Monday, December 29, 2008

Off-label whistleblower suit dismissed

A whistleblower suit alleging off-label promotion of a blood thinning drug has been dismissed by a federal judge in Chicago.

The suit, filed under the qui tam provisions of the federal False Claims Act, alleged that Aventis promoted off-label uses of Lovenox, thereby inducing doctors and hospitals to submit fraudulent Medicare claims.

Judge Matthew Kennelly ruled that Medicare claims filed as a result of the alleged off-label scheme were not “material” to the amount the government paid for treatment of any patient. He found that because Medicare reimbursement was based on a diagnosis group code tied to a patient diagnosis and age, and not tied to services given a patient, the Medicare claims could not have been false.

Yale will pay $7.6 million to resolve allegations of research grant mischarging

Yale University has agreed to pay $7.6 million to resolve allegations that it violated the False Claims Act and common law by mismanaging federally-funded research grants.

The grant awards were made by approximately 30 different federal agencies, including the Department of Health and Human Services, the National Science Foundation, the Department of Energy, the Department of Defense, and the National Aeronautics and Space Administration. These five agencies provided approximately 94 percent of the almost $3 billion in federal grant funding to the university between 2000 and 2006.

Investigators alleged that Yale researchers had improperly allocated charges to federal grants when the charges were not covered by that grant. It was also alleged that some researchers charged 100 percent of their time to federal grants when they in fact spent much of their time working on other projects.

Texas sleep clinic settles FCA suit

HMS Diagnostics has paid over $550,000 to settle allegations that it violated the federal False Claims Act, according to a press release from the U.S. Attorney's Office in Houston.

The government alleged that the HMSD, an independent diagnostic testing facility specializing in sleep disorders, violated Medicare rules and regulations by using uncertified technicians to administer polysomnograph sleep tests.

Friday, December 19, 2008

NY State recovers $551 million in improperly paid Medicaid funds

New York Governor David Paterson and State Medicaid Inspector General James Sheehan announced that the state recovered $551 million in funds lost to Medicaid fraud and abuse.

The federal government requires states to root out Medicaid abuses, and New York had agreed to find $215 million of wrongdoing, but in fact recovered more than twice the targeted amount. Last year, all 50 states recovered a combined $305 million, the governor said.

Thursday, December 18, 2008

KPMG survey finds business pressures lead to corporate misconduct

KPMG LLP, an audit, tax and advisory firm, has released a survey that suggests that ethics in companies and organizations may be trumped by pressures to succeed.

74 percent of the 5,000 U.S. workers surveyed said that they had personally observed misconduct within their organizations within the last 12 months.

Pressure to “do whatever it takes” to meet business goals was the most-cited cause of corporate fraud and misconduct, with 59 percent of respondents citing it. That was followed by belief that rewards will be based on results and not the means used to achieve them; the belief that the code of conduct is not taken seriously; lack of familiarity with the standards that apply to the job; and other reasons.

A summary of the survey's findings shows variations by industry, with 80 percent of government employees reporting that they witnessed misconduct, as compared to 73 percent of healthcare employees, and 65 percent of employees in the banking and finance inductries.

Tuesday, December 09, 2008

Aerospace company settles qui tam suit

L-3 Vertex Aerospace has paid the government $4 million to resolve allegations that the company overcharged the government on an Iraq war contract.

The False Claims Act suit, which was originally filed by a former employee as a whistleblower suit, accused the company of submitting false and inflated claims for hours worked maintaining helicopters at camp Taji, Iraq.

The U.S. Justice Department press release noted that the case was prosecuted as part of a National Procurement Fraud Initiative. The National Procurement Fraud Task Force was formed in October 2006 to promote the early detection, identification, prevention and prosecution of procurement fraud.

Thursday, December 04, 2008

Annual report on anti-fraud efforts in health care released

The Health Care Fraud and Abuse Control Program, a collaboration between the Justice Department and the Dept. of Health and Human Services has released its annual report.

The report shows that the government won or negotiated $1.8 billion in settlements in FY 2007 and paid out $122.8 million to whistleblowers.

The HCFAC program is designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse.

Tennessee hospitals settle FCA suits

Two Tennessee hospitals, Jackson Madison General Hospital and Milan General Hospital, have agreed to pay the federal government $2.6 million and $5.3 million respectively to settle false claims allegations.

The U.S. Attorney for the Western District of Tennessee announced the resolution on December 1st.

Jackson Madison was alleged to have violated the False Claims Act by submitting claims for non-emergency ambulance transportation that did not meet Medicare's standard of medical necessity.

Milan General Hospital settled allegations that it improperly admitted Medicare patients into its psychiatric unit.

Medical transcription service to pay$6.6 million to resolve qui tam suit

MedQuist Inc., a medical transcription service provider based in New Jersey, will pay $6.6 million to resolve False Claims Act allegations, the U.S. Dept. of Justice reported.

The company provided medical transcription services to several federal government clients, including the Department of Veterans Affairs (VA), the Department of Defense (DOD) and the Public Health Service (PHS). The suit, which was originally filed by whistleblowers under the qui tam provisions of the FCA, alleged that MedQuist knowingly overbilled these entities for medical transcription services.