Peter Budetti, director of Program Integrity at the Centers for Medicare and Medicaid Services, has focused his attention on fraud prevention, detection, and prosecution. On average, between $70 billion and $234 billion is lost annually due to healthcare fraud. Obama’s administration has also committed resources to minimizing fraud.
Sutter Hospital, a large hospital chain in Northern California, has had a qui tam lawsuit filed against them for false billing of anesthesia services. It is believed that the fraudulent amount is in the hundreds of million of dollars. Some of the billing codes for the services or supplies that Sutter Hospitals used were previously paid.
The Justice Department has intervened in a qui tam lawsuit originally filed in September of 2009 against ambulance company Rural/Metro Corp., alleging the company fraudulently billed Medicare and Medicaid for services provided to dialysis patients which were either not necessary or not rendered.
Senator Chuck Grassley, a champion of qui tam whistleblower protection is co-sponsoring legislation to update the 1989 Whistleblower Protection Act originally co-authored by Senator Grassley. The law currently provides protection from retaliation to federal employees who expose possible waste, fraud and abuse in federal agencies.
Telecommunications giant Verizon Communications, Inc. paid the United States $93,525,410.96 amid allegations that subsidiary MCI Communications Services, Inc. fraudulently overcharged the General Services Administration (GSA) for voice and data telecommunications services contracts. The government alleges that MCI billed the GSA for various federal, state and local taxes and surcharges, violating the terms of their contract and regulations in connection with FTS2001 and FTS 2001 Bridge contracts.
Ohio Attorney General Mike DeWine has voiced his support for a state False Claims Act (FCA) in Ohio. The FCA legislation was introduced by Republican Senators Jim Hughes of Columbus and Scott Oelslager of North Canton. Like most state False Claims Act and the federal FCA, the Ohio FCA would allow whistleblowers to provide information about alleged fraud in state spending and potentially share in any amount recovered should the case be successfully prosecuted.
The Justice Department recently filed a False Claims Act action against engineering and construction firm KBR, Inc., the prime contractor on the Army’s Logistics Civil Augmentation Program III contract. As the prime contractor, KBR provided logistics support services to US troops stationed in Iraq.
In a qui tam lawsuit brought by three former employees, Bristol-Myers Squibb (BMS) is accused of fostering a culture that encouraged kickbacks. In a document titled “Bristol-Myers Squibb Cultural Expectations” published for the companies’ sales reps, employees are encouraged to commit company funds and personnel to regions that can produce gains.
In 2005, Guidant (now a division of Boston Scientific) admitted to knowing for three years that their Ventak Prizm heart defibrilator could short circuit, leading to both unnecessary shocks to the heart as well failures to shock when necessary, but the medical device giant did nothing to alert physicians or the public.
In a split 2-1 decision March 28th, the 4th Circuit U.S. Court of Appeals upheld the automatic 60 day sealing provision of the False Claims Act. The suit, brought by the American Civil Liberties Union, the Government Accountability Project and OMB Watch, alleges the secrecy unlawfully blocks the public’s access to judicial proceedings and violates the whistleblower’s right to freedom of speech by forbidding them to discuss the misconduct.
If you are aware of any person, corporation or entity that you think may be violating the Federal False Claims Act or a State False Claims Act, contact us today.