Monday, March 16, 2009

San Mateo County will settle FCA allegations for $6.8 million

San Mateo County, Calif., will pay the federal government $6.8 million to resolve allegations that the San Mateo Medical Center (SMMC) submitted false claims to Medicare and Medicaid.

The U.S. Dept. of Justice charged that the SMMC falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The suit also alleged that the county obtained Medicaid payments for services provided to patients at Institutes of Mental Disease (IMDs) who were ineligible for federal funding.

The suit originated as a whistleblower claim filed by a former county employee.

Healthways announces proposed settlement of qui tam lawsuit

Healthways, Inc. announced that it has agreed to a proposed settlement to resolve a whistleblower lawsuit filed under the False Claims Act.

The suit, which the Nashville Post says the government did not join, alleged that the company's former Diabetes Treatment Center of America business paid doctors for referrals.

The company has agreed to pay approximately $40 million to resolve the 15 year old suit: $28 million to the government and another $12 million in attorney's fees and other costs.

Thursday, March 12, 2009

Weill Cornell Medical College settles research grant suit

Weill Medical College of Cornell University will pay $2.6 million to resolve charges it violated the False Claims Act.

The suit, originally brought by a whistleblower, alleged that the college defrauded the government in connection with research grants awarded by the National Institutes of Health and the Dept. of Defense.

The U.S. Attorney for the Southern District of New York said in a press release that the college made false statements in grant applications. In one instance, a principal researcher failed to disclose the extent of her other projects, as required by federal guidelines. This deprived the government of its right to assess the researcher's ability to perform the projects in the grant applications. The researcher's commitments exceeded 100% of her available time.

Victory Memorial Hospital settles Medicare fraud suit

Victory Memorial Hospital has agreed to pay at least $2.3 million to resolve allegations brought in a whistleblower suit that it defrauded the Medicare program. The U.S. Attorney's Office for the Eastern District of New York announced the settlement under the False Claims Act.

The hospital, which operated as a not-for-profit in Brooklyn until May 2008, allegedly understated revenues from patients in its cost reports. This resulted in higher reimbursements from Medicare.

Feds intervene in suit against EMC alleging fraud

The United States has intervened in a whistleblower suit filed against EMC Corp. The suit alleges that EMC Corp. gave kickbacks to federal IT consultants and overcharged government agencies for hardware, software and services, according to a Dept. of Justice press release.

The company, the world's largest manufacturer of storage computers, is also alleged to have made false statements to the General Services Administration, the government's purchasing agency, about its commercial pricing practices in order to obtain a higher price on its contracts

Kansas cardiologist settles FCA suit

Joseph P. Galichia, M.D. and his practice group have agreed to pay the United States $1.3 million to settle claims that they violated the False Claims Act by submitting false claims to Medicare, the Justice Department announced.

The government alleged that claims were submitted for services not provided or
were submitted without proper documentation.

In May 2000, Galichia agreed to pay more than $1.5 million to settle a previous False Claims Act matter.

U.S. joins suit against Community Health Systems

The Dept. of Justice announced on March 6 that it has intervened in a whisleblower suit against Community Health Systems Inc. (CHS) and three of its hospitals in New Mexico.

The suit alleges that CHS and the hospitals violated the False Claims Act by knowingly causing to be presented to the United States false claims for federal matching Medicaid funds.

The New Mexico hospitals claimed payments under that state’s version of Medicaid’s “disproportionate share” (DSH) payment program, through which the federal government matches state and local funds to provide extra money to hospitals that treat a “disproportionate share” of low-income patients.

The whistleblower, Robert Baker, is represented by Peter W. Chatfield of the law firm of Phillips & Cohen LLP.

WV hospital settles Medicaid suit

Cornerstone Hospital of Huntington, WV, will pay $690,000 to settle a whistleblower suit brought under the qui tam provisions of the False Claims Act, according to a press release issued by the U.S. Attorney's Office.

Two former employees alleged that the hospital, a Long-Term Acute Care Hospital (LTCH), submitted false and fraudulent claims to Medicare. LTCHs are specialty care hospitals for extended-stay patients with chronic conditions. The qui tam complaint alleged that Cornerstone billed for supplies and services not rendered, unbundled services, submitted duplicate claims, billed for supplies and services rendered without a physician's order, billed for supplies and services without regard to medical necessity, and billed for services rendered by unqualified providers.

Whistleblowers not adequately protected from retaliation, GAO report concludes

A new report from the U.S. General Accountability Office concludes that whistleblowers who report illegal activities are not adequately protected from retaliation by their employers.

The report, Whistleblower Protection Program: Better Data and Improved Oversight Would Help Ensure Program Quality and Consistency, found these problems stem largely from a lack of resources and proper tracking of complaints, as well as a complicated patchwork of regulations that aim to protect whistleblowers.

The investigation was requested by U.S. Reps. George Miller (D-CA), Lynn Woolsey (D-CA) and U.S. Senator Patty Murray (D-WA). According to Rep. Miller's website, only one in five whistleblower complaints is successful.

“In the face of intimidation and retaliation, whistleblower protections are often the only thing that give workers the strength to stand up and speak out,” said Senator Murray. “While I’m troubled by the GAO’s findings, I was glad to see that President Obama proposed increased funding for Occupational Safety and Health Administration (OSHA) in his budget, which will help strengthen its ability to enforce whistleblower protections."