ATTORNEY NEWSLETTER
Provider Allegedly Reimbursed For Ineligible Expenses
Pre-Determined Prices Not Fair Market Values
Former Medical Director Will Receive $950,000 Reward
Civil lawsuits may be brought by private citizens on behalf of the government for redress against fraud against government agencies. The cases are brought under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. In Fiscal Year 2022, private citizens and businesses helped the government recover $1.9 billion in cases of fraud against the government. The private individuals or businesses, known as “relators,” brought the cases, referred to as “qui tam” cases,” under the FCA. I f the government recovers, these individuals are eligible for rewards. 31 U.S.C. § 3730(d). Relators received over $488 million in rewards during Fiscal Year 2022. 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 Settlement[1]
In a recent press release by the U.S. Department of Justice (DOJ), a healthcare provider has agreed to pay $5 million to resolve allegations that it violated the False Claims Act and the California False Claims Act by causing the submission of false claims to California’s Medicaid program (Medi-Cal). The settlement resolves allegations that defendant knowingly caused the submission of false claims to Medi-Cal for “Enhanced Services” defendant purportedly provided to Medi-Cal members between Jan. 1, 2014, and June 30, 2016. The United States and California alleged that defendant claimed and received payments that were not for “allowed medical expenses” permissible under the program; were pre-determined amounts that did not reflect the fair market value of any Enhanced Services; and/or the Enhanced Services were duplicative of services already required to be rendered by the provider. The United States and California further alleged that the payments were unlawful gifts of public funds in violation of the California Constitution.
“Millions of Americans depend on the Medicaid program for essential health care services,” said U.S. Attorney Martin Estrada for the Central District of California. “When providers cheat the system, they cheat us all. My office will not stand for this type of misconduct. We will ensure that the nearly $100 million recovered in this case goes to those in need and not to unscrupulous providers.”
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 District in which 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.
