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Aug 10, 2021 by |

Alameda County Whistleblower Attorney: $2.7 Million To Settle Whistleblower Allegations Of Medicare Fraud

ATTORNEY NEWSLETTER

Complaint Alleged False Claims For Dental Services

Five Years Of False Claims Alleged

Violations Of Sterilization Requirements

The False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., provides a remedy of civil damages when a party 1) makes a false statement or engages in a fraudulent course of conduct that is done with 2) knowledge that was 3) material and 4) caused the government to pay out money or forfeit money it was due.  The FCA allows private individuals to bring actions on behalf of the government to recover these damages.  31 U.S.C. § 3731(b)(1).  Last year, the Department of Justice (“DOJ”) recovered $2.2 billion in FCA settlements and judgments with $1.8 billion of those dollars involving the health care industry. Most of the false claims in the healthcare industry involve government payments under Medicare and Medicaid (known as Medi-Cal in California).  The private parties who initiated the vast majority of FCA cases are referred to as “relators” under the statute but are more commonly known as whistleblowers.  The FCA provides motivation for whistleblowers to root out fraud because the whistleblower stands to personally recover anywhere from 15% to 30% of the damages and penalties or settlement that stems from the claim. 31 U.S.C. § 3730(d).  If you have credible information of Medicare fraud, violations of regulations, illegal kickbacks or other healthcare fraud in Alameda County or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).

Settlement of False Claims for Medicaid Reimbursement

The DOJ recently announced that a regional health care system which operates dental clinics will pay $2.7 million dollars to resolve federal and state false claims allegations.  The case[1] against UAHS was brought about by a whistleblower who should be eligible for a sizable monetary award under the FCA’s reward provisions.  According to the Assistant U.S. Attorney involved in the case, the defendant “submitted false claims to Medicaid for dental services that were performed using handpieces which had not been appropriately sterilized.” Health care providers are legally required to heat sterilize dental handpieces between each patient use.  However, defendant allegedly did not purchase enough handpieces to allow for such sterilization and instead “directed personnel to use wipes to ‘clean’ handpieces between patients.”  The government alleged that by billing Medicaid for services provided using unsterilized equipment, defendant violated the Federal False Claims Act as well as the applicable State False Claims Act.

“It is inconceivable that a healthcare business would seek to cut corners when it comes to the appropriate cleaning and sterilization of medical devices,” said U.S. Attorney James P. Kennedy, Jr. “This settlement under the False Claims Act holds [defendant] accountable for the risks created for patients in the past, while ensuring that in the future patient safety will be preserved and that taxpayers will only pay for services which are properly provided.” An unnamed whistleblower brought the case is eligible to receive a monetary award for 15-30% of the $2.7 million settlement.

Rewards And Remedies For Retaliation

Typically, the individuals with information of any kind of false claim in the healthcare industry comes from employees of the healthcare provider submitting the false claims.   While the law prohibits retaliation against any employee who acts as a whistleblower, the reality is that such retaliation occurs.  But employees, agents, executives, officers, and others can fight back when it does. 31 U.S.C. § 3730(h).  If you are fired because you brought any fraud to light, you may be entitled to sue your employer in court  and seek double back pay (with interest), reinstatement, reasonable attorneys’ fees, and reimbursement for certain costs in connection with the litigation. 31 U.S.C. § 3730(h)(2). Evans Law Firm, Inc. can represent you in any action for retaliation as well as represent you in your underlying whistleblower application.

Contact Us

If you have credible information of fraud against Medicare or Medi-Cal call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.  In addition to FCA and CFCA whistleblower cases, Ingrid also handles bank fraud whistleblower cases under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program. 

[1] Evans Law Firm, Inc. was not involved in this case in any way.

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