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Articles Tagged with California qui tam law

benjamin-child-17946-copy-300x200Any time a person needs to file a lawsuit, it is natural to worry about going to court. Most people do not want to face the person they are accusing in court, and just the process of appearing in court often means the case will be quite lengthy, meaning the person bringing the lawsuit will have to deal with the matter for some time. All of these factors hold true in qui tam lawsuits, too. Fortunately, whether you are bringing a lawsuit under the federal False Claims Act or the California False Claims Act, there is a likelihood that the case will settle. Below are just a few of the most common reasons why that is.

Reduce Legal Fees

Going to court always means that there are going to be more legal fees. When attorneys must prepare for court, it involves much more of their time and many lawyers charge higher fees for going to court than for reaching a settlement. The companies accused of making false claims know this and they will often settle to reduce the amount of legal fees they will have to pay because they also have to pay the relator’s legal fees.

chris-greenhow-662446-unsplash-copy-300x225Plaintiffs in a qui tam lawsuit are known as relators. The majority of relators are employees who have noticed activity that defrauds the government and violates the federal False Claims Act and the California False Claims Act. Due to the fact that it is mainly employees who file qui tam lawsuits, others sometimes think that they have no right to file these claims. That is not true. Anyone who has observed wrongdoing and fraudulent activity that is not public information can file a qui tam lawsuit. When they do, there are a few things relators in qui tam lawsuits can expect. These facts are found below.

The Complaint is Filed

All qui tam cases begin with the whistleblower filing the complaint. Again, a whistleblower can be anyone who observes wrongdoing. Although it is not required, it is strongly advised that relators speak to a qui tam lawyer who can help with their claim. All lawsuits are complex, but whistleblower lawsuits are some of the most complicated. A lawyer can guide relators through the process and give them the best chance of success.

aidan-bartos-313782-copy-300x200Under the federal Anti-Kickback statute, doctors and other healthcare professionals are prohibited from knowingly or willfully paying, offering, soliciting, or accepting remuneration in exchange for patient referrals. Under the statute, it is also illegal to offer something of value or pay for payments of goods and services that healthcare professionals are reimbursed for by the federal government. 

The purpose of the law is to protect both patients and the federal government from fraud and abuse by involving money in healthcare decisions. The penalties for violating the Anti-Kickback statute are steep. Healthcare professionals can face up to ten years in federal prison, a fine of $100,000, or both. However, healthcare professionals are also protected by several ‘safe harbors’ under the law. These are provisions that give healthcare professionals immunity from the Anti-Kickback statute. Although there are several safe harbors, the most common are found below.

Investments Interests

glenn-carstens-peters-RLw-UC03Gwc-unsplash-copy-300x200Individuals who believe they have observed someone else defrauding the government often wonder if they have a valid claim. The answer to that is a difficult one, and no one can really determine if a claim is valid without fully analyzing the facts of the case. However, if you believe that you have witnessed someone at your work or elsewhere defrauding the government, below are a few guidelines you can follow to determine if you have a case. Of course, a San Francisco qui tam lawyer can always provide the best advice on whether you have a valid claim. 

Is it Just a Hunch?

Qui tam cases are typically more successful when the whistleblower has actually witnessed specific instances of wrongdoing. This is because whistleblowers need specific knowledge that a violation has occurred. That makes it easier to collect evidence, identify the wrongful act, and then pursue the claim. Simply having a hunch or a feeling that someone is doing something wrong usually is not enough to go on to pursue a case. 

hans-reniers-746177-unsplash-copy-300x200One common category of healthcare fraud schemes in the medical laboratory industry revolves around medically unnecessary testing. There are many different ways in which the medical laboratory industry fraudulently commits medically unnecessary testing, which are highlighted below. If you believe you have witnessed healthcare fraud involving medically unnecessary testing, contact the healthcare fraud attorneys at Willoughby Brod to learn more about what you should do next.

What is Medically Unnecessary Testing?

Medically unnecessary testing occurs when clinical laboratories order tests that are excessive, unnecessary, or inappropriate for a patient’s treatment. Not only can this be extremely costly, it can also be dangerous to a patient’s life.

aidan-bartos-313782-copy-300x200As a relator in a qui tam lawsuit, you are entitled to receive up to 50% of the recovered amount under the California False Claims Act (CFCA). With such a big range of recovery, however, you may be wondering just how much you are actually entitled to receive. The factors listed below, provided by the U.S. Department of Justice, help decide your overall recovery. To learn more about your chances of recovery in your particular case, contact the California qui tam attorneys at Willoughby Brod today.

Limits of Recovery

Depending on whether the government intervenes in your whistleblower suit, you may be entitled to receive different levels of compensation under the federal False Claims Act (FCA) and the CFCA. The limits are as follows:

When qui tam cases under the False Claims Act (FCA) are first filed, they are to remain under seal for 60 days. During this time, the case is secret. The defendant is not even served yet, so it likely does not know there is a suit filed against it unless there are quiet rumblings or leaks. During this 60-day period, the government is given an opportunity to investigate the allegations and decide whether to join the suit or not. Once the government makes its decision, the case is unsealed. In certain instances, this is when the defendant is served. However, in many cases, the seal is partially lifted and the defendant is served prior to the whistleblower case being made public.

The truth of the matter, though, is that a qui tam case is never under seal for just 60 days. The FCA, the government can ask for extensions of the seal period if they can show it is for good cause. This happens regularly and continuously to the point where many qui tam cases remain confidential for years.

How Long Do Qui Tam Cases Remain Under Seal?

david-everett-strickler-196946-copy-300x195On July 13, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the Department of Justice’s largest ever health care fraud enforcement action. The work of the Medicare Fraud Strike Force, established in 2007, led to 412 defendants being charged with health care fraud offenses based on information they all participated in fraudulent schemes to obtain about $1.3 billion in false billings to Medicare, Medicaid, and TRICARE. Additionally, HHS has begun the suspension process against 295 health care providers’ licenses.

Hundreds of Individuals Charged With Health Care Fraud

Of the 412 defendants, 115 are physicians, nurses, and other licensed medical professionals. Many of these defendants were charged with federal crimes for prescribing medically unnecessary drugs and compound medications, many of which were not actually distributed to the patients or purchased. Providers could then bill for these unnecessary or unpurchased medications and receive a greater amount of reimbursements from state and federal health services.

jimi-filipovski-189724-copy-300x176There are currently two False Claims Act (FCA) qui tam cases against United Health Group (UHG) pending in the Central District of California. The cases are: U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc. and U.S. ex rel. Swoben v. Secure Horizons, et al. The cases were brought by James Swoben, who was previously an employee of Senior Care Action Network Health Plan and a consultant within the risk adjustment industry, and Benjamin Poehling, who was the former finance director of a UHG group that managed the insurer’s Medicare Advantage Plans.

The Qui Tam Cases Against UHG

On May 2, the U.S. intervened in the Swoben False Claims Act suit against UHG based on the allegations the insurer overcharged Medicare Advantage and prescription drug programs. In the DOJ’s complaint, it alleges the insurer knowingly ignored patients’ medical conditions to increase payments it received from Medicare and funded chart reviews to increase the risk adjustment payments it reviewed. However, any information the reviews uncovered regarding misdiagnoses were disregarded to avoid repaying Medicare.

 jimi-filipovski-189724-copy-300x176In the qui tam case of BlueWave Healthcare v. U.S., the government was allowed to execute writs of attachment against both real and personal property and writs of garnishment against bank accounts of the defendants under the Federal Debt Collection Procedures Act (FDCPA). The defendant’s attempted to appeal the denial of their motions to quash these writs, but this appeal was dismissed for lack of jurisdiction.

About the Case

The qui tam case was filed by Scarlett Lutz and Kayla Webster against BlueWave HealthCare Consultants, Robert Bradford Johnson, and Floyd Calhoun Dent in 2014. Lutz and Webster, the relators, alleged that the defendants had violated the Anti-Kickback Statute and the False Claims Act. They stated that the defendants arranged for illegal kickback payments to doctors, which were labeled processing and handling fees. The federal government intervened in the case in April of 2015.

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