Posts Tagged ‘fraud’

Attorney General Nominee Pledges Support to Fight Fraud using False Claims Act

Alabama Senator Jeff Sessions is being questioned this week at confirmation hearings on his nomination for U.S. Attorney General by President-elect Donald Trump.  On Tuesday, Senator Sessions pledged his support to fighting fraud against the government and his support of the False Claims Act as a means to do so. Read More…

 

Expert: Fraud Leads to Poor Quality Healthcare

Photo by HFMA.org

Photo by HFMA.org

Harvard professor and healthcare expert Atul Gawande recently noted that the unnecessary medical care endangers patients and robs the taxpayers.  In a recent article published in The New Yorker, Gawande cited fraud as a significant contributor to what leading researchers describe as “low-value care.”  Gawande, a general surgeon, notes that ‘[d]octors get paid for doing more, not less,” and that a huge percentage of Medicare patients receive unnecessary and wasteful care.  You can read Dr. Gawande’s full article on The New Yorker’s website.


Excerpted in Part:

I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

 

 

James Hoyer Lead Investigator Explains Florida Fraud for the Tampa Bay Times

Al Scuderi- Lead Investigator James Hoyer Law FirmJames Hoyer’s lead investigator Al Scudieri was recently interviewed for an article about the abundance of fraud complaints in Florida by Robert Trigaux of the Tampa Bay Times.

Al’s theory as to why fraud is so prevalent in Florida is that:

Florida’s not only the third most populated, its population is different… I think we have a more affluent, elderly population. With a heavier concentration of those demographics in this state, they are the most susceptible…They are the ones bad people want to target.

You can read the full article here.

 

 

Health-Care False Claims Cases Reap $18.3 Billion, Report Shows

Whistleblower Award

Health-Care False Claims Cases Reap $18.3 Billion, Report Says

Stack Of CashFederal and state governments recovered $18.3 billion between 2008 and 2012 from lawsuits and criminal cases claiming health-care companies overbilled, according to an advocacy group that encourages whistle-blowers.

Taxpayers Against Fraud, a Washington-based group, released a study showing total health-care recoveries, excluding whistleblower payments, rose to $5.8 billion last year from $1.5 billion in 2008. Those totals include criminal fines and state false claims recoveries, two figures not normally tallied.

Still, recoveries are a small fraction of the $2.8 trillion the U.S. spends annually on health care, or 17.8 percent of the gross domestic product, according to the World Health Organization. Senator Charles Grassley, an Iowa Republican who sponsored a 1986 amendment that propelled the U.S. law forward, said the Justice Department should do more to deter companies than collect payments.

“Right now, it’s a cost of doing business,” Grassley said in an interview. “When it’s a cost of doing business, behavior isn’t going to change and criminal prosecution needs to be pursued. When you jail somebody, it makes a bigger point than any fine you’re going to get.”

The health-care recoveries involve dozens of companies, including Pfizer Inc. (PFE:US), the world’s biggest drugmaker; GlaxoSmithKline Plc (GSK), the biggest U.K. drugmaker; Merck & Co. (MRK:US), the second-biggest U.S. drugmaker by sales; and McKesson Corp. (MCK:US), the largest U.S. pharmaceutical distributor. Many of the settlements involve corporate integrity agreements pledging compliance with the law.

29 States

Most cases were filed under the federal False Claims Act, the law that lets citizens sue on behalf of the government and share in any recovery. Twenty-nine states have similar laws. Most of the recoveries by the U.S. between 1987 and 2012 were in health-care cases, where the government recovered $24.1 billion, according to Justice Department statistics.

Between 2008 and 2012, the civil U.S. recoveries amounted to $9.4 billion, according to the Justice Department. The TAF report shows that criminal fines associated with false claims recoveries over the same period were $4.5 billion, while state recoveries were $4.4 billion. Taken together, the civil, criminal and state false claims recoveries account for the five-year total of $18.3 billion.

Whistle-Blowers

Whistleblowers over that period collected $1.4 billion beyond the $9.4 billion paid to the U.S. The law allows whistle-blowers to recover between 15 and 30 percent. Not every case settled by the U.S. was initiated by whistle-blowers.

The TAF report argues that the federal government recovers about 20 times more than it spends on investigations and prosecutions of health-care fraud cases.

Whistleblowing is increasing in other sectors, including finance and taxation. With programs in place at the Securities and Exchange Commission, the Internal Revenue Service, and the U.S. Commodity Futures Trading Commission, many more cases are coming, according to Patrick Burns, co-executive director of TAF.

“We are on the edge of a new era of incentivized integrity programs,” said Burns. “It takes a long time to investigate, negotiate and litigate these cases, but I think we will see billions recovered under these programs in the years ahead.”

If you believe you have information regarding fraud against the government and are considering bringing a False Claims Act case, please contact James Hoyer for an evaluation of your claims. Click here for more information about the firm, and to submit your information electronically, or you may contact our office at 813-397-2300.

If you believe you have information regarding fraud against the government and are considering bringing a False Claims Act case, please contact James Hoyer for an evaluation of your claims.  Click here for more information about the firm and to submit your information electronically, or you may contact our office at 813-397-2300. – See more at: http://www.jameshoyer.com/supreme-court-denies-cert-in-allison-engine-retroactivity-case/#sthash.PgY15ire.dpuf

 

 

Overview of the SEC Whistleblower Program

The Whistleblower Program is designed to aid the SEC’s efforts to protect investors from those who violate the securities laws by encouraging those who are aware of misconduct to come forward to report it to us so that prompt and effective action can be taken to prevent or stop the misconduct.”

—Sean X. McKessy, Chief, Office of the Whistleblower

In response to the fiscal crisis of the late-2000s, Congress passed the Dodd-Frank Wall Street Reform and Consumer Protection Act in 2010.  Commonly referred to as “Dodd-Frank,” the legislation restored much of the regulatory authority that had deteriorated over the previous decades.  The authors of the legislation recognized the crucial role that whistleblowers have served in exposing corporate fraud and protecting the public coffers.  Therefore, as part of these reforms, Dodd-Frank created the Securities and Exchange Commission’s Office of the Whistleblower.

The Office of the Whistleblower rewards citizens for exposing violations of the federal securities laws and offers protections in the event that employers retaliate against employees who report the abuse to the Securities and Exchange Commission (“SEC”).  Specifically, Dodd-Frank authorizes the SEC to provide monetary awards to eligible individuals who come forward with high-quality, original information that leads to a SEC enforcement action in which over $1,000,000 in sanctions is ordered. The range for awards is between 10% and 30% of the money collected.  Prior to Dodd-Frank, whistleblowers could seek rewards from the SEC of up to only 10% of regulatory penalties.

According the SEC, an eligible whistleblower “is a person who voluntarily provides us with original information about a possible violation of the federal securities laws that has occurred, is ongoing, or is about to occur.”  If the information provided causes the SEC to initiate a new investigation, re-open a previously closed investigation, or pursue a new line of inquiry in connection with an ongoing investigation, and the SEC brings a successful enforcement action based at least in part on the information provided, the whistleblower may be entitled to a reward.

This is an exciting and promising development in the ongoing fight against taxpayer fraud.  The whistleblower program began operating in August 2011 and the first award was made just one year later in August 2012.  That first whistleblower received nearly $50,000, which was 30% of the amount collected in an SEC enforcement action against the perpetrators of the scheme.  Most recently, the SEC said three unnamed whistleblowers would each receive 5% of any sanctions collected in a Massachusetts federal court case against an investment fund that swindled its investors of nearly $2 million.  The SEC said in an administrative order that the whistleblowers “voluntarily provided original information to the commission that led to the successful enforcement” of the matter.

This is only the beginning.  According to Sean McKessy, chief of the SEC’s Office of the Whistleblower, “we are likely to see more awards at a faster pace now that the program has been up and running and the tips we have gotten are leading to successful cases.”

One of the primary reasons the SEC’s whistleblower bounty program is beginning to show signs of success is the number of safeguards in place to protect citizens who provide helpful tips.  Among the numerous protections afforded by Office of the Whistleblower, anyone wishing to provide information pertaining to securities fraud may do so anonymously.  However, in order to do so, you must have an attorney represent you in connection with your submission and you must also provide the attorney with a completed form signed under penalty of perjury at the time you make your anonymous submission.

The James Hoyer law firm has many years of experiencing representing whistleblowers and advocating on their behalf, including claims submitted anonymously to the SEC.  If you believe you have information regarding a possible violation of federal securities laws or regulations and are considering submitting your information to the SEC, please contact James Hoyer for an evaluation of your claims.  Click here for more information about the firm and to submit your information electronically, or you may contact our office at 813-397-2300.

Written by Sean Keefe