False Claims-Qui Tam

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Jordan Rau, Kaiser Health News

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians across the nation, the federal government charged in a lawsuit filed this spring.

In addition, Wheeling paid an obstetrician-gynecologist a salary as high as $1.3 million a year, so much that her department bled money, according to a related lawsuit by a whistleblowing executive. The hospital paid a cardiothoracic surgeon $770,000 and let him take 12 weeks off each year even though his cardiac team also routinely ran in the red, that lawsuit said.

Despite the losses from these stratospheric salaries and perks, the recruitment efforts had a golden lining for Wheeling, the government asserts. Specialists in fields like labor and delivery, pain management and cardiology reliably referred patients for tests, procedures and other services Wheeling offered, earning the hospital millions of dollars, the lawsuit said.
Continue Reading Kaiser Health News: Hospitals Accused Of Paying Doctors Large Kickbacks In Quest For Patients

The Department of Justice announced Thursday that two pain management clinics in northern Virginia have agreed to pay approximately $3.3 million to settle Medicare fraud allegation brought by a qui tam whistleblower.

The settlement resolves allegations that National Spine and Pain Centers (NSPC), and Physical Medicine Associates (PMA) fraudulently billed Medicare and other federal healthcare providers. The programs charged for physician services that were delivered by nurse practitioners. The case also involved the ordering medically unnecessary urine drug tests. The whistleblower was former PMA physician assistant.

The case follows news of whistleblower lawsuits moving forward against a Tennessee-based chain of pain clinics for a similar scheme.
Continue Reading Doctors and PA blow the whistle over sham urine tests at pain clinics

Retaliation against whistleblowers takes many forms. A little person working at the White House recently reported a supervisor moved files to a high shelf out of her reach. Others report being followed, shunned, smeared, fired and worse. Whistleblowers often find themselves in a hostile work environment.

Julie Myers Wood, a corporate compliance consultant, thinks that works against both whistleblowers and their employers. In-house reporting programs with whistleblower protections built in are the way to go, writes Wood, who has a resume filled with high level federal government positions.

Institutions must shift their mindsets to view the reporting of regulatory problems as an opportunity to shine by addressing the problem, improving the institution and preventing large settlements. 

In a column posted on the Forbes website Monday, she suggests companies work with whistleblowers to both protect the company and strengthen compliance.

Companies need to get to a place where they embrace the potential whistleblower by creating a transparent culture, instilling the shared value of compliance at all levels.

Her advice is not aimed at whistleblowers, some of whom have had bad experiences with in-house hotlines. Advocates suggest employees approach internal reporting systems carefully – they are there to protect the company and can be used against whistleblowers.

Wood encourages the development of internal reporting programs with the message – let’s try to keep this in house. For companies, that is a good thing. But whistleblowers have found that internal reporting isn’t always effective or to their advantage. They have other options. Working with law enforcement or government agencies, they can remain anonymous in many cases and often qualify for a reward.  …
Continue Reading Can companies protect workers, protect themselves and avoid creating a hostile work environment for whistleblowers?

Two major whistleblower awards were revealed late last week.

Reuters is reporting a $1.7 million award to three Takata employees who exposed problems in airbag inflators.

In a separate case, CareWell Urgent Care Centers will pay $2 million to two states and the U.S. Department of Health and Human Services (HHS) to settle a case involving both overbilling and unnecessary care. The walk-in clinics allegedly overbilled Medicaid and the insurance plan for state employees, according to a release issued Friday from Massachusetts Attorney General Maura Healey. 

The case was triggered after a former CareWell nurse practitioner came forward, according to a story in The Boston Globe.

Aileen Cartier, who worked at several of the company’s locations for almost two years, said managers told staff to take medical histories and perform exams on patients that far exceeded what was needed for their simple ailments. …
Continue Reading Health and Human Services whistleblower rewarded. NTSA whistleblowers take a different route

Duke University reported in January that its scientists won $384.6 million last year from the National Institutes of Health, “ranking 9th in the country among universities, research institutions and teaching hospitals that are awarded the taxpayer-based research dollars.”

This week, they had to give some of it back.

Duke has agreed to pay $112.5 million to the U.S. Government to settle a suit brought by a whistleblowing lab tech. The case involves another research technician who fabricated data from 2006 to 2013. The findings were used in applications for some of those NIH-funded studies.

The government investigation began after Joseph M. Thomas brought a qui tam case under the False Claims Act. Thomas’s share of the settlement will be $33,750,000.

The Justice Department announcement quoted U.S. Attorney Matthew G.T. Martin saying that taxpayers expect federal grant dollars will be used honestly.

“Individuals and institutions that receive research funding from the federal government must be scrupulous in conducting research for the common good and rigorous in rooting out fraud,” the statement notes.  “May this serve as a lesson that the use of false or fabricated data in grant applications or reports is completely unacceptable.”…
Continue Reading U.S. settles whistleblower False Claims Act suit. Duke University to pay $112 million in fabricated research data case

Title page Supreme Court case 18-31`5Members of the Supreme Court are skeptical of interpreting the statute of limitations in False Claims Acts cases in a way that would “help fraudsters,” according to attorney Stephen M. Kohn, who attended arguments today in a key False Claims Act case.

Kohn is author of an amicus brief in the case submitted on behalf of the National Whistleblower Center. A decision in Cochise Consultancy, Inc. v. United States, will determine the statute of limitations window for False Claims Act (FCA) cases when the government declines to intervene.

“The Justices appeared to understand the purpose of the False Claims Act is to help the government uncover fraud and were skeptical of interpreting the statute of limitations in a manner that would help fraudsters,” Kohn noted

More from Kohn’s report:

Demonstrating the Courts understanding as to why Congress would have wanted a longer statute of limitations when the relator moves a False Claims Act case forward, even without the government, Justice Sotomayor noted that, “in qui tam the recovery in bulk goes to the government.”…
Continue Reading Supreme Court justices described as “skeptical” of limiting statute of limitations for False Claim Act

The Supreme Court is scheduled to hear arguments on Tuesday in Cochise Consultancy, Inc. v. United States, a case that will determine the statute of limitations window for False Claims Act (FCA) cases when the government declines to intervene.

At issue: How should the statute of limitations apply in a qui tam suit in which the United States declines to intervene? Does the three-year limitations period begin to run from the date of the whistleblower’s knowledge of the alleged false claim? Or does it begin on the date of the government official’s knowledge of the alleged false claim?

The case revolves around whistleblower Billy Joe Hunt. In 2013, he filed a qui tam case alleging fraud by his former employer, a war contractor performing munitions clean-up work in Iraq in 2006. The government declined to intervene in Hunt’s case and it was dismissed by a district court. The Eleventh Circuit then allowed the case to go forward ruling that the FCA’s three-year limitations period was triggered by the government’s knowledge of the alleged fraud—not the whistleblower’s knowledge.

Those arguing in support of the Eleventh Circuit ruling include the federal government and a 20-state coalition. An amicus brief filed on the coalition’s behalf by the Indiana attorney general argues that the states have a “strong fiscal interest in ensuring the False Claims Act (FCA) provides adequate time to investigate, prepare, and file FCA claims.”…

Continue Reading Case before Supreme Court Tuesday will have a implications for qui tam whistleblowers

The Department of Defense Inspector General (DOD IG) should coordinate with the military services to do a better job of protecting whistleblower confidentiality and addressing delays in handling cases, according to a new report.

The Government Accountability Office report found the IG offices have made progress since past reviews, but needs to do more to protect confidentiality. The review found that employees without “the need to know” have had access to sensitive whistleblower information.

While the timeliness of handling cases has improved in some areas, delays persist in others, according to the report. For example, the average number of days to complete military and contractor reprisal investigations increased between 2017 and 2018 from 394 days to 541 days.

The DOD IG completed closed 73 investigations in 2018, including 13 senior official misconduct cases and 60 military, contractor, and civilian reprisal cases. However, about 85 percent of all investigations “did not meet the timeliness goals.”…

Continue Reading GAO: Department of Defense is getting better at dealing with whistleblowers, but has some work to do.

The False Claims Act (FCA) has long served as a powerful weapon against fraud and waste in government programs, from rancid Civil War rations to Medicare scams. The Department of Justice (DOJ) recovered $2.88 billion under the law last year, with whistleblowers involved in the majority of cases.

March 2 marks the anniversary of the law, which was signed in 1863 by President Abraham Lincoln. After the Civil War, the FCA continued to identify military contractors guilty of mismanagement and fraud. With rising health costs, much of it covered by Medicare, most cases now involve medical providers and suppliers. The DOJ’s December report noted that $2.5 of the $2.8 billion in recovery involved the health care industry. The first line of a story in the trade publication Modern Healthcare reports “Healthcare industry groups have always hated False Claims Act whistleblower lawsuits.”…

Continue Reading For more than 150 years, the False Claims Act has been key to ferreting out fraud in US military and health care spending.

When does the statute of limitations clock start running in a False Claims Act (FCA) case when the government declines to intervene in a whistleblower case?  That is the question the Supreme Court will consider when it takes up Cochise Consultancy, Inc. v. United States.

The National Whistleblower Center filed an amicus curiae brief in the case this week.

At issue: Must an FCA plaintiff rely on the statute of limitations in a suit in which the United States declines to intervene? If so, does the three-year limitations period begins to run from the date of the whistleblower’s knowledge of the alleged false claim, or from the date of the government official’s knowledge of the alleged false claim?

The brief, written by NWC board chair Stephen M. Kohn, notes that his organization takes the position that the “merits of a claim often bear no relation to the duration of a case.”…
Continue Reading Brief: Supreme Court needs to uphold False Claims Act statute of limitations as “clearly set forth in the law.”