Articles Tagged with California False Claims Act lawyer

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.