2017 Starts Off with Multi-Million Dollar False Claims Fraudulent Billing Claim & DOJ’s 2016 Year End Report Review

For 40 years, our attorneys have been helping California employees who have been wronged or witnessed wrongdoing against their coworkers or the government.  We ensure that every measure is taken to protect our clients so that they may continue to safeguard our rights and call-out companies with the knowledge that they will be protected under the laws’ anti-retaliation provisions while obtaining the best representation under the law.

After reviewing the Department of Justice’s Fiscal Year 2016 report, we are proud to inform our readers that whistleblowers filed over 700 Qui Tam (or whistleblower) lawsuits on behalf of the government and collected $519 million dollars from the recoveries.  The government recovered $2.5 Billion for prosecuting health care fraud cases with a close second being $1.7 Billion from the financial industry.  See an example below as well as these other cases.

In one exemplary case, last week the federal government stated that it is planning on pursuing civil actions under the False Claims Act (“FCA”) against a health system, six radiologists, and the system’s former Chief Operating Officer.  The crux of the allegations surround a whistleblower lawsuit filed under seal in 2014 alleging that the hospital billed Medicare and other government programs for services performed by physician assistants without the required supervision by the radiologists.  This type of whistleblower lawsuit is also called a Qui Tam complaint and is ordinarily filed under seal by a citizen on behalf of the government.  Each false claim may be assessed against the company that defrauded the government with a range of $5,500 to $11,000 per false claim plus three times the amount of damages to the government.

Most often, the FCA is used within the health care industry to stem out fraud related to billing, staffing, and kickbacks. Examples of these are when a provider of health care services such as a doctor or hospital bills for services that were not provided or the bill was submitted at an improperly higher rate of reimbursement for the services.  In addition, health care companies are often fount to illegally bill the government for substandard services by fraudulently using higher diagnostic codes or by falsely certifying the medical necessity of medical procedures. Alternatively, these companies may realize that they have credit from their services that they have to repay to the government, but the companies do not reimburse the government within the 60 day time frame.  At that point, the nonpayment becomes a false claim. To combat retribution for filing FCA claims, the Health and Safety Code Section 1278.5 prohibits retaliation against patients, physicians, nurses and medical staff who whistleblow to the government or its agencies on patient care issues at a health care facility.

If you witness any potential false claims in California (i.e. requests for reimbursement to the government, not actually rendering work when reimbursement is received, or receiving and knowingly retaining an overpayment) by your company, or you are retaliated against for voicing your concern about potential wrongdoing, immediate action is vital.  Contact the experienced employment law attorneys at Stephen Danz & Associates for a free consultation to discuss your circumstances and legal options.