ATTORNEY NEWSLETTER
Alleged Kickbacks In Form Of Giveaways
Whistleblower To Receive $2.7 Million Reward
How Whistleblower Cases Work
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[1]
The U.S. Department of Justice (DOJ) recently announced that a medical testing laboratory has agreed to pay $27 million to resolve alleged violations of the False Claims Act and similar state statutes for billing Medicare, Medicaid and other federal health care programs for medically unnecessary urine drug tests, and for providing free items to physicians who agreed to refer expensive laboratory testing business to the lab. “The Justice Department is committed to ensuring that laboratory tests are ordered based on each patient’s medical needs and not just to increase laboratory profits,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will not tolerate practices that unnecessarily increase the costs of federal health care programs and result in the misuse of taxpayer funds.”
In the settlement agreement, the United States alleged that defendant systematically billed federal health care programs for excessive and unnecessary urine drug testing from Jan. 1, 2013, through Dec. 31, 2022. In particular, the United States contended that the lab caused physicians to order excessive numbers of urine drug tests, in part through the promotion of “custom profiles,” which were, in effect, standing orders that caused physicians to order a large number of tests without an individualized assessment of each patient’s needs. This practice violated federal health care program rules limiting payment to services that are reasonable and medically necessary for the treatment and diagnosis of an individual patient’s illness or injury.
The United States also alleged that the lab’s provision of free point of care urine drug test cups to physicians — expressly conditioned on the physicians’ agreement to return the urine specimens to the lab for additional testing — violated the Anti-Kickback Statute. The Anti-Kickback Statute generally prohibits laboratories from giving physicians anything of value in exchange for referrals of tests.
The relator in the case will receive a reward of $2,743,002 out of the settlement.
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.
[1] Evans Law Firm, Inc. was not involved in the case in any way.
