In the largest series of arrests for Medicare fraud to date, 243 health care workers—including 46 doctors, nurses, and other licensed medical professionals—were nabbed in a nationwide sweep. The Medicare Fraud Strike Force, which includes personnel from the FBI, the Department of Health and Human Services (HHS), the Department of Justice (DOJ), and local law enforcement organizations, led the takedown in 17 areas over the course of three days. It is alleged that the health care professionals generated roughly $712 million of fraudulent Medicare billings. Continue reading
Educational loan abuse and fraud are starting to see their share of whistleblowers bringing cases under the False Claims Act (FCA). Student loans taken under dubious circumstances have become multi-million-dollar moneymakers at for-profit schools like ITT and the University of Phoenix.
In February, 2016, the US District Court of South Carolina awarded a default judgment of $9,283,123 against Lacy School of Cosmetology and its president, Earnest “Jay” Lacy, for false claims involving the US Department of Education and federal student loans and grants. The suit was filed under the qui tam provisions of the FCA, which enables private citizens to bring civil actions on behalf of the government and to receive a share of the recovery. Continue reading
Two whistleblowers—a cardiac nurse and a healthcare consultant—are sharing more than $3.5 million, which is their portion of a $23 million qui tam False Claims Act settlement. The case, which was resolved mid-February of 2016, involved 51 hospitals that allegedly disobeyed Medicare rules regarding coverage of implanting heart defibrillation devices.
The hospitals in 15 states were allegedly charging for implanting cardioverter defibrillators, or ICDs, in patients who weren’t supposed to receive them under certain rules. An ICD functions similarly to an external defibrillator, delivering a shock to the patient’s heart when an abnormal heart rhythm is detected. The difference is that the ICD is small enough to be implanted in the chest, near the heart. Only patients who have specific health characteristics and risk factors are eligible for ICD reimbursement under Medicare rules. Each pocket-watch-sized device costs about $25,000. Continue reading
On December 3, 2015, the District of South Carolina’s U.S. Attorney’s Office announced that it had collected over $7 million during fiscal year 2015 for U.S. taxpayers in various criminal and civil cases. In criminal actions, roughly $4.4 million was received, while for civil actions, the amount was almost $2.7 million. Most of the $7 million collected came from False Claims Act and whistleblower actions. Continue reading
Whistleblower cases involving the Veterans Administration (VA) took a significant upturn in fiscal year 2015, according to the Office of Special Counsel (OSC). Although it is small—with only 140 employees—and independent, the agency’s job is to protect whistleblowers and other federal employees from prohibited personnel actions. The OSC’s 2015 whistleblower disclosures rose 56 percent from 2014, for a total of 755 disclosures for the fiscal year. A large amount of the increase is the result of a waterfall of new cases from the VA. Continue reading
When you think of Medicare fraud, ambulance services might not come to mind. After all, in a life-threatening situation, you’re going to call 911 for an ambulance. You’re not going to think about kickbacks, unnecessary procedures, upcoding, and other deceitful practices happening in the ambulance industry. And yet, ambulance fraud is big business for some Medicare suppliers. Continue reading
Settlements and judgments from cases involving fraud and false claims brought under the False Claims Act (FCA) totaled more than $3.5 billion in fiscal year (FY) 2015. That makes four years in a row that FCA recoveries have exceeded $3.5 billion. Of that $3.58 billion for FY 2015, a record amount—$2.91 billion—was recovered by the government because of cases initiated by whistleblowers. Continue reading
You’d think that Congress would take care of its own. When it comes to benefits, it seems as if they always do. So it might astonish you to know that, of all the classes of people protected by whistleblower laws, Congressional staffers have been left out in the cold. They are not protected.
In October, 2015, Major Bradley Podliska was fired while working for the House Select Committee on Benghazi. Major Podliska claims he was fired because he would not restrict the focus of his inquiry to former Secretary of State Clinton and the State Department. Continue reading
The U.S. Securities and Exchange Commission (SEC) has released its annual accounting to Congress regarding the Dodd-Frank Whistleblower Program. The latest report disclosed a 30 percent rise in whistleblower tips since 2012. In fiscal year (FY) 2015 alone, nearly 4,000 tips were collected.
But that’s not all that the report revealed. While whistleblower confidentiality must be upheld according to Dodd-Frank, the latest report noted certain characteristics that the whistleblowers have in common, by aggregating personal information.
One of the positives to arise from the 2008 financial crisis was the stiffening of regulations, and the protection of whistleblowers, regarding securities fraud, with the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010. Under Dodd-Frank, the Office of the Whistleblower was established for the Securities Exchange Commission (SEC) to encourage those who have information about securities and commodities laws violations to notify the authorities. The Commodity Futures Trading Commission (CFTC) has similar rules and regulations under Dodd-Frank.
If you believe you have legally actionable information regarding securities or commodities fraud, we hope this page will answer your questions. But if concerns still weigh on you, we hope you will contact us at the Louthian Law Firm.