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Jul 7, 2022 by |

San Francisco Whistleblower Attorney: Department Of Justice Announces Two Settlements Of False Claims Act Healthcare Cases

ATTORNEY NEWSLETTER

Two False Claims Act Cases Settle For $4.9 Million

Allegations Of Double-Billing Tests And Services Never Performed

Individuals Initiated Both Cases

Federal law authorizes private citizens to bring suits against businesses and individuals believed to be defrauding the government. False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq..  Much government fraud occurs in the healthcare sector under programs like Medicare.  The government pays out billions on fraudulent claims each year according to reports, but fortunately individual FCA cases also recoup billions each year for the government.  Cases brought by private citizens (referred to in the law as “relators”) are known as “qui tam actions.”  The FCA authorizes awards to relators for bringing and prosecuting these cases concerning fraud on the government. 31 U.S.C. §3730 (d).  Frequently, relators are current or former employees, representatives or agents of the businesses committing the alleged fraud.  Two recent settlements where the relators will receive substantial rewards for their efforts are discussed below.   If you have credible information of fraud against the government in violation of the FCA and live 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).

Recent False Claims Act Settlements[1]

The U.S. Department of Justice (DOJ) recently two settlements of FCA cases alleging healthcare fraud.  

In the first case, the government contended that a testing provided perpetrated a scheme to evade Medicare regulations when submitting claims to for its predictive marker tests to circumvent Medicare’s rules for billing for certain laboratory services.  Specifically, the government alleged that in some cases the patient’s hospital and the testing service both billed for the same test resulting in double billing and in other cases the tests were performed after the required time limits for tests had expired under Medicare rules.  The case settled for $2.8 million without any judicial determination of liability.  The relator will receive a share of the settlement as a reward.

In the second case, a behavioral healthcare provider has agreed to pay $2.1 million to resolve allegations that the company violated the False Claims Act by billing claims to Medicaid programs that were not reimbursable under the applicable regulations. The settlement resolves allegations that from January 1, 2016, through October 31, 2019, the company submitted reimbursement claims to Medicaid and received payment based on those claims for services that were not covered by Medicaid. The relator involved in this case will also receive a share of the settlement as a reward.

Bringing A Qui Tam Action

Individuals with original and credible information of false claims, like the relators in the two reported cases, begin FCA qui tam cases by filing a complaint under seal in the federal court. At the same time, the relator submits a disclosure to the DOJ outlining the material evidence the relator has of the alleged false claims. 31 U.S.C. § 3730(b). The seal period of the complaint lasts 60 days during which the DOJ investigates the claims.  31 U.S.C. § 3730(b)(2). (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.)  If the government decides to intervene in the case, the government essentially takes over the litigation. 31 U.S.C. § 3730(c)(1).   If the government declines to intervene, the relator may proceed with the litigation on his or her own.  31 U.S.C. § 3730(c)(3).

Contact Us

If you have credible information of government fraud in San Francisco or elsewhere in California, 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 two cases in any way.  The reported cases are captioned United States ex rel. Caughron v. CDx Holdings, Inc. f/k/a Caris Life Science, Civil Action No. 18-CV-0352 (E.D.N.Y.) and United States and the State of North Carolina ex rel. Ginger L. Hill v. Healthkeeperz, Inc. Case No. 1:20CV32 (W.D.N.C.).

 

 

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