ATTORNEY NEWSLETTER
Allegedly Failed To Return Known Overpayments
More Than 100 Medically Unnecessary Flights Alleged
Whistleblower To Receive $190,000 Reward
Every year, private citizens and businesses assist the government in recovering funds paid out by the government on fraudulently submitted claims for payments. Citizens help the government recover these funds by bringing civil lawsuits on behalf of the government under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. The private individuals or businesses in these actions are known as “relators,” and the cases themselves referred to as “qui tam” cases. If the government recovers, the relators are eligible for rewards. 31 U.S.C. § 3730(d). Relators received over $488 million in rewards during Fiscal Year 2022, and multiple large rewards have been made in 2023. 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). 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 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 Settlement[1]
In a recent press release by the U.S. Department of Justice (DOJ), an air medical transport services company agreed to pay the federal government $1,050,873, to resolve civil allegations that it had failed to return known overpayments received from Medicare, Medicaid, Tricare, and the Department of Veterans Affairs.
The United States alleged that the company violated the False Claims Act, by improperly retaining overpayments for more than 100 flights that it knew to be medically unnecessary and, therefore, ineligible for reimbursement by federal healthcare programs. Federal healthcare programs only provide reimbursement for air ambulance transportation if the beneficiary’s medical condition requires air transport, and transport by ground ambulance is not appropriate. The United States alleged that the company’s internal review process identified flights that did not meet these coverage requirements, including instances where patients were flown despite not meeting trauma criteria. The False Claims Act, a federal law that prohibits causing the submission of false or fraudulent claims to the federal government, also forbids knowingly concealing, avoiding, or decreasing an obligation to pay (or repay) the government. As such, healthcare providers also face False Claims Act liability when they fail to return known overpayments to federal healthcare programs.
The settlement resolves a lawsuit brought by a private citizen under the qui tam provisions of the False Claims Act. As part of this resolution, the individual who filed the qui tam complaint will receive approximately $190,000 from the settlement.
How A Qui Tam Action Begins
False Claims Act whistleblower cases begin when the relator files a complaint under seal in the federal district court where the 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.
