ATTORNEY NEWSLETTER
Allegedly Submitted False Rebate Claims
Former Employee Blows Whistle
How Qui Tam Cases Begin
Healthcare fraud is a major type of fraud perpetrated annually in the U.S. Individuals and insurance companies suffer as a result of this fraud but the biggest loser in dollar terms is the United States government through its health programs like Medicare and Medicaid. Private citizens bring cases under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq, to help the government recoup the billions of dollars paid out annually on false claims for payment or reimbursement. The private individuals bringing the cases are referred to as “relators,” and the cases themselves, brought in the federal district court where the defendant’s business is located, are called “qui tam” cases. If the government recovers, the individuals bringing the lawsuits are eligible for rewards. 31 U.S.C. § 3730(d). 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. Much fraud occurs in the healthcare field and false claims to the government are often accompanied by other infractions such as illegal kickbacks for medical referrals prohibited by the Anti-Kickback Statute and Stark Law. 42 U.S.C. § 1320a-7b (Anti-Kickback Statute); 42 U.S.C. § 1395nn (Stark Law). If you have credible information of fraud against the government in violation of the FCA, Anti-Kickback Statute or Stark Law 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 US Department of Justice (DOJ) recently announced that a group of related pharmacies and an affiliated insurance carrier have agreed to resolve allegations that they violated the False Claims Act (FCA) by failing to accurately report drug rebates to the Medicare Program. As part of the settlement, defendants will pay the United States $101 million. The settlement resolves allegations that, between 2014 and 2020, the defendants improperly reported to the Centers for Medicare and Medicaid Services (CMS) portions of rebates received from manufacturers as bona fide service fees, even though manufacturers did not negotiate with the defendants to pay such fees. The United States further alleged that defendant insurance carrier knew the retained rebates did not meet the regulatory definition of bona fide services fees. A former employee blew the whistle on the alleged fraud by bringing a qui tam action. He will receive a share of the settlement as a reward, in an amount that has yet to be determined.
“Participants in Medicare’s drug program must accurately report price concessions, including drug manufacturer rebates, to ensure that the government receives the benefit of those concessions,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement reflects the Justice Department’s commitment to hold accountable entities that pursue their own financial interests at the expense of taxpayer programs.”
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.
