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Feb 17, 2024 by |

San Francisco Whistleblower Attorney: Qui Tam Suit Leads To $345 Million False Claims Act Settlement

ATTORNEY NEWSLETTER

Stark Law Violations Alleged

Government Alleges Illegal Downstream Referrals

Former Chief Financial Officer Blew Whistle

Private citizens help the government recover billions of dollars every year in cases of fraud against the government.  The cases are brought in federal courts throughout the country under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq.  The private individuals bringing the cases are referred to as “relators,” and the cases themselves are called “qui tam” cases. If the government recovers, the individuals bringing the lawsuits are eligible for rewards. 31 U.S.C. § 3730(d).   Much government fraud, and the majority of the qui tam cases brought every year, relate to fraud in the healthcare field, under programs like Medicare and Medicaid (known as Medi-Cal in California).  As an example of healthcare fraud, kickbacks (by hospitals, clinics and nursing homes, among others) to physicians for patient referrals are illegal, and when the patients are covered by Medicare or other government payment programs, these kickbacks constitute fraud against the government, in violation of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), the Stark Law (42 U.S.C. § 1395nn), and the False Claims Act (31 U.S.C. §§ 3729 et seq.). Relators of fraudulent conduct are often employees or managers, or former employees or managers, or (in healthcare cases) patients of the business engaging in the fraud.  If you have credible information of fraud against the government in violation of the FCA, Stark Law or Anti-Kickback Statute 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 Stark Law Case Settlement[1]

In a recent press release by the U.S. Department of Justice (DOJ), a health network agreed to pay the United States $345 million to resolve allegations that it violated the False Claims Act and Stark Law.  The government alleged that defendant knowingly submitted claims to Medicare for services that were referred in violation of the Stark Law, which prohibits hospitals from billing certain services referred by physicians with whom the hospital has financial relationships unless the relationship meets one of the law’s statutory or regulatory exceptions.

According to the United States’ complaint, defendant began an illegal scheme in 2008 and 2009 to recruit physicians for employment to take their “downstream referrals.” The network allegedly successfully recruited hundreds of local physicians, including cardiovascular specialists, neurosurgeons, and breast surgeons, by paying them salaries that were much higher than what they were receiving in their private practices. The complaint further alleged that defendant knew the compensation figures it provided to the valuation firm it hired to analyze the compensation it proposed paying to its recruited specialists were false. The network allegedly ignored repeated warnings from the valuation firm regarding the legal perils of overcompensating its physicians. 

The case stemmed from a qui tam whistleblower lawsuit filed by the company’s former Chief Financial and Chief Operating Officer, who will receive a share of the settlement as a reward. 

How A Qui Tam Action Begins

Any False Claims Act whistleblower case begins by a relator filing a complaint under seal in the federal court usually for the United States District Court for the district where defendant is located or does business. 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 case in any way. 

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