False Claims Act/Qui Tam

This blog is about qui tam, a  lawsuit brought under the False Claims Act by a private plaintiff on behalf of the Federal or State Government (rather than by the Government itself). The False Claims Act was originally enacted by Congress in 1863, as a response to widespread abuses by government contractors against the Union Army during the Civil War. The qui tam provisions are now used widely and this blog is intended to keep readers up to date with all qui tam related news and to provide commentary when warranted.  This blog also contains an array of laws and regulations concerning qui tam set out in an easy to read format.

New Poll: Nearly Two Thirds of Business Professionals Expect Uptick in Recovered Government Funds

by Nolan and Auerbach on January 27, 2010

Sixty-four percent of business professionals polled during a recent Deloitte webcast think the Fraud Enforcement and Recovery Act will be effective in increasing the total dollar amount the government will recover under the False Claims Act, according to a Jan. 27 Deloitte press release.

Respondents indicated their greatest concerns under the Fraud Enforcement and Recovery Act’s enforcement changes are: an expanded universe of companies potentially liable for FCA violations (24 percent); increased consequences of failing to return overpayments to the government (13 percent); extended whistleblower protections to non-employees (12 percent); and revived government ability to use Civil Investigative Demands (11 percent).

Approximately two-thirds (66 percent) of respondents were unaware that private qui tam plaintiffs — or whistleblowers — can bring suits under the FCA on behalf of the U.S. government against companies misusing government funds and keep a share of recovered funds.

Respondents expect that the financial services (44 percent) and health care and life sciences (23 percent) industries will see the highest increase in litigation resulting from increased Fraud Enforcement and Recovery Act, as well as FCA enforcement activity.

More than 800 business professionals from the banking and securities, consumer and industrial products, energy, resources and power, financial services, health care and life sciences, public sector technology, media and telecommunications and manufacturing industries responded to the online polling questions during an October 2009 Deloitte webcast.

For the full release, go to: http://www.prnewswire.com/news-releases/deloitte-poll-nearly-two-thirds-of-business-professionals-expect-uptick-in-recovered-government-funds-82784237.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. at http://www.whistleblowerfirm.com/.

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Government intervenes in Allison Engine Case to help appeal District Court Ruling

by Nolan and Auerbach on January 12, 2010

The Department of Justice (DOJ) intervened in Allison Engine Co. v. United States ex rel Sanders , a qui tam case pending in the U.S. District Court for the Southern District of Ohio, and which had already made one trip up to the U.S. Supreme Court. .”( In 2008, the Supreme Court agreed that there was no “presentment” requirement in Section 3729(a)(2), but held that a Defendant must be shown to have made a false statement or record for the purpose of getting a false claim paid or approved by the Government. Allison Engine Co. v. United States ex rel Sanders, 128 S.Ct. 2123 (2008).

One of the issues in the case is a key retroactivity provision of the False Claims Act, as amended by the Fraud Enforcement and Recovery Act of 2009 (FERA) (signed into law May 20, 2009). In an opinion issued in October 2009, the District Court essentially held that because FERA’s amendments in Section 3729(a) create liability for conduct that was not previously actionable, they are unconstitutional on grounds they violate the Ex Post Facto clause. The Court also found that the wording of the retroactivity provision was directed to “claims” pending as of the retroactivity date, not “cases,” so that provision did not apply to the claims at issue in Allison, which had been submitted 15 or more years earlier.

This action by DOJ was taken to support Relators’ “Motion To Certify . . . For Interlocutory Appeal” filed on the same date. Both motions argue that the District Court’s Order involves a controlling issue of law, that there are substantial grounds for differences of opinion regarding the Order and that an immediate appeal would materially advance the litigation. If the motions are granted, the Sixth Circuit Court of Appeals will be asked to decide both the constitutionality of the retroactivity provision of FERA and whether that provision applies to “claims” or “cases” that are pending on the retroactivity date, June 7, 2008. The case is important because unless DOJ and the Relator succeed in overturning the District Court, an important False Claims Act (”FCA”) provision as amended by FERA will not apply retroactively and its application will be construed in a manner very limited to plaintiff’s. It is likely that if the Sixth Circuit hears the appeal, that it will at least hold that the retroactivity provision was directed to “cases” not claims.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

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New York City Home Health Agencies Pay $24 Million to Settle False Claims Act Claims

by Nolan and Auerbach on December 17, 2009

The United States Department of Justice announced December 17, 2009 that the U.S. and state of New York have entered into settlement agreements with three home health agencies to resolve allegations that they submitted false claims to the New York Medicaid and Medicare programs.

The U.S. contends that Nursing Personnel Home Care knowingly supplied aides with phony training certificates to Extended Home Care and Excellent Home Care, which then billed New York Medicaid for the aides’ services. Allegedly, Extended Home Care and Excellent Home Care knowingly billed for aides with phony certificates who were untrained, and Extended Home Care and Excellent Home Care knowingly submitted claims to the Medicare program for home health aide services purportedly rendered by aides supplied by Nursing Personnel Home Care that were not actually provided.

The U.S. is receiving about $9.7 million as a result of the settlement with these three companies, and the state of New York is receiving about $14.3 million, for a total recovery of $24 million.

The allegations resolved by these settlements were initiated by two lawsuits filed under the whistleblower provisions of the False Claims Act.

For the full press release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1362.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. 

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Supreme Court Hears Argument to Decide Whether Fraud Allegations in State Reports are Public Disclosures

by admin on December 2, 2009

On November 30, the US Supreme Court heard oral argument in Graham County Soil & Water Conservation District v. United States ex rel. Wilson, No. 08-304 (“Graham County II”), concerning the “public disclosure” provision in Section 3730(e)(4)(A) of the False Claims Act. The public disclosure provision and the “original source” provision of the False Claims Act is intended to define the statutory bar against copycat whistleblowers who merely repeat what they have read or heard in public arenas, without having first-hand information of such information. The issue in Graham County was whether fraud publicly disclosed in a state(as opposed to a federal) administrative investigation or audit report are “publicly disclosed” for purposes of the FCA. Counsel for the Relator and for the the Government (from the Solicitor General’s Office) urged the Court to restrict the term “administrative to federal sources because of a “likelihood” that Congress believed that federal authorities would focus upon strictly federal sources. At oral argument, it seemed that the Justices were of the opinion that the statutory language was far from clear, and that the legislative history on the specific phrase is non-existent. Therefore it may be that the issue will be decided upon policy grounds taking into account the purposes of the False Claims Act as intended by its drafters.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA .

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Justice Department Recovers $2.4 Billion in False Claims Act Cases in 2009

by Nolan and Auerbach on November 20, 2009

Qui Tam is the Government’s best weapon to fight fraud!

The United States secured $2.4 billion in settlements and judgments in cases involving fraud against the government in the fiscal year ending Sept. 30, 2009, the Justice Department announced November 19, 2009. This represents the second largest annual recovery of civil fraud claims in history, and brings total recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, to more than $24 billion.

Of the $2.4 billion in settlements and judgments obtained in fiscal year 2009, nearly $2 billion was recovered in lawsuits filed under the False Claims Act’s qui tam provisions.

For the full press release, go to: http://www.prnewswire.com/news-releases/justice-department-recovers-24-billion-in-false-claims-cases-in-fiscal-year-2009-more-than-24-billion-since-1986-70521362.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

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Iowa Hospital to Pay U.S. $4.5 Million to Resolve False Claims Act Allegations

by Nolan and Auerbach on August 31, 2009

Covenant Medical Center in Waterloo, Iowa has agreed to pay the United States $4.5 million to resolve allegations that it violated the False Claims Act, the Department of Justice announced today.

This settlement resolves allegations that Covenant submitted false claims to Medicare by having financial relationships with five physicians that violated the Stark Law. The United States alleged that Covenant violated the Stark Law by paying commercially unreasonable compensation, far above fair market value, to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest paid hospital-employed physicians not just in Iowa, but in the entire United States, according to the DOJ.

For the full press release, go to: http://www.usdoj.gov/opa/pr/2009/August/09-civ-849.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA .

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House Approves Anti-fraud Legislation

by Nolan and Auerbach on May 21, 2009

U.S. Senator Chuck Grassley (R-Iowa) announced in a May 18, 2009 press release that The Fraud Enforcement and Recovery Act, introduced by Senators Patrick Leahy (D-Vt.), Grassley and Ted Kaufman (D-Del), had cleared Congress that day with an approval by the House of Representatives.

The senate unanimously passed the amended bipartisan legislation, according to the release, and the bill is now headed to the President’s desk to be signed into law.

To see the press release, go to iowapolitics.com

For more information about Qui Tam law and Health Care Fraud, contact Nolan and Auerbach, PA.

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President Announces Support for Important False Claims Act Amendments

by Nolan and Auerbach on April 22, 2009

The Obama Administration strongly supports enactment of S. 386 (the Fraud Enforcement and Recovery Act of 2009), according to a statement released April 20, 2009, by the Executive Office of the President. The White House’s recent endorsement of this legislation which, among other things, restores the original power of the False Claims Act, comes with broad support from law enforcement and the Department of Justice, according to an April 22 press release by Senator Patrick Leahy (D-Vt.), who introduced the Fraud Enforcement and Recovery Act (with Senators Chuck Grassley (R-Iowa) and Ted Kaufman (D-Del.) on February 5.

To read the press release and the senator’s statement, go to http://leahy.senate.gov/press/200904/042209a.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

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The Time is Now for Fraud Enforcement and Recovery Act, Grassley says

by Nolan and Auerbach on April 21, 2009

As he debates on the senate floor on a bill that he cosponsored, the Fraud Enforcement and Recovery Act, Senator Chuck Grassley of Iowa released a statement reminding Americans that these fragile economic times are ideal for passing a bill aimed at empowering whistleblowers to help recover and stop health care and other types of fraud. The legislation, addressing among other things weaknesses in the False Claims Act (FCA), is necessary to encourage individuals in qui-tam type lawsuits to pursue cases that the Justice Department might or might not pursue.

Grassley says in his April 20, 2009, statement that special interests are surfacing, who don’t want to encourage whistleblowers to report wrongdoing and are looking to squelch the bill.

The point: We can’t keep spending, as a nation, without taking steps to combat fraud and abuse. The Fraud Enforcement and Recovery Act not only ensures that law enforcement officials and prosecutors have the tools and resources necessary to enforce our laws, but it also amends the civil False Claims Act to ensure that taxpayer money lost to fraud, waste or abuse can be recovered.

The legislation, most importantly, will ensure that the law adheres to the FCA’s original intent.

“Specifically, these amendments address a loophole that was created in the FCA by the Supreme Court decision in Allison Engine which could be used by fraudfeasors to evade liability by hiring subcontractors to perform work on government contracts.  Some defendants are already filing briefs in court seeking to have FCA cases dismissed based upon this decision, and it needs to be addressed to protect taxpayer dollars,” Grassley writes.

“We need to act now to stomp out new claims of fraud to send a message that the American taxpayers won’t be taken for a ride.”

To read the entire statement, go to: http://grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=20209.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA .

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Watchdog Groups Call on President to Support Stronger Whistleblower Protections

by Nolan and Auerbach on April 3, 2009

Our nation’s watchdog organizations, including the American Civil Liberties Union, American Federation of Government Employees, National Whistleblower Center and Project on Government Oversight, sent a letter to President Obama on April 1, 2009 urging that the government fulfill his campaign and transition policy commitments to strengthen whistleblower rights.

In the letter, the coalition asks the president to strongly endorse legislation that would protect from retaliation of federal employees who expose waste, fraud, abuse, suppression of federal research, and threats to public health and safety, and give them access to jury trials. The legislation would also direct federal government agency heads to institute “no-retaliation” policies for employees.

The groups are concerned that a signing statement issued by the president on March 11, attached to H.R. 1105, the omnibus spending bill, contradicts those earlier steps and could have a chilling affect on lawful whistleblowing disclosures, according to a press release about the letter on Project on Government Oversight’s website.

To read the letter, click here. For a copy of the POGO press release, go to http://www.pogo.org/pogo-files/alerts/whistleblower-issues/wi-wp-20090401.html.

For more information about qui tam law, whisleblowers and health care fraud, contact Nolan and Auerbach, PA.

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Whistleblower Exposes What Could be Massive Medi-Cal Fraud Scheme

by Nolan and Auerbach on March 21, 2009

The State of California has joined a qui tam action against seven private laboratories to recover hundreds of millions of dollars in false claims submitted to the state’s Medi-Cal program for the poor, according to a March 20 press release by the California Office of Attorney General.

The lawsuit contends that the medical labs systematically overcharged the Medi-Cal program during the past 15 years. The defendants, including Quest Diagnostics and Laboratory Corporation of America, allegedly engaged in illegal kickbacks and overcharging the state by up to 400% for blood, urine and other lab tests. It is estimated that damages could amount to hundreds of millions of dollars.

Filed under California’s False Claims Act, the qui tam lawsuit asks for relief in the amount of triple the amount of California’s damages, civil penalties of $10,000 for each false claim; and recovery of costs, attorneys’ fees and expenses.

This is one of the largest, if not the largest, single state qui tam intervention against multiple laboratories, in history.

To read the full press release, go to: http://ag.ca.gov/newsalerts/release.php?id=1705&. For more about qui tam law and Healthcare Fraud, contact Nolan and Auerbach, PA.

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SEC Ponders Cash Rewards for Whistleblowers

by Nolan and Auerbach on March 12, 2009

As Bernard Madoff was planning his guilty plea in a history-making fraud case, Securities and Exchange Commission Chairman Mary. L. Schapiro announced that the SEC is considering offering cash rewards to whistleblowers who expose financial wrongdoing, according to a March 12, 2009 Washington Times article. The practice of offering cash bounties to securities fraud whistleblowers would be similar to financial rewards given to people who help to expose insider-trading. Having this power, Schapiro said in the article, would enable the SEC to pursue cases more aggressively.

For the full article, go to: http://washingtontimes.com/news/2009/mar/12/sec-considers-cash-bounties-to-whistleblowers/.

For more about qui tam whistleblower law, contact Nolan and Auerbach, PA.

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Weill Medical College of Cornell University to Pay in Excess of $2.6 Millon to Settle Fraud Connected to Research Funding

by Nolan and Auerbach on March 9, 2009

Weill Medical College of Cornell University has agreed to pay $2,606,751 to resolve civil charges that the New York City-based college defrauded the government in connection with federal research funds awarded under grants made by the National Institutes of Health (NIH).

A whistleblower, who filed a qui tam complaint under the False Claims Act, first brought the case to government’s attention.

Weill Medical College made false statements to the NIH and the Department of Defense (DOD) in connection with the school’s federal grant applications. In particular, the principal research investigator who sought funding for the grants failed to disclose to the government the full extent of her various active research projects, according to a March 6, 2009 press release by the U.S. Attorney Southern District of New York.

For the complete release, go to http://www.usdoj.gov/usao/nys/pressreleases/March09/weillmedicalcollegesettlementpr.pdf.  For more information about the False Claims Act, contact Nolan and Auerbach, PA .

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U.S. Intervenes in Whistleblower Suit against Community Health Systems and New Mexico Hospitals

by Nolan and Auerbach on March 8, 2009

The United States is intervening in a whistleblower suit that alleges that Community Health Systems Inc. (CHS) and three of its hospitals in New Mexico violated the False Claims Act (FCA) by presenting the government with false claims for federal matching Medicaid funds.

According to the U.S. Department of Justice, which made this announcement March 6, 2009, the suit was filed under the qui tam or whistleblower provisions of the FCA by Robert Baker, a former revenue manager in CHS’s corporate office.

The relator’s complaint alleges that, beginning in 2000, CHS and its hospitals improperly obtained federal funds through the New Mexico Sole Community Provider Fund (SCPF) and Sole Community Hospital Supplemental Payments (SCHSP) Medicaid programs.

To review the DOH press release, go to http://www.usdoj.gov/opa/pr/2009/March/09-civ-200.html. Or, for more information about the False Claims Act or qui tam whistleblower law, contact Nolan and Auerbach, PA.

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2009 FCA Amendment Aims to Increase Government Accountability and Whistleblower Protection

by Nolan and Auerbach on March 5, 2009

The fate of a bill amending the False Claims Act (FCA) is in Senate hands. The False Claims Clarification Act of 2009, introduced by Sen. Chuck Grassley (R-Iowa) (S. 458), could fuel government’s ability to recover taxpayers’ dollars lost to fraud and abuse by increasing government accountability and extending whistleblower protection. Under the new legislation, the attorney general would be required to submit an annual report to Congress about settlements made under the FCA. This would help determine if the Department of Justice is using the act as it is intended and ensure that qui tam relators are protected from the court’s potential abuse of provisions to seal a case.

To review the legislation, go to http://thomas.loc.gov/cgi-bin/query/z?c111:S.458: Or, for more information about qui tam whistleblower law, contact Nolan and Auerbach, PA.

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Dallas Hospital Reaches Settlement With the Government for Stark Violations

by Nolan and Auerbach on January 2, 2008

According to the U.S. Attorney Richard B. Roper of the Northern District of Texas, Harris Methodist HEB Hospital, a 284 bed acute-care facility, will pay $1.9 million to settle allegations that it violated the False Claims Act by improperly submitting claims for payment for orthopedic-related items and services.  These claims were identified as having taken place between March 15, 2004 and September 1, 2005.

According to the hospital in its own news release, the parent company of Harris Methodist HEB Hospital (Texas Health Resources) did a self report by telling the Office of Inspector General of Health and Human Services about it identification of a physician contract that did not comply with federal regulations. This triggered an investigation based on information provided by Harris Methodist HEB that Medicare and Texas Medicaid programs paid for orthopedic items and services referred to the hospital by a physician group that received free rent from the hospital, a violation of Stark self-referral law (also known as Physician Self-Referral Law).

The Stark law was created to forbid physicians from profiting from their own referrals.  This law acts to sanction improper physician referrals and to stop the potential for over-utilization. In this fashion, physicians and other health care professionals are able to exercise independent judgment for what is in the best interests of their patients as opposed to themselves.

To read the full story click here or on the following to read more about the False Claims Act and the Stark Laws .

If you believe you have information concerning a violation of the False Claims Act and want to read more about Nolan & Auerbach, P.A. you may contact us.

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Hospitals Are Giving Lessons on Blowing the Whistle on Fraud

by Nolan and Auerbach on December 27, 2007

A federal law that takes effect in January 2007 requires the country’s hospitals and nursing homes to educate their employees and officers on how to detect and report fraud. This requirement applies to companies that earn at least $5 million a year in Medicaid business. Under the False Claims Act, whistleblowers have received millions of dollars for disclosing large-scale fraud.

To read more, click here.

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U.S. Joins Suit Against Renal Care Group Alleging False Billings to Medicare for Home Care Renal Dialysis

by Nolan and Auerbach on August 28, 2007

Last month, the United States intervened in a qui tam lawsuit accusing Renal Care Group Inc. (RCG) and Renal Care Group Supply Company (RCGSC) of fraudulently billing Medicare. The suit alleges that RCG and RCGSC fraudulently billed for supplies and equipment provided to End Stage Renal Disease (ESRD) patients who received dialysis treatments at home. Both companies are owned by Fresenius Medical Care Holdings Inc. which was also named in the lawsuit.

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Feds Sue Nursing Home Company

by Nolan and Auerbach on June 25, 2007

Cathedral Rock Corporation of Ft. Worth, Texas, which operates five nursing homes in St. Louis, Missouri has to now defend itself against a medicaid fraud lawsuit brought by federal authorities for violations of the False Claims Act.  The lawsuit was brought by two whistleblower nurses who complained that patients were being neglected and that the facilities provided “worthless” health care.

To read more on this story click here.

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Medicis Pharmaceutical Pays $9.8 Million to Settle False Claims Accusations

by Nolan and Auerbach on May 17, 2007

Medicis Pharmaceutical, located in Scottsdale, Arizona, is paying $9.8 million to settle False Claims Act allegations.  This case was brought by four former Medicis sales representatives. The allegations centered around Loprox, a topical skin preparation.  Loprox, while approved by the FDA as a fungicide for patients over 10 years of age, was off-label marketed for the treatment of diaper rash.  This marketing or promoting for unapproved uses by Medicis Pharmaceutical is prohibited.

To read more about this case, click here or  to read more on filing qui tam actions go to Nolan & Auerbach.

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