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

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

Consistency by a state with the Federal False Claims Act, is a requirement for a large federal incentive afforded to the state, when Medicaid dollars are successfully recovered in a Federal False Claims Act lawsuit. The federal incentive allows states to receive an additional 10% of the Medicaid recoveries if they allow whistleblower/qui tam lawsuits in their state False Claims Acts, as long as the state False Claims Acts afford the same rights to whistleblowers as the federal False Claims Act does.

In an April 28, 2010 press release , Grassley asked the Inspector General for the Department of Health and Human Services and the Attorney General to review existing state False Claims Acts, to make sure they are in compliance with recent changes to the federal False Claims Act; and to issue appropriate guidance for any state interested in the federal incentive.. In addition to the 14 states which have already qualified for this incentive (and are now subject to this review), six states applied for it but did not meet the requirements.

For the full press release, go to: http://www.iowapolitics.com/index.iml?Article=194624. For more information about qui tam law and health care fraud, contact Nolan & Auerbach, PA.

In April 1999, the Food & Drug Administration (FDA) determined that the unapproved drug Nitroglycerin SR lacked substantial evidence of effectiveness and published a notice proposing to withdraw approval of the product.  The qui tam lawsuit alleged that, after the FDA notice, Nitroglycerin SR no longer was legally eligible for reimbursement by government health care programs such as Medicaid.

The lawsuit alleged that  Eon submitted false quarterly reports to the government that misrepresented Nitroglycerin SR’s regulatory status as a Covered Outpatient Drug under the Medicaid program.

The settlement resolves allegations against Eon in a multi-defendant whistleblower action, which remains sealed in part.

For the full release, go to: http://www.justice.gov/opa/pr/2010/February/10-civ-171.html.

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

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/.

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.

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. 

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

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.

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 .

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.

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 .

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.

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 .

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.

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.

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.

To read more, click here.