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We are attorneys that investigate False Claims Act cases nationwide, including in the state of New Jersey for Medicare fraud, tax fraud, contractor fraud and more against a range of employers including healthcare providers, medical device companies, defense contractors, and pharmaceutical companies. We stand ready to provide a free case evaluation to you; please call us today.

FIGURES PUBLISHED BY GOVERNMENT

In its Semiannual Report to Congress, the Department of Health & Human Services (HHS) Office of Inspector General (OIG) today announced expected recoveries of about $6.9 billion from audits and investigations. The report highlights OIG accomplishments for the second half of FY 2012 (April 1, 2012 – September 30, 2012) and for FY 2012 in total.

“OIG has been at the forefront of fighting waste, fraud, and abuse in Medicare, Medicaid and more than 300 other HHS programs for more than 30 years,” said Inspector General Daniel R. Levinson. “We’ve made significant progress over the past year with the help of a dedicated, professional staff and the collaborative efforts of our government partners. In the coming months, we’ll continue our work protecting the integrity of HHS programs and the health and welfare of the people they serve.”

The $6.9 billion in expected recoveries consists of $923.8 million in audit receivables and $6 billion in investigative receivables. In addition, OIG reported $8.5 billion in estimated savings resulting from legislative, regulatory, or administrative actions that were supported by our recommendations. Such savings generally reflect third-party estimates (such as those by the Congressional Budget Office) of funds made available for better use through reductions in Federal spending.

OIG also excluded 3,131 individuals and entities from participation in Federal health care programs in FY 2012. OIG reported 778 criminal actions against individuals or entities that engaged in crimes against HHS programs; and 367 civil actions, which include false claims and unjust enrichment lawsuits filed in Federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

Additional highlights of OIG accomplishments for FY 2012 include:

• Medicare Fraud Strike Force efforts resulted in the filing of charges against 305 individuals or entities, 181 convictions, and $151 million in investigative receivables. The strike force teams coordinate law enforcement operations conducted jointly by Federal, State, and local law enforcement entities. The teams, now a key component of the Health Care Fraud Prevention and Enforcement Action Team, have a record of successfully analyzing data to quickly identify and prosecute fraud.
• A May 2, 2012 nationwide takedown involved $452 million in false billing – the highest amount of Medicare false billings in a single takedown. Over 200 OIG Special Agents, Forensic Examiners and Analysts participated in Medicare Fraud Strike Force operations in 7 cities that resulted in charges against 107 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes.
• GlaxoSmithKline (GSK) agreed to pay $3 billion to resolve violations regarding its marketing and promotion practices associated with several drugs. In three False Claims Act settlement agreements, the United States alleged that GSK promoted several drugs for off label uses and paid kickbacks to induce the prescription of certain drugs, improperly promoted certain drugs with false and misleading statements about the drugs’ safety, and violated the requirements of the Medicaid drug rebate program. As part of the settlement, GSK entered into a 5-year Corporate Integrity Agreement with OIG. In addition to the settlement with the Federal government, GSK entered into separate Medicaid related settlements with multiple States.
• In Gaps Continue in Nursing Home Preparedness and Response During Disasters, OIG found that from 2007 to 2010, most nursing homes nationwide met Federal requirements for written emergency plans and preparedness training. However, plans lacked relevant information, including only about half of the tasks on the CMS checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems. State long term care ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters. States reported making some efforts to assist nursing homes during disasters, mostly related to nursing home compliance issues and ad hoc needs.
• Two audits revealed that payments for evaluation and management services (E/M) do not always reflect the actual services provided for cardiovascular and musculoskeletal surgeries. Reviews of Medicare claims for cardiovascular and musculoskeletal surgeries in 2007 revealed that Medicare’s payment methodology often did not reflect the actual number of preoperative and postoperative physician E/M services actually provided to beneficiaries, resulting in wasteful spending. The physician fee schedule includes global surgery fees for the surgical service and the related E/M services provided during the global surgery period, which, for major surgeries, includes the day before the surgery, the day of the surgery, and the 90 days after the day of the surgery. In determining a global surgery fee, Medicare estimates the number of E/M services that physicians provide to typical beneficiaries receiving such surgeries and compensates physicians regardless of the E/M services actually provided. For the two types of surgeries, we estimated that Medicare paid a net $63 million in E/M services that were not provided in 2007.
• The report Questionable Billing by Community Mental Health Centers revealed that in 2010, about half of community mental health centers (CMHC) met or exceeded thresholds that indicated unusually high Medicare billing for at least one of nine questionable billing characteristics related to partial hospitalization programs (PHP). PHPs are intense, structured, outpatient mental health treatment programs. We found that about 90 percent of CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.
• OIG is responsible for overseeing the activities of all State Medicaid Fraud Control Units (MFCU or Unit) and publishes periodic onsite review reports. In Medicaid New York State Medicaid Fraud Control Unit: 2011 Onsite Review, the New York MFCU filed criminal charges against more than 400 defendants, obtained more than 400 convictions, and was awarded more than $750 million in recoveries from fiscal years 2008 to 2010. Our review found a number of noteworthy practices, including the Unit’s approach to patient abuse and neglect cases, its list of ongoing investigations (created to avoid conflicts among investigating agencies), and its use of technology. Our report includes findings and recommendations with respect to staff size, training, file maintenance, and policies and procedures.
• The Administration for Families and Children (ACF) altered its FY 2011 triennial reviews to determine whether grantees kept on file the source documents proving children’s eligibility and began performing unannounced reviews. ACF promulgated draft regulations that, once final, will require grantees to keep eligibility documents on file. We found in the memorandum report ACF Strengthened Its Oversight of Head Start Eligibility in Fiscal Year 2011 that ACF was not consistent in issuing findings to grantees missing eligibility information in FY 2011 and that, in FY 2012, ACF took action to reduce this variation when issuing findings. Also, ACF developed an online complaint process for the Head Start program to capture complaints that could help the agency uncover problems with grantees. The review was a follow-up to Government Accountability Office (GAO) testimony at a May 2010 congressional hearing about potential eligibility fraud at eight Head Start grantees. At the same hearing, ACF committed to improving its oversight of eligibility. The report did not contain recommendations.

THE SCOPE OF FRAUD

Amazingly, some estimates have suggested that approximately 10% of the entire annual United States budget is lost to companies or individuals who are defrauding the government. The United States Federal budget for 2010 was $3.456 billion, meaning around $345.6 million was wrongfully wasted on fraud.

The entities defrauding the government do so in a variety of ways: Medicare or Medicaid fraud whereby they bill the government for services which they never provided or overbill for services that were provided; SEC Trading; Tax Fraud; TARP Fraud; Military/Defense contract fraud; Pharmaceutical Manufacturing;contract fraud involving any number of large government spending programs; or other types public benefit fraud.

HELPING THE PUBLIC.

As a whistleblower attorney, we are interested in speaking with persons willing to make known the truth about company practices and are willing to file a qui tam or whistleblower action. One area in particular we are interested in discussing are lawsuits involving medical device companies where the company is alleged to have overcharged, engaged in kickback programs, and the like. We will nevertheless investigate claims in a variety of areas.

Workers and persons all across the country witness actions at their work that may be unlawful or even corrupt. Unfortunately, some employees and workers feel that they will be fired, terminated, harrassed or punished if they report an unlawful or corrupt action. These reporters, however, are protected by the law as a Whistleblower and can receive compensation because of the False Claims Act or the Medicaid False Claims Act. If you have reported actions that may be fraudulent, then you should talk to a Whistleblower or qui tam lawyer about your facts.

Whistleblowers help the government to get back billions of dollars each year with the help of the False Claims Act. In fact, fraudulent Medicaid claims are also caught by whistleblowers having the Medicaid False Claims Act on their side. If you report a false claim or fraudulent action to the government, then the government will give you, the whistleblower, a part of the money that gets recovered. This is because of qui tam requirements. Qui Tam means that a person files a lawsuit for the king and also for him or herself. The phrase is qui tam pro domino rege quam pro se ipso in hac parte sequitur, or, “he who sues for the king as well for himself.”

These requirements and lawsuits were made popular during the Civil War when many people were getting away with fraudulent actions against the government. In 1986, the False Claims Act was amended to raise the total compensation given to people who reported fraudulent actions, or whistleblowers. If a whistleblower works with a lawyer then it may be possible for them to get three times the amount the government would get in damages and also get additional compensation for general fines.

TYPES OF CASES

The most common situations that could form the basis of a Qui Tam action include:

• Submitting a false or fraudulent record, bill or statement to the government in order to fraudulently obtain money such as reporting a medical service that was never performed for Medicare or Medicad;
• Conspiring with a third party to submit or present have a false or fraudulent claim to the government;
• Withholding property of the government with the intent to defraud or conceal the property from the government;
• Fraudulently buying property of the government from someone not authorized to sell that property; and
• Making a false statement to fraudulently avoid paying money to the government or to avoid delivering property to the government.

FOR HELP, PLEASE CONTACT US.

We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us.

Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more.

For more information, please contact our team of whitsleblower and qui tam attorneys today.

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