ATTORNEY NEWSLETTER
Defendants Allegedly Submitted False Evaluation Codes
Whistleblower To Receive $2.8 Million Reward
How Qui Tam Cases Begin
Billions of dollars are lost annually by the government for payments on false claims for government reimbursement. Private citizens bring cases in federal courts throughout the country under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq, to help the government recoup these funds. Each year, citizens recover billions of dollars for the government (and by extension, all of us) through these cases. 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. 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 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 physicians; group has agreed to pay $14.9 million to settle allegations of submitting false claims for certain Evaluation and Management (E&M) codes inconsistent with Medicare, Medicaid and TRICARE requirements.
E&M codes are used by healthcare professionals to indicate services provided and the condition of a patient. The DOJ alleged that defendants submitted claims for two E&M codes between 2015 and 2019 to inappropriately inflate claims as a way of boosting profits. The government specifically alleged that defendants submitted claims for payment to the Medicare Program domiciliary rest home visit code for established patients (99337) and for the chronic care management code (99490) “that did not support the level of service provided.” The U.S. Attorney on the case stated that this was referred to as “upcoding and unnecessary billing.” Principal Deputy Assistant Attorney General Brian M. Boynton explained: “Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans.”
A former general manager of the defendant group will receive over $2.8 million as a reward for bringing the qui tam action.
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.
