ATTORNEY NEWSLETTER
Allegedly Ineligible Claim Submissions
Clinical Trial Expenses Billed To Medicare
How False Claims Cases Work
Fraud against the government costs taxpayers billions every year and the majority of fraudulent claims submitted to the government for payment arise from the healthcare sector. To combat this fraud, private citizens help the government recover billions of dollars every year from those submitting false claims for government payments. The cases are brought in federal courts throughout the country under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. The private individuals bringing the cases are referred to as “relators,” and the cases themselves 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. 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 non-profit cancer treatment and research center has agreed to pay $19,564,743 to resolve its civil liability under the False Claims Act for improper claims submitted to federal healthcare programs for certain patient care items and services provided during research studies that were not eligible for reimbursement.
This settlement resolves defendant’s civil liability for claims that it submitted to Medicare and other federal healthcare programs during the period from 2014 to 2020 for services that were not reimbursable under Centers for Medicare and Medicaid Services rules governing reimbursement for clinical care provided in connection with clinical research trials. Specifically, the government alleged that defendant billed federal healthcare programs for items and services provided as part of clinical trial research that should have been billed to non-government trial sponsors.
“Healthcare providers participating in federal healthcare programs must ensure that they comply with applicable rules and regulations, including those relating to the submission of claims in connection with clinical research,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “As today’s settlement reflects, when providers run afoul of their obligations, they can mitigate the consequences by making timely self-disclosures, cooperating with investigations and taking appropriate remedial measures.”
Acting Special Agent in Charge Fernando Porras of the Department of Health and Human Services Office of Inspector General (HHS-OIG) also stated that “Providers participating in clinical trials funded by federal health care programs must abide by specific guidelines that safeguard these programs. Providers will be held accountable if they bill for services outside the rules governing reimbursement. Together, with our law enforcement partners, we will continue to maintain the fiscal integrity of federal healthcare programs.”
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 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.
