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Whistleblowers and fears of losing funds key to enforcing U.S. vaccine rules

Workplace whistleblowers and a fear of losing federal funds are expected to play vital roles in ensuring compliance with COVID-19 vaccine mandates ordered by President Joe Biden’s administration for U.S. businesses, nursing homes and hospitals, according to experts.

Biden announced last Thursday that his administration will enforce the vaccine mandates starting on Jan. 4. The rules apply to employers with at least 100 workers, federal contractors and employees of nursing homes and other healthcare facilities that receive reimbursements under the Medicare and Medicaid government healthcare programs.

On Saturday, a federal appeals court suspended the new vaccine and testing requirement for private companies while the court considers it in more depth. It gave the Justice Department until late Monday to respond. The portion of the mandate for the healthcare sector is not affected by Saturday’s ruling.

If the rule goes into effect, the U.S. Occupational Safety and Health Administration (OSHA), which enforces work safety rules, is not likely to immediately swoop in to ensure that vaccination and testing rules are being followed, experts said.

The Centers for Medicare & Medicaid Services (CMS), the regulator for the two federal health programs, does not typically survey accredited healthcare providers unless there is a complaint or a need for recertification, according to Sandy DiVarco, a partner at the firm McDermott Will & Emery who represents healthcare providers.

Since patients and clients do not have access to staff vaccination records, those complaints would likely come from another staff member, DiVarco added.

“On a stakeholder call, CMS reiterated their desire to work with providers to come into compliance and not to sort of send SWAT teams to go out and look for problems,” DiVarco said.

Healthcare facilities could lose their access to Medicare and Medicaid funds if they fail to heed the vaccine requirements. Medicare serves people aged 65 and older and the disabled while Medicaid serves the poor.

“For most hospitals across the country not being able to participate in Medicare would be crippling,” said Akin Demehin, the American Hospital Association’s director of policy.

The healthcare workers mandate applies to more than 10 million employees, around 70% of whom already have been vaccinated. It covers around 76,000 healthcare providers that receive Medicare or Medicaid reimbursements including hospitals, nursing homes, dialysis centers, ambulatory surgical settings and home-health agencies.

For the private employer rules, OSHA has an estimated 800 safety and compliance inspectors to cover more than 100,000 companies covered by the mandate. The agency likely will rely on whistleblowers concerned about unvaccinated co-workers or that unvaccinated people are not being tested as required, said James Hermon, a labor and employment expert with the firm Dykema Gossett.

Hermon predicted that OSHA will hit a couple of big employers with major fines soon after the mandate takes effect.

“That will be done intentionally to put some virtual heads on spikes,” Hermon said. Each violation can bring a fine of nearly $14,000.

The financial threat from a federal law called the False Claims Act, which rewards whistleblowers for reports of fraud that results in losses for the government, might ensure compliance with the vaccine rules better than OSHA’s penalties, according to one expert.

“We’re interested in these cases and we’ve been looking at them,” said Reuben Guttman, a whistleblower lawyer with the firm Guttman, Buschner & Brooks, who said he has been talking to unions. “The idea of using the False Claims Act to enforce health and safety standards is not novel.”

(Reporting by Diane Bartz, Ahmed Aboulenein and Tom Hals; Editing by Will Dunham)

Source: https://kfgo.com/2021/11/08/whistleblowers-and-fears-of-losing-funds-key-to-enforcing-u-s-vaccine-rules/.

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Reuben A. Guttman, District of Columbia Fellow, Co-Publishes “Pretrial Advocacy”

District of Columbia Fellow Reuben A. Guttman has co-authored a new book, “Pretrial Advocacy,” to be released by the National Institute for Trial Advocacy. (Now available in print and e-book here.) The volume, which was also written by Rutgers Professor J.C. Lore, discusses the “unwritten rules” of pre-trial preparation and grapples with the challenges of efficiently developing cases that can stand up to jury scrutiny in the face of overflowing demand, even though 90% of civil cases never make it to trial.

If anybody is qualified to talk about effective legal advocacy, its Reuben Guttman. The Guttman, Buschner & Brooks founding partner has spent his 36-year career releasing staggering sums of money from the grasps of oil refineries, pharmaceutical organizations, and prisons who have run afoul of laws such as the False Claims Act and the Federal Fair Labor Standards Act. Mr. Guttman, who started his legal career as counsel for the Service Employees International Union, AFL-CIO, is a whistleblower’s best friend—in 2015, he helped Florida’s Lynn Szymoniak gain an $18 million settlement after she uncovered a fraudulent foreclosure scheme that threatened to undermine her own housing and that of thousands of other homeowners.

In addition to being a legal superstar, Mr. Guttman is a familiar figure in the academy and the press. When he isn’t giving his time to Emory University School of Law as an adjunct professor, journal advisor, or board member, he’s writing for or being quoted in more than 30 journals and media outlets as varied as The New York Times and Peking University Public Interest Law Journal. Mr. Guttman’s international influence stretches from the U.S. federal government, where he has testified before Congress and advised President Clinton’s transition team, to as far away as China, where he has offered his thoughts on Chinese labor laws at the Dutch Embassy and lectured at universities in Shanghai and Beijing.

Source: American Bar Foundation.

Now Available in print and e-book here.

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Oglethorpe Inc. Agrees to Pay $10.25 Million to Resolve False Claims Act Lawsuit

Florida based Oglethorpe Inc. and it’s three Ohio treatment facilities will pay $10.25 million to settle allegations of illegal patient kickback provisions, unnecessary inpatient admission, and the resulting submission of false claims to Medicare. The suit alleged that Oglethorpe’s treatment centers, which include two inpatient psychiatric hospitals and one substance abuse treatment facility, provided free long-distance transportation to induce patients to seek treatment at the facilities. Claims submitted to Medicare or Medicaid for services provided to these patients violate the Anti-Kickback Statute and therefore constitute false claims. The government also accused Oglethorpe of submitting claims for medically unnecessary inpatient admissions and associated services, which are also false claims.

The civil settlement resolves claims that were brought under the qui tam or whistleblower provision of the False Claims Act. The whistleblower in this case, a former client advocate at one of Oglethorpe’s facilities, will receive a percentage share of the total funds recovered.

Read the DOJ press release here: https://www.justice.gov/opa/pr/ohio-treatment-facilities-and-corporate-parent-agree-pay-1025-million-resolve-false-claims

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With Biden Team Focused On Other Crises, Experts Say Drug Epidemic Is Exploding

“It’s a front-burner issue on any day of the week but not on this day… And that’s a real problem,” says firm Partner Reuben Guttman of the Biden administration’s current handle on the nations uncontrolled drug overdose rates. Read the full article, from NPR and WAMU 88.5, here: https://wamu.org/story/21/01/29/with-biden-team-focused-on-other-crises-experts-say-drug-epidemic-is-exploding/

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Insitu Inc. to Settle False Claims Allegations for $25 million

Washington State company Insitu Inc., an unmanned aerial vehicle contractor, has agreed to pay $25 million to settle allegations that it submitted false cost and pricing data for determination of contract value with the U.S. Special Operations Command and Navy. The lawsuit was built upon evidence that between 2009 and 2017 Insitu entered into multiple federal contracts that were based on pricing data for new parts and materials while the company fully intended to, and in fact did, purchase and use less expensive recycled or refurbished parts. The settlement was the result of a whistleblower complaint filed by a whistleblower and former executive of Insitu. The whistleblower will receive over $4.6 million from the recovery.

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