Archives for 2015

Supreme Court to Decide “Implied Certification” Issue

December 8, 2015

Medicaid Beneficiary Supreme Court Case - Behn & Wyetzner SCOTUS to decide the issue of “implied certification” in Universal Health Services v. United States ex rel. Escobar

On December 4, 2015, the Supreme Court granted the defendant United Health Services’ Petition for a Writ of Certiorari to decide, among other things, the issue of whether the “implied certification” theory of legal falsity under the False Claims Act is viable.

Escobar involved a teenaged girl, a Medicaid beneficiary, who was treated by unlicensed workers who had held themselves out to be social workers, psychologists, and psychiatrists, when they were nothing of the sort. Treatment by these workers led to the girl’s death when she was prescribed a drug that caused her to have seizures, one of which was fatal.

Healthcare Fraud Post-ACA

September 16, 2015

Healthcare Fraud After the Affordable Care Act| Behn & Wyetzner ACA (the Affordable Care Act) expanded healthcare coverage to millions of low-income Americans and put in place numerous reforms within the health insurance sector. Currently, updates to healthcare delivery systems and financing methodologies implemented since ACA was enacted are predicted to result in dramatic reductions in unnecessary medical care in this country. But still, an avalanche of fraud continues to harm healthcare programs, and in particular government programs like Medicare and Medicaid.

Fortunately, powerful anti-fraud provisions in ACA and the False Claims Act have led to revocation of billing privileges for tens of thousands of providers who cheated the government, and Medicare claims are now routinely screened using advanced computer algorithms before being paid. These measures, combined with continued financial incentives for qui tam whistleblowers (called “Relators” under the False Claims Act), will help prevent healthcare fraud and ensure that healthcare coverage post-ACA is provided in a reasonable and cost-efficient manner.

Historic Number of Medicare Fraud Arrests Made in June

July 2, 2015

Medicare Fraud Schemes - Behn & Wyetzner This June, federal officials announced the largest coordinated criminal Medicare fraud action and the first large-scale effort focused on Medicare Part D fraud in the history of the U.S. Justice Department. The Medicare Fraud Strike Force levelled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes. Those charged with fraud under the False Claims Act included 46 doctors, nurses and other licensed medical professionals.

Senators Grassley and Leahy Introduce Legislation to Strengthen Whistleblower Laws

July 2, 2015

Whistleblower Legislation This June, Senate Judiciary Committee Chairman Chuck Grassley and Ranking Member Patrick Leahy introduced legislation to extend whistleblower protection for employees who provide information to the Department of Justice related to criminal antitrust violations.

How a Pharmacist Becomes A Qui Tam Whistleblower

June 29, 2015

Pharmacists as Qui Tam Whistleblowers | Behn & Wyetzner As front-line professionals responsible for dispensing medications to Medicaid beneficiaries, pharmacists are particularly well positioned to discover and report Medicaid fraud. As a result, pharmacists have initiated a number of highly successful qui tam actions under the False Claims Act. Time after time, successful qui tam whistleblower actions by pharmacist relators have successfully recovered taxpayer funds.

Why Whistleblower Laws Are So Important

June 15, 2015

Whistleblower Law & False Claims Act | Behn & Wyetzner Whistleblower laws form the foundation of the False Claims Act and are are crucial because they provide protection and incentives for qui tam whistleblowers (also called relators) to bring information to the government. Under federal and state laws, defendants who violate the False Claims Act are liable for triple damages (plus penalties) to the government.

Medicaid and the False Claims Act

June 1, 2015

Medicaid False Claims Act Violations | Behn & Wyetzner Healthcare is the largest single cost in the federal budget – approximately 22 percent of the total — and the cost increases dramatically from year to year. With fraud following that money, the government is highly incentivized to investigate and prosecute corruption in the healthcare and pharmaceutical industries.

False Claims Act violations involve making fraudulent medical billing claims for payment from the government healthcare programs. One of the largest programs is Medicaid, healthcare for the indigent. Fraudulent conduct can involve overbilling, or receiving payments under these programs while not in compliance with healthcare regulations. Qui tam law suits brought by Medicaid fraud attorneys have recovered billions of dollars from companies committing health care fraud.

Billions in Recoveries For Qui Tam Whistleblowers

May 11, 2015

Qui Tam Whistleblower Recoveries | Behn & Wyetzner More than $30 billion has been recovered in Federal civil actions under the False Claims Act (“FCA”) since the statute which originated in the Civil War era, was amended in 1986 to provide enhanced rewards and protections for qui tam whistleblowers.

In fiscal year 2014, $5.69 billion in fraud against the government was recovered for taxpayers. Most of these cases were brought by qui tam relators, whistleblowers who come forward with their qui tam attorneys to report alleged fraud, and can receive 15-to-25 percent of the recoveries. This was another record year for Federal False Claims Act recoveries, according to the U.S. Department of Justice.

Without qui tam whistleblowers, billions of dollars of fraud payments or demands for payment hidden from the Government would have gone unnoticed. This stolen money would have remained in the pockets of individuals and entities responsible for the frauds, but courageous whistleblowers stepped up to return defrauded dollars to the U.S. Treasury and, as a result, shared in those recoveries.

Higher Penalties, Sentences Imposed in Qui Tam Whistleblower Cases

March 5, 2015

Support for Qui Tam Whistleblowers Programs | Behn & Wyetzner According to a recent study published by Andrew C. Hall, Gerald S. Martin, Nathan Y. Sharp and Jaron H. Wilde, when qui tam whistleblowers participate in financial misrepresentation enforcement actions, the wrongdoers face significantly increased penalties and prison time.

The study’s authors analyzed over a thousand qui tam financial fraud enforcement actions between 1978 and 2012 and determined 145 cases (almost 13% of the total) involved whistleblower information. Due to whistleblowers’ assistance, the government obtained an additional $20.75 to $21.27 billion in judgments, the study estimates. Prison sentences for guilty corporate executives and managers also increased by roughly two years when qui tam whistleblowers were linked with the enforcement action. Read Moreabout Higher Penalties, Sentences Imposed in Qui Tam Whistleblower Cases

SEC Division of Enforcement Breaks Record in Judgements Obtained

February 4, 2015

Record Number of Judgements for SEC Division of Enforcement | Behn & Wyetzner The SEC Division of Enforcement recently released its fiscal year 2016 budget request, providing a detailed account of the Division’s activities during FY 2014 as well as an estimated budget for upcoming years.

Of particular note, the Division set a record by obtaining judgments worth more than $4.16 billion in disgorgement and penalties. The Office of the Whistleblower received approximately 3,600 leads from whistleblowers (more tips than ever before), made the largest number of awards, and announced its largest single award ever to an individual ($30 million). During the same time period, the Division’s total costs came in around $455 million. Thus, for every dollar spent, the Division returned more than nine times that amount.