Difference between revisions of "False Claims Act"

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*Paying kickbacks [https://www.zuckermanlaw.com/sp_faq/violation-anti-kickback-law-also-violation-false-claims-act/ to refer patients] for services that will be reimbursed by Medicare
*Paying kickbacks [https://www.zuckermanlaw.com/sp_faq/violation-anti-kickback-law-also-violation-false-claims-act/ to refer patients] for services that will be reimbursed by Medicare
*[https://www.zuckermanlaw.com/sp_faq/false-claims-act-prohibit-fraudulent-inducement-contract/ Fraudulently inducing a contract], i.e., making false representations to induce the government to enter into a contract
*[https://www.zuckermanlaw.com/sp_faq/false-claims-act-prohibit-fraudulent-inducement-contract/ Fraudulently inducing a contract], i.e., making false representations to induce the government to enter into a contract
*[https://www.zuckermanlaw.com/sp_faq/false-claims-act-prohibit-bid-rigging/Bid rigging]
*[https://www.zuckermanlaw.com/sp_faq/false-claims-act-prohibit-bid-rigging/ Bid rigging]
*[https://www.zuckermanlaw.com/sp_faq/can-violation-good-manufacturing-practices-give-rise-false-claims-act-liability/ Violating good manufacturing practices]
*[https://www.zuckermanlaw.com/sp_faq/can-violation-good-manufacturing-practices-give-rise-false-claims-act-liability/ Violating good manufacturing practices]
*[https://scholar.google.com/scholar_case?about=7153274485431199107&hl=en&lr=lang_en&as_sdt=20000006&as_vis=1 Double-billing Medicare]
*[https://scholar.google.com/scholar_case?about=7153274485431199107&hl=en&lr=lang_en&as_sdt=20000006&as_vis=1 Double-billing Medicare]
*Defective pricing, including noncompliance with the requirement to submit current, accurate and complete certified cost and pricing data under the Truth in Negotiations Act
*Defective pricing, including noncompliance with the requirement to submit current, accurate and complete certified cost and pricing data under the Truth in Negotiations Act
*Inaccurate disclosure of pricing information and practices, such as Hewlett-Packard’s [https://www.justice.gov/opa/pr/hewlett-packard-agrees-pay-united-states-55-million-settle-allegations-fraud $55 million settlement] for providing incomplete commercial sales practices information to GSA contracting officers during contract negotiations and Informatica LLC’s [https://www.justice.gov/opa/pr/informatica-agrees-pay-2157-million-alleged-false-claims-caused-its-commercial-pricing $21.57 million settlement] to resolve allegations that it provided false information concerning its commercial discounting practices for its products and services to resellers, who then used that false information in negotiations with GSA for government-wide contracts.
*Inaccurate disclosure of pricing information and practices, such as:
**Hewlett-Packard’s [https://www.justice.gov/opa/pr/hewlett-packard-agrees-pay-united-states-55-million-settle-allegations-fraud $55 million settlement] for providing incomplete commercial sales practices information to GSA contracting officers during contract negotiations.
**Informatica LLC’s [https://www.justice.gov/opa/pr/informatica-agrees-pay-2157-million-alleged-false-claims-caused-its-commercial-pricing $21.57 million settlement] to resolve allegations that it provided false information concerning its commercial discounting practices for its products and services to resellers, who then used that false information in negotiations with GSA for government-wide contracts.
*Billing Medicaid for unnecessary medical services
*Billing Medicaid for unnecessary medical services
*Overbilling for services performed, such as Northrop Grumman’s [https://www.justice.gov/opa/pr/northrop-grumman-systems-corporation-pay-2745-million-settle-false-claims-act-allegations $27.45 million settlement] for overstating the number of labor hours its employees worked on two Air Force contracts by individuals stationed in the Middle East.
*Overbilling for services performed, such as:
*Providing defective products, such as Sapa Profiles Inc.’s [https://www.justice.gov/opa/pr/aluminum-extrusion-manufacturer-agrees-pay-over-46-million-defrauding-customers-including $34.6 million settlement] to resolve claims that it falsified thousands of certifications after altering the results of tensile tests designed to ensure the consistency and reliability of aluminum.
**Northrop Grumman’s [https://www.justice.gov/opa/pr/northrop-grumman-systems-corporation-pay-2745-million-settle-false-claims-act-allegations $27.45 million settlement] for overstating the number of labor hours its employees worked on two Air Force contracts by individuals stationed in the Middle East.
*Falsifying admission criteria and regularly diagnosing patients with “disuse myopathy,” an invented medical term meaning generalized weakness, in order to qualify for higher levels of reimbursement as an Independent Rehabilitation Facility (IRF).  *Encompass Health paid [https://www.justice.gov/opa/pr/encompass-health-agrees-pay-48-million-resolve-false-claims-act-allegations-relating-its $48 million] to resolve allegations that some of its IRFs provided inaccurate information to Medicare to maintain their status as an IRF and to earn a higher rate of reimbursement and that some admissions to its IRFs were not medically necessary;
*Providing defective products, such as:
*Creating a fraudulent joint venture to secure government contracts that are set aside for businesses that participate in the Service-Disabled Veteran-Owned Small Business program. In 2019, A&D General Contracting agreed to pay approximately [https://www.justice.gov/usao-sdca/pr/san-diego-contractor-sentenced-defrauding-federal-agencies-agrees-pay-32-million $3.2 million] for fraudulently obtaining over $11 million in government contracts which had been set aside for service-disabled veteran-owned small businesses.
**Sapa Profiles Inc.’s [https://www.justice.gov/opa/pr/aluminum-extrusion-manufacturer-agrees-pay-over-46-million-defrauding-customers-including $34.6 million settlement] to resolve claims that it falsified thousands of certifications after altering the results of tensile tests designed to ensure the consistency and reliability of aluminum.
*Violating the federal Anti-Kickback Statute and the FCA by billing millions of dollars for unlawfully forcing patients to endure 72-hour hospital stays for observation and mental illness treatment against their will. Pacific Health Corp. paid $16.5 million to settle claims that it doled out kickbacks for referrals of homeless patients and provided them with unnecessary treatments.
*Falsifying admission criteria and regularly diagnosing patients with “disuse myopathy,” an invented medical term meaning generalized weakness, in order to qualify for higher levels of reimbursement as an Independent Rehabilitation Facility (IRF).   
*Making improper payments to doctors to get them to write prescriptions for two Teva products. In 2020, Teva agreed to pay [https://www.bizjournals.com/philadelphia/news/2020/01/06/teva-agrees-to-pay-54m-to-settle-whistleblower.html $54M to settle a qui tam case] alleging that it paid doctors speaker fees and pricey to prescribe multiple sclerosis drug Copaxone and Parkinson’s disease drug Azilect.
**Encompass Health paid [https://www.justice.gov/opa/pr/encompass-health-agrees-pay-48-million-resolve-false-claims-act-allegations-relating-its $48 million] to resolve allegations that some of its IRFs provided inaccurate information to Medicare to maintain their status as an IRF and to earn a higher rate of reimbursement and that some admissions to its IRFs were not medically necessary.
*Paying doctors and kickbacks or financial incentives to get patient referrals.  In 2020, Agnesian HealthCare paid [https://www.fdlreporter.com/story/news/2020/01/06/agnesian-healthcare-pay-10-million-whistleblower-lawsuit/2824811001/ $10M to settle a qui tam case] alleging that its compensation plan for doctors violated the Stark Law, the Anti-Kickback Statute, the federal False Claims Act and the Wisconsin False Claims by rewarding and offering incentives to its network of affiliated doctors to refer Medicare and Medicaid patients exclusively to Agnesian doctors and facilities.
*Creating a fraudulent joint venture to secure government contracts that are set aside for businesses that participate in the Service-Disabled Veteran-Owned Small Business program.
**In 2019, A&D General Contracting agreed to pay approximately [https://www.justice.gov/usao-sdca/pr/san-diego-contractor-sentenced-defrauding-federal-agencies-agrees-pay-32-million $3.2 million] for fraudulently obtaining over $11 million in government contracts which had been set aside for service-disabled veteran-owned small businesses.
*Violating the federal Anti-Kickback Statute and the FCA by billing millions of dollars for unlawfully forcing patients to endure 72-hour hospital stays for observation and mental illness treatment against their will.
**Pacific Health Corp. paid $16.5 million to settle claims that it doled out kickbacks for referrals of homeless patients and provided them with unnecessary treatments.
*Making improper payments to doctors to get them to write prescriptions for two Teva products.  
**In 2020, Teva agreed to pay [https://www.bizjournals.com/philadelphia/news/2020/01/06/teva-agrees-to-pay-54m-to-settle-whistleblower.html $54M to settle a qui tam case] alleging that it paid doctors speaker fees and pricey to prescribe multiple sclerosis drug Copaxone and Parkinson’s disease drug Azilect.
*Paying doctors and kickbacks or financial incentives to get patient referrals.   
**In 2020, Agnesian HealthCare paid [https://www.fdlreporter.com/story/news/2020/01/06/agnesian-healthcare-pay-10-million-whistleblower-lawsuit/2824811001/ $10M to settle a qui tam case] alleging that its compensation plan for doctors violated the Stark Law, the Anti-Kickback Statute, the federal False Claims Act and the Wisconsin False Claims by rewarding and offering incentives to its network of affiliated doctors to refer Medicare and Medicaid patients exclusively to Agnesian doctors and facilities.
*[https://www.justice.gov/usao-mdfl/pr/villages-dermatologist-agrees-pay-more-17-million-settle-false-claims-act-liability Upcoding in the form of billing for 14,000-level tissue transfers], which should have been billed as lower-level wound repairs.
*[https://www.justice.gov/usao-mdfl/pr/villages-dermatologist-agrees-pay-more-17-million-settle-false-claims-act-liability Upcoding in the form of billing for 14,000-level tissue transfers], which should have been billed as lower-level wound repairs.
*Making misrepresentations regarding certified cost or pricing data in violation of federal procurement laws and regulations.  See 10 U.S.C. 2306a; 41 U.S.C. Chapter 35; FAR 15.403-4 and 15.403-5.
*Making misrepresentations regarding certified cost or pricing data in violation of federal procurement laws and regulations.  See 10 U.S.C. 2306a; 41 U.S.C. Chapter 35; FAR 15.403-4 and 15.403-5.