Two Former Employees Blow Whistle On Alleged False Billing
Complaint Says Drugs Never Dispensed
Realtors Will Share Reward
The False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., 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). The citizens, known as “relators,” brought the cases, referred to as “qui tam” cases,” under the FCA. If the government recovers, these individuals are eligible for rewards. 31 U.S.C. § 3730(d). In Fiscal Year 2022, private citizens helped the government recover $1.9 billion in cases of fraud against the government. During that year, relators received over $488 million in rewards for their efforts in bringing government fraud to light and helping the government recover funds paid out on false claims. The majority of alleged fraud in FCA cases occurs in the health care sector, as a recent settlement discussed below illustrates. Relators of fraudulent conduct are often employees, or former employees, or (in healthcare cases) patients of the business engaging in the fraud. False certification of eligibility for government funds is one significant source of government fraud, as the reported case below illustrates. If you have credible information of government fraud in Los Angeles 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).
Pharmacy Settles FCA Allegations
In a recent settlement announced by the U.S. Department of Justice, a pharmacy has agreed to pay $213,677 to resolve allegations that it violated the False Claims Act by knowingly billing federal health care programs for medications that were never dispensed. The United States alleged that, from Jan. 1, 2016, through Dec. 31, 2019, the pharmacy billed both Medicare Part D and a State Medicaid program for 200 prescription medications that were never distributed to patients. According to the government’s allegations, inventory records showed that the pharmacy did not buy enough of these medications to fill all of the prescriptions billed to these health care programs.
“Pharmacies may bill only for medications that they actually sell,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Our office will continue to pursue entities that knowingly and unjustly enrich themselves at the taxpayers’ expense.” The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by former employees of the pharmacy. The two former employees will share a reward for their efforts.
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).
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:firstname.lastname@example.org”>email@example.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.
 Evans Law Firm, Inc. was not involved in the case in any way.