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Dec 7, 2022 by |

Los Angeles Whistleblower Attorney: Neurological Care Provider Agrees To Pay $51 Million To Resolve Allegations of False Billing

ATTORNEY NEWSLETTER

$51 Million Settlement Reached

Allegations Of Unnecessary Billing

Realtors Will Share $12.75 Million Reward

In Fiscal Year 2021, private citizens helped the government recover $1.6 billion in cases of fraud against the government.  The citizens, known as “relators,” brough the cases, referred to as “qui tam” cases,” under the False Claims Act, 31 U.S.C. §§ 3729 et seq. (FCA).  The FCA allows individuals with knowledge of fraud against the federal government to initiate actions on behalf of the government to recover government funds paid out as a result of fraudulent claims.  31 U.S.C. §3730(b).  If the government recovers, these individuals are eligible for rewards. 31 U.S.C. § 3730(d).  Relators of fraudulent conduct are often employees, or former employees, of the business engaging in the fraud.  Each year relators in FCA cases recover billions of dollars for the government. Any business billing the government for products or services is subject to government regulation affecting that business and its billing practices for government work, and is also subject to the fines and penalties of the FCA.  Healthcare fraud is the largest type of fraud perpetrated against the government every year for false claims under federal programs like Medicare and Medicaid. If you have credible information of government fraud in San Francisco 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).

$51 Million Settlement

In a recent settlement announced by the U.S. Department of Justice,[1] a nonprofit child spinal injury and neurological compensation plan has agreed to pay $51 million to resolve allegations that they violated the False Claims Act by billing the Medicare program.   According to the Legislative scheme that created the plan, “qualified claimants” can get reimbursed for “medically necessary and reasonable” expenses that stem from “birth-related neurological injuries subject to the terms and conditions of the [enabling legislation], applicable regulations, and guidance documents.” The settlement agreement states that one source of funding for the plan is “participating and nonparticipating physicians and hospitals.”

“Both federal and Florida Law general establish Medicaid as the payer of last resort—meaning, subject to various exceptions, Medicaid pays claims for covered health care services only after other responsible third parties have met their burden of costs,” the settlement agreement explains. The plan was established with the goal of reimbursing “[a]ctual expenses for medically necessary and reasonable’ health care items and services. The plan is not required to pay ‘[e]xpenses for items or services that the infant has received, or is entitled to receive, under the laws of any state or the Federal Government, except to the extent such exclusion may be prohibited by federal law.’”

Allegedly, the plan engaged in False Claims Act violations in a number of ways, including publishing “literature, instructional materials, and other documents, including the Benefits Handbook, that declared itself as payer of last resort.” According to the settlement agreement, the Plan also “caused Plan participants’ parents or guardians to submit claims to Medicaid for payment before the Plan paid them and did not prevent Plan participants’ parents or guardians from submitting, and did not advise such parents or guardians not to submit, claims to Medicaid first.” 

Fundamentals Of A Qui Tam Case

Qui tam cases begin with filing a complaint in the federal district court where the allegedly fraudulent conduct occurred.  31 U.S.C. § 3730(b).  The complaint is filed under seal.  The government has sixty days to review the allegations and decide whether to intervene.  This review period can be extended.  If the government decides to intervene, the government essentially takes over the litigation.  31 U.S.C. § 3730(c).  If the government decides not to intervene, the relator has the right to continue the litigation on his or her own.  If the relator continues the litigation alone, he or she receive a larger percentage of the amount the government eventually recovers.  31 U.S.C. § 3730(d).  The relator may also pursue claims for wrongful retaliation against the defendant if the relator was fired or demoted as a result of blowing the whistle.  31 U.S.C. § 3730(h).

Contact Us

If you have credible information of government fraud 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 and Evans Law Firm, Inc. also handle 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 the case in any way.

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