Articles Tagged with government fraud law firm

It is no secret that, as a whistleblower’s law firm, we are big fans of the False Claims Act (“FCA” or “the Act”).  The Act holds liable any person/entity that presents a false or fraudulent claim for payment to the federal government (or an agency thereof) and/or create false records to that end.  In essence, it forbids overcharging the government for goods or services or charging for goods/services that are never delivered.  The Act’s qui tam provision is particularly powerful since it enables private individuals to bring suits on the government’s behalf.  This is key because it is often private parties, rather than the government itself, who are aware of these fraudulent schemes.  Recent trends show that the legislature and the courts are committed to working with whistleblowers and, more generally, to using the False Claims Act as a powerful tool to battle health care fraud and other forms of fraud on the U.S. government.

DOJ Nearly Doubles Per Claim False Claims Act Penalties

As Becker’s Hospital Review, a healthcare industry journal, reported last month, the Department of Justice (“DOJ”) recently published an interim final rule substantially increasing the monetary penalty for violations of the FCA.  Previously, penalties ranged from $5,500 to $11,000 per claim.  The new penalties neacash2rly double the old ones and range from $10,781 to $21,563.  These increased penalties took effect on August 1 and only apply to violations occurring after November 2, 2015.  The increase was made pursuant to the Bipartisan Budget Act of 2015 which required agencies to increase FCA penalties and authorized rulemaking to implement a “catch up adjustment” to account for inflation.  The DOJ is just one of the agencies updating penalties (the Railroad Retirement Board was the first), but it is certainly among the most impactful.

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.

Last week, we looked at the recoveries made on behalf of the federal government using the False Claims Act (“FCA”) in 2015.  While informative, those numbers don’t tell the whole story.  Many states have their own versions of the FCA.  These statutes are particularly important in the Medicaid fraud arena since Medicaid is a state and federal partnership so fraud typically involves both federal and state funds.  Today, our government fraud law firm looks at one such statute, Washington’s Medicaid Fraud False Claims Act (“WFCA”).  Each state’s laws are unique, but this review can help readers understand the importance of state claims in this arena.

Washington’s Legislative Auditor Reviews the State False Claims Act, Recommends Reauthorization

In 2015, with the WFCA set to expire on June 30, 2016, the healthcashstate’s Legislative Auditor undertook to study the statute, its results, and recommend or counsel against reauthorization.  As the resulting report (Proposed Final Report issued 12/16/15) explains, government can investigate possible Medicaid fraud via federal (civil and/or criminal) investigations, state criminal investigations, and state civil investigations.  Absent reauthorization, Washington would lose the authority for the final category.  Additionally, if the federal government is investigating a case that also involved fraud on Washington state, the state can only participate in the case and any recovery if it has a state FCA that (like the WFCA) meets certain standards set forth in the federal law.

longgavelIn the previously published Part One of this FAQ (link provided below), we looked at the False Claims Act (“FCA” or “the Act”) and discussed its coverage and enforcement.  This concluding section of the two-part series focuses on the role of whistleblowers in False Claims Act cases and how our False Claims Act whistleblowers’ attorney can help these honest people step forward to join the fight against fraud.

  • What happens after I file a whistleblower’s lawsuit?

Qui tam lawsuits (the legal term for suits filed by private citizens on the government’s behalf) under the FCA are filed under seal which essentially means they are kept secret.  The claim and a written disclosure of the information on which it is based must be served on the appropriate U.S. Attorney and the Attorney General.  From the time of filing, the government has 60 days to investigate the claim, although it can (and often does) ask for an extension if necessary.  Notably, the defendant is not informed until this investigation is complete.

Fraud follows the money.  If something is expensive, there is probably someone looking to steal it or profit from it.  Given the ever-rising cost of health care, it is hardly surprising that health care fraud is a growing problem and that Medicare and other government health programs are frequent targets.  Home health care services are among the priciest services covered by Medicare and, not surprisingly, home health fraud is a major threat to the Medicare system, Medicare beneficiaries, and to all Americans who seek any form of health care and/or all taxpayers.  Our home health Medicare fraud law firm partners with the brave, honest individuals who step forward to share knowledge, fight fraud, and return wrongfully obtained money to the government.

The Background: Home Health Services Under Medicare

Medicare covers certain home health services for qualified beneficiaries.  Eligible services include intermittent skilling nursing care and a range of additional services like physical, occupational, and speech therapy.  Generally, these services are coordinated by a home health agency (“HHA”).  Medicare’s home health benefit does not cover meal delivery, round-the-clock care, personal care, or help with cleaning and other homemaker services.