Tuesday, July 29, 2008

Pathologist settles FCA suit

A Maryland pathologist has agreed to pay the United States $457, 379 to settle claims that she billed Medicare and the Federal Employees Health Benefits Program for medically unnecessary services and services not rendered.

Shahla Moshiri, who owns and operates Chesapeake Diagnostics Laboratory, billed the health care programs for the physician interpretation of Pap smears that were not abnormal and therefore did not warrant such interpretation.

Amerigroup to settle FCA suit for $225 million

Health care insurer Amerigroup Corp. has agreed to pay $225 million to the United States and the state of Illinois.

A former employee brought the qui tam suit, alleging that the insurer denied benefits to certain pregnant women even though it received payment from the state to provide those services through the Medicaid program.

Tool distributor settles qui tam suit

W.W. Grainger, a tool and maintenance products, has paid $6 million to settle charges that it defrauded the U.S. government.

A whistleblower suit filed by a former employee alleged that the company sold supplies to government agencies at a greater markup than allowed by their contracts. Grainger was also alleged to have violated both contracts and federal law by supplying the agencies with products from countries that don't have free trade agreements with the United States.

Tuesday, July 22, 2008

St. Louis University settles FCA allegations

St. Louis University, in St. Louis, Missouri, has agreed to pay $1 million to settle allegations that its School of Public Health violated the FCA by mischarging supplemental pay for its faculty members to federally funded grants.

The whistleblower suit alleged that the school engaged in a scheme to defraud the government by overstating the time certain faculty members were spending on grants received from the Centers for Disease Control and Prevention.

Springfield, Missouri, health system will pay $60 million to settle FCA allegation

Lester E. Cox Medical Centers of Springfield, Missouri, has agreed to pay the United States $60 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute, the Justice Department reported. The government alleged that Cox's relationships with certain physicians violated the Anti-Kickback Act by providing inducement for referrals.

It was also alleged that Cox included non-reimbursable costs on its Medicare cost reports and improperly billed for services provided to dialysis patients.

Wednesday, July 02, 2008

Washington Post article says government can't keep up with whistleblower suits

An article in the Washington Post quotes sources who say that the Justice Department doesn't have the resources to handle the volume of whistleblower suits being filed.

The 300 to 400 whistleblower suits filed each year must be investigated under seal, with the relators unable to proceed until the government decides whether or not it will intervene. Critics say the delay in reaching that decision can hurt the False Claims Act suit.

There are approximately 75 lawyers in the Justice Department division responsible for reviewing the suits and they are able to review only about 100 cases each year. Some suits are delayed because there are criminal proceedings which take priority.

Tuesday, July 01, 2008

Dental companies settle whistleblower lawsuit

InterDent, Inc., InterDent Service Corporation and Dedicated Dental Systems Corporation have paid the United States $377,470 to resolve allegations of fraud against Medi-Cal’s dental program, Denti-Cal. They have also paid $351, 530 to the State of California to resolve similar allegations.

The False Claims Act suit, which originated as a whistleblower suit brought by an orthodontist, alleged that the companies used the Denti-Cal provider number of the whistleblowing orthodontist to bill Denti-Cal for work performed by unauthorized dentists.

The press release from the U.S. Attorney's Office in Los Angeles says that the case was handled jointly with the California Attorney General's Office.

California school district joins qui tam suit against builder

Western Placer Unified School District has joined a qui tam lawsuit against the architect and builder of one of its middle schools.

The suit alleges that NTD-Stichler and Edge Development inappropriately received double payment for work from the district and failed to credit the district for work that was not done, or for work that was done with inferior materials.

According to an article in the Lincoln News Messenger, the suit seeks damages of almost $39 million.

L.A. Dept. of Water & Power files FCA suit

The Los Angeles Department of Water and Power has filed a False Claims Act suit against a construction and engineering firm, accusing it of defrauding the utility. The suit, filed in federal court in Los Angeles, alleges that CH2M Hill conspired to defraud DWP by artificially inflating the value of work done by the company and its subcontractors. The suit alleges a wide variety of overcharges, including impermissible and overstated mark-ups.

According to an article in the Los Angeles Times, the agency is seeking at least $13.5 million, plus punitive damages.

Government recovers $2 billion in health fraud in 2008

The federal government expects to recover $2.2 billion for the first half of 2008, resulting from efforts to reduce waste, farud and abuse in federal health programs.

The Dept. of Health and Human Services Office of Inspector General said in its semiannual report to Congress that half of that is attributable to audit-related recoveries and the other half to investigative-related recoveries, including False Claims Act suits.

House holds hearings on FCA amendments

Amendments to the False Claims Act were the subject of hearings by the U.S. House of Representatives Committee on the Judiciary.

Among the witnesses at the June 19 hearings on HR 4854 were qui tam attorneys Shelley Slade and James Helmer, who spoke of the need for Congressional action. Among other things, the amendments would ensure that the False Claims Act covers government funds even when they are paid by government contractors to subcontrators . It would also allow the government to move to dismiss a suit on the grounds that the allegations had already been publicly disclosed, but would prevent defendants from doing so.


The House bill is a companion bill to S 2041.

Washington Post on health care fraud

The Washington Post says that experts are concerned about the growing problem of health care fraud, which is estimated to cost taxpayers over $60 billion each year.

The article notes that Medicare automatically pays most provider bills that are submitted with federally issued supplier numbers. The audit systems focus on overbilling and unorthodox treatment rather than fraud.

These circumstances allowed a high school dropout using a laptop computer to bilk the federal government out of $105 million.