare’s mental health coverage. Medicare Part B includes outpatient mental health services holdinghand for all program beneficiaries. This coverage includes an annual depression screening and necessary outpatient mental health treatment such psychotherapy and medication management. If a beneficiary requires inpatient mental health treatment, coverage is provided via Medicare Part A, the hospital insurance arm of the program.

May 29, 2015

New U.S. Supreme Court Ruling is a Mixed Bag for Whistleblowers

by Gregory J. Brod

When someone identifies an act of health care fraud, it is important that they speak up. However, under the False Claims Act (FCA) the ways in which they speak up are limited by Federal law. A recent Supreme Court ruling on qui tam lawsuits arising under the FCA will have broad implications for whistleblowers.

The Background

According to the LII Supreme Court Bulletin, Benjamin Carter first filed a qui tam suit against Kellogg Brown & Root Services, Inc. (KBR) in 2006. His lawsuit alleged that KBR had fraudulently billed the United States government for water purification services that were either performed improperly or not performed at all. The District Court dismissed the complaint based on the first-to-file rule which states that when a private person brings a qui tam lawsuit under the FCA, no person can bring a related action based on the same underlying facts. In this case, Mr. Carter’s complaint was dismissed because there was a pending case with similar claims that had been filed earlier. While Mr. Carter appealed, the pending case was dismissed. Mr. Carter filed a new lawsuit, which was also dismissed for the same reason – the pending case was now pending on appeal.

May 22, 2015

Medicare Fraud: Home Health Care Scams

by Gregory J. Brod

According to ABC News, the rate of Medicare fraud is on the rise. One of the areas in which Medicare fraud is growing is home health care fraud. It’s important to be aware of this type of fraud, as it makes up a significant portion of health care fraud and often takes advantage of some of the most vulnerable members of society.

Home health care fraud can include billing for medically unnecessary services or care that was not actually provided. Home health care companies may fraudulently obtain patients’ personal medical information –including their Medicare numbers -and falsify medical documents and records in order to send fraudulent bills to Medicare for costly home health care services.

Health care fraud whistleblowers play a critical role in ending the perpetration of Medicare fraud, including home health care fraud. To protect those individuals who are most at risk, it’s important for witnesses to report suspicions of health care fraud.