ATTORNEY NEWSLETTER
Alleged Billing For Medically Unnecessary Treatments
Whistleblower To Receive $3.16 Million Reward
How Whistleblower Cases Work
Each year, according to the federal Government Accountability Office (GAO), the federal government loses billions as the result of fraud. The GAO announced earlier this year that data for 2018-2022 shows the government lost an estimated $233 billion to $521 billion annually. Private citizens and businesses help the government recover billions every year in cases of fraud against the government. Much of the fraud committed against the government every year occurs in the health care field, as a recent case, discussed below, illustrates. Any private citizen assisting the government in recouping funds paid out on fraudulent claims starts by bringing a civil lawsuit on behalf of the government under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. The private individuals or businesses bringing the 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, often in large amounts as in the settlement discussed below. 31 U.S.C. § 3730(d). Relators of fraudulent conduct are often current or former employees, accountants, controllers or managers, or competitors 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
The U.S. Department of Justice (DOJ) recently announced that a healthcare company has agreed to pay $19.85 million to resolve allegations that it violated the False Claims Act and related state statutes by knowingly billing for medically unnecessary inpatient behavioral health services or for services that did not meet federal and state regulations. The United States contended that, between 2014 and 2017, defendant knowingly submitted false claims for payment to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable or medically necessary. In particular, the United States contended that the healthcare provider admitted beneficiaries who were not eligible for inpatient treatment and failed to properly discharge beneficiaries when they no longer needed inpatient treatment and had improper and excessive lengths of stay. The United States further alleged that the provider knowingly failed to provide adequate staffing, training and/or supervision of staff, which resulted in assaults, elopements, suicides and other harm resulting from these staffing failures. In addition, the company allegedly failed to provide inpatient acute care in accord with federal and state regulations, including, but not limited to, by failing to provide active treatment, to develop and/or update individualized assessments and treatment plans, to provide adequate discharge planning and to provide required individual and group therapy.
“This settlement demonstrates the Justice Department’s commitment to ensuring that federal healthcare programs pay only for services that are needed and properly provided,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “It is particularly important that health care providers satisfy these requirements when providing services to a vulnerable patient population, such as residents of an inpatient behavioral health facility.”
The settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by former employees of the defendant. The whistleblowers’ share of the settlement will be $3,166,144.42.
Starting A Qui Tam Action
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.
