Articles Tagged with California False Claims Act lawyer

rawpixel-760036-unsplash-300x289Under the False Claims Act, an individual or agency can be held liable if they knowingly submit a false claim to the government, or cause the submission of a false claim. When individuals see these wrongdoings and false claims being made, they can pursue a whistleblower lawsuit to correct the wrong. Like any lawsuit though, they will need to provide certain proof before a lawsuit can proceed. The two elements of proof in these lawsuits are that the claim must have been made knowingly, and it must have been false or fraudulent. 

Knowingly Making a False Claim

Defendants cannot only be held liable for submitting a false claim, they can also be held liable if they intended to submit one, even if they never did. However, the false claim must be made by a person with full intention of defrauding the government. Simple negligence or innocent errors are not enough to hold a person liable for the fraudulent act. 

samson-duborg-rankin-91091-unsplash-copy-300x200Many people are familiar with whistleblower lawsuits (often called qui tam actions) brought under the federal False Claims Act (31 USC §3729 et seq.) but many states have their own version of the law, as well. California has its own version and was one of the first states to promulgate a state false claims act.

California’s False Claims Act

The California False Claims Act (CFCA) was first enacted in 1987. Like its federal counterpart, it was put into place to encourage the public to help control fraud against the government. It does this by rewarding whistleblowers for coming forward and helping prosecute actions against companies or individuals who are defrauding the government by sharing any recovery with the complaining individual (who is called a relator). The two laws are quite similar, although there are important differences between them.

jonathan-perez-409943-copy-300x200A doctor was arrested on December 13, 2018 for improperly distributing opioids to his patients and billing Medicare for the drugs. The doctor now faces 45 federal charges relating to healthcare fraud for not only prescribing illicit drugs to patients but requiring those with insurance to accept injections so that he could bill additional costs to public health programs like Medicare. While this is an extreme example of pharmaceutical fraud, there are numerous smaller incidents of pharmaceutical fraud that take place every day. If you believe your employer or healthcare provider is engaging in pharmaceutical fraud or any type of healthcare fraud, contact the qui tam attorneys at Willoughby Brod immediately to report the fraud.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the False Claims Act (FCA) or California False Claims Act (CFCA) and result in false claims to insurers and Medicare/Medicaid.

benjamin-child-90768-300x200The majority of U.S. states have their own version of the federal False Claims Act (FCA), and California is no exception. Anyone who engages in fraudulent activity in California may be subject to punishment under the California False Claims Act (CFCA). While the FCA and CFCA have many similarities, they have a few differences, as well, which are outlined below. If you believe your employer or another corporation is engaging in fraudulent acts, contact the whistleblower lawyers at Willoughby Brod today to learn about your options for reporting the fraud and how we can help.

Similarities Between the FCA and the CFCA

The FCA and CFCA have many similar provisions, including the following key provisions:

ken-treloar-385255-copy-300x200The False Claims Act (FCA), which prohibits entities that conduct business with the government from defrauding the government, goes all the way back to the time of the Civil War. It is sometimes called the Lincoln Law because of the president who was in office when the law went into effect.

Since the advent of Medicare and Medicaid, physicians and hospitals fraudulently obtaining payments from publicly funded healthcare programs have been defendants in many FCA lawsuits. Often the violation is not as simple as doctors submitting claims to Medicare for services they did not perform, although such fraudulent claims certainly do constitute FCA violations. Likewise, some FCA violations occur when doctors perform unnecessary procedures (for example, performing a surgery when the patient’s condition could be adequately managed with medication) just to be able to bill Medicare for them. It can even be an FCA violation if a doctor benefits financially from referring a Medicare or Medicaid patient for other services. If you are a healthcare worker and have evidence that your workplace has intentionally benefited financially from referrals made at the expense of Medicare or Medicaid, filing a qui tam lawsuit could offer you legal and financial protection while also protecting patients and taxpayers from fraud.

The Stark Law

hush-naidoo-382152-copy-300x200The federal government’s False Claims Act (FCA) case against United Health Group (UHG) continues after major developments. In the case of U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., The U.S. District Court in the Central District of California dismissed half of the claims brought through the initial qui tam suit and the government’s revised complaint. A short time later, the Department of Justice (DOJ) decided to not continue with a part of the suit and to focus on the remaining claims.

The District Court’s Decision

In February 2018, the district court analyzed the government’s amended complaint based on the FCA’s materiality requirement. Based on the Supreme Court’s decision in Universal Health Servs. Inc. v. United States ex rel. Escobar, the government must plead that their allegations are material to the government’s payment decision. They must demonstrate that, if the facts are true, the unlawful conduct influenced how much the government paid the other party.

andres-de-armas-103880-copy-300x200On July 24, the U.S. Attorney’s Office for the Central District of California announced that Celgene Corp., a pharmaceutical manufacturer headquartered in New Jersey, will pay $280 million to numerous states and the federal government to settle claims that it submitted false claims to the federal government and state health programs. From the settlement, $259.3 million will go to the federal government, $20.7 million will be divided among 28 states and the District of Columbia. California is set to receive more than any other state at $4.7 million.

U.S. ex rel. Brown v. Celgene Corp.

The settlement is the result of a whistleblower lawsuit filed by Beverly Brown under the qui tam provision of the False Claims Act. Brown, who was a sales manager at Celgene, brought a lawsuit on behalf of the federal and state governments. She provided evidence that Celgene promoted two cancer drugs, Thalomid and Revlimid, for uses that were not approved by the U.S. Food and Drug Administration and therefore not covered by federal healthcare programs.

Last week, we wrote about the upcoming Supreme Court case that will decide if the implied certification theory is a valid interpretation of the Federal False Claims Act (“FCA”).  It is a decision that could substantially empower government fraud whistleblowers.  However, it is worth remembering that the federal false claims act is only relevant to cases involving alleged fraud on the federal government, including Medicare fraud.  State false claims acts, which in many cases are relatively similar to their federal counterpart, are a key tool for fighting fraud on the state government including state-level government contract fraud and Medicaid fraud (a joint state/federal program).  Our government fraud law firm supports whistleblowers nationwide, including in our home state of California.  The case law specifically supports implied certification under the California False Claims Act (“CFCA”) and we believe other states may accept the theory as well.

Courts Hold Implied Certification Theory Valid Under California False Claims Act

lawbooksIn San Francisco Unified School Dist. ex rel. Contreras v. Laidlaw Transit Inc., 182 Cal. App. 4th 438 (Cal. App. 1st Dist. 2010) and again in a 2014 decision, the Court of Appeals for the State of California considered a suit brought by a group of whistleblowers on behalf of the San Francisco Unified School District (“District”) under the CFCA.  The Plaintiffs alleged that the Defendant submitted payment claims to the District despite knowing it was in breach of assorted contract terms relating to student transportation services.  These violations allegedly rendered the Defendant’s buses unsafe and unhealthy.  The Plaintiffs also alleged that the Defendants knowingly falsified records and/or statements.