The Virginia Birth-Related Neurological Injury Compensation Program Settles for $20.7 Million
The Virginia Birth-Related Neurological Injury Compensation Program ("The Program") and the Virginia Birth-Related Neurological Injury Compensation Fund ("The Fund") have recently agreed to pay a $20.7 million settlement to resolve FCA allegation brought against them by a whistleblower suit. Relators allege that the defendants knowingly caused numerous Program participants to submit false claims to Medicaid. By law, Medicaid is the "payer of last resort" for all healthcare claims for a covered beneficiary, meaning if another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay all of or part of the costs of the claim before Medicaid makes any payment. If a third party is liable to pay for part of a Medicaid participant's care, "Medicaid will only pay that part of the care which is over and above the amount covered by the third party."[1] The text of Va. Code Ann. §38.2-5009 specifically says that the Program will not cover any items or expenses that would be covered "under the laws of any state or the federal government except to the extent prohibited by federal law." However, the Program and the Fund made themselves the de facto payers of last resort, improperly shifting payment onto the Medicaid program. More
Why Do So Many False Claims Cases Settle Before Trial?
It is widely recognized that many more False Claims Act (FCA) cases settle than go to trial.[1] While it is difficult to determine the exact proportion of cases that settle vs. cases that are tried, comprehensive reports on FCA developments published semi-annually indicate about a 16:1 ratio of notable settlements to verdicts/ judgments.[2] More
Medicare Advantage Provider to Pay $270 Million to Settle False Claim Act Liabilities
HealthCare Partners Holdings LLC, doing business as Davita Medical Holdings LLC (DaVita), has agreed to settle a False Claims Act liability case and will pay $270 million to the United States Government. DaVita, headquartered in El Segundo, California, did not admit fault. Relators allege that DaVita was providing inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments. More
The Government Fights Back Against Ambulance Fraud: A Recent $21 Million Settlement and Other Related Cases
The U.S. Government has successfully combatted several instances of ambulance fraud this past year, by intervening in False Claims Act (FCA) qui tam suits and by pursuing a criminal health care fraud case against an ambulance company owner. These cases against AmeriCare, Hart to Heart, and the owner of Tonieann EMS and Rosenberg EMS, mainly involve allegations that these companies systematically billed government-provided insurance for medically unnecessary ambulance transports. However, a recently-resolved case against Paramedics Plus and several affiliates involved allegations of an illegal kickback scheme enacted to win and maintain exclusive ambulance contracts. More
Walgreens Agrees to Settle Three Civil Fraud Lawsuits Totaling Over $270 Million
Walgreens Boots Alliance, Inc. ("Walgreens") has agreed to pay $269.2 million to settle two whistleblower lawsuits accusing it of overbilling federal healthcare programs for over a decade. In both settlements, Walgreens "admitted and accepted responsibility for conduct the Government alleged in its complaints under the False Claims Act". The U.S. Department of Justice made the announcement on January 22, 2019. In addition, Walgreens recently settled another False Claims Act claim, although the monetary value is modest in comparison with the first two. In the third settlement, Walgreens agreed to pay $3.5 million to the U.S. and the State of Wisconsin to settle allegations that, from 2011 to 2014, Walgreens violated Wisconsin Medicaid rules by dispensing routinely stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for a medically appropriate treatment. More
The Public Disclosure Bar
The False Claims Act qui tam provision allows private citizens to act as whistleblowers, and file a lawsuit on behalf of the government if they are aware of fraud taking place. These whistleblowers, or relators, are eligible to receive a portion of the money the government recovers if the lawsuit is successful.
It is important to note that the False Claims Act is designed to encourage people to report fraud that might otherwise go undetected; it is not designed to reward people who repeat allegations that have already been publicized. To that end, the False Claims Act includes language stipulating that the court will dismiss a case if substantially the same allegations contained therein were already publicly disclosed and the relator bringing the action is not an original source of the information. This section of the Act is commonly referred to as the "public disclosure bar". More
An Overview of Nursing Home Fraud: False Claims Act Cases from the Last Three Years
The last three years have seen several FCA cases related to nursing home fraud achieve success. Two cases of note—one against a skilled nursing facility chain and one against a rehabilitation therapy provider—settled for over $100 million, and a recent Third Circuit decision revived a dismissed case against a pharmaceutical company and narrowed the public disclosure bar. Still other cases involving similar allegations of inflating reimbursement levels and engaging in illegal kickback schemes have settled for millions or involved criminal prosecution of the individuals responsible. More
Lincare Settles False Claims Act Allegations for $5.25 Million
Lincare, Inc., one of the nation's largest providers of durable medical equipment has paid $5.25 million to resolve allegations brought forth through a qui tam action filed by a Relator on behalf of the United States. More
Attorney General Nominee Historically Opposed to False Claims Act Whistleblower Provision
William Barr, currently an attorney at Kirkland & Ellis who is nominated for the position of Attorney General, has historically been opposed to the False Claims Act qui tam whistleblower provision which allows private citizens to sue in the name of the United States government. More
False Claims Act and the Opioid Crisis: First-ever Civil Injunction Filed by Justice Department to Combat Opioid Over-Prescription
In August 2018, the U.S. Department of Justice announced allegations against an Ohio doctor for violating the False Claims Act (FCA) in addition to violating the Controlled Substances Act (CSA) for prescribing opioid prescriptions in excessive amounts or to those who are not in need of the medication. Although an FCA case is not the most traditional approach to these issues, it is clear that the Justice Department is making the opioid crisis a top priority and therefore potentially invoking the FCA more often in these cases. The government's focus on the opioid crisis has been consistently increasing and expanding from targeting manufacturers of opioids to targeting prescribers and healthcare providers that submit claims to federal health care programs or to the federal government.
Subscribe to this blog's feedRecent Posts
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- Sutter Health Settles False Claims Act Allegations for $30 Million
- Duke University Pays U.S. Government $112.5 Million to Settle False Claims Act Allegations
- Recent Supreme Court Ruling Gives Whistleblowers More Time
- Where Does Attorney General William Barr Stand on the False Claims Act?
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- Durable Medical Equipment Provider Agrees To Pay $1.6 Million To Resolve False Claims Allegations
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