Federal False Claims Act Cases and Healthcare Fraud in San Diego
The Department of Justice “obtained more than $2.8 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2018.”
“Of the $2.8 billion in settlements and judgments recovered by the Department of Justice [for False Claims Act cases] this past fiscal year, $2.5 billion involved the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. This is the ninth consecutive year that the Department’s civil health care fraud settlements and judgments have exceeded $2 billion. The recoveries included in the $2.5 billion reflect only federal losses but, in many of these cases, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.”
Our San Diego California whistleblower lawyers have a strong record of success helping whistleblowers who disclose healthcare fraud and other types of fraud obtain a correct percentage of winning claims.
San Diego healthcare fraud
We help nurses, doctors, pharmaceutical representatives, contractors, and others present their claim to the US Department of Justice when they become award of fraud involving an employer or a company they work with. Generally, healthcare requires pay statutory damages for each offense and restitution when they commit fraud. The False Claims Act cases are brought in favor of the following agencies:
- Medicare and Medicare Part D
- Any other applicable federal healthcare agencies that reimburse health providers
They ways pharmaceutical companies, managed care provides, and others commit fraud
Employees who observe any of the following types of fraud may have a valid False Claims Act case if the disclosure meets any of the relevant requirements:
- Charging patients for services, treatments, or drugs that aren’t reasonably medically necessary
- Creating fictional patient accounts
- Falsifying credentials and certifications
- Upcoding to obtain more money
- Billing for services that were never performed
- Inflating utility and other overhead costs
Pharmaceutical fraud by pharmaceutical manufacturers
Some drug makers try to take advantage of the laws or the doctors they work with to get doctors, hospitals, and other health providers to favor their drugs over the drugs of other companies.
- Off-label marketing. The FDA requires that drug makers label the acceptable uses for each drug they make. Doctors can prescribe drugs to patients even if the use is off-label, not one listed on the label. Drug makers can’t induce doctors to make an off-label recommendation of their drug to get around the FDA labeling requirement.
- Best price to Medicare. Drug companies who fail to provide their drugs to Medicaid patients may be in violation of the law.
- Illegal kickbacks. Drug companies can’t offer, and doctors can’t accept any form of remuneration (cash or otherwise) so that the doctor favors the pharmacy manufacturer’s medications.
Drug makers can’t offer drugs that violate FDA rules.
Stark Law requires that doctors can’t refer patients to a facility in which the doctor (or a family member of the doctor) has a financial interest – unless there is a valid exception under the law. Facilities include testing facilities, hospitals, other doctors, medical device makers, and other entities.
The Anti-Kickback Statute (AKS) holds that health providers can’t make referrals if they are making the referral because a pharmacy or some other business or person gave them a financial incentive to do induce the referral. Cash, lavish expense accounts, and other benefits generally qualify as a kickback. Like the Stark Law, the AKS does provide for some exceptions called safe harbors.
The government expects that when they give a university or private company grant funds or tax credits that the working relationship will be an honest one. Examples of fraud that may qualify for an FCA claim include:
- Lying on the application to get the grant
- Changing the data and the results
- Overbilling for expenses
- Not using the R&D grant funds or credits for the intended purpose
- Not complying with applicable federal laws
As the DOJ report for 2018 shows, healthcare fraud is big business. The DOJ in the same report that reported billions in healthcare fraud announced that “of the $2.8 billion in settlements and judgments reported by the government in fiscal year 2018, over $2.1 billion arose from lawsuits filed under the qui tam provisions of the False Claims Act. During the same period, the government paid out $301 million to the individuals who exposed fraud and false claims by filing these actions.”
If you are aware of any healthcare fraud, call the experienced San Diego law offices of Stephen Danz & Associates. You can reach us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.