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.
The DOJ has announced that Texas Heart Hospital of the Southwest LLP and its subsidiary THHBP Management Company, LLC have agreed to pay the US $48 million to settle allegations that the hospital submitted claims to Medicare that were in violation of the Physician Self-Referral Law and the Anti-kickback Statute of the False Claims Act. The allegations of misconduct rest on the hospitals requirement that it’s owners, who are physicians, satisfy a yearly quota of 48 patient contacts in order to maintain ownership. Under the Physician Self-Referral Law, commonly known as the Stark Law, hospitals may not bill Medicare for services furnished by a doctor with which the hospital has a financial relationship, barring certain regulatory exceptions. The law is intended to ensure physicians operate in the best interest of their patients and not under the influence of improper financial inducements.
The settlement is the result of a qui tam complaint brought by two former Texas Heart Hospital physician owners. They will collectively receive almost $14 million as their share in the recovery.
Read the DOJ press release here: https://www.justice.gov/opa/pr/texas-heart-hospital-and-wholly-owned-subsidiary-thhbp-management-company-llc-pay-48-million
RIPPING OFF THE U.S. government has reached epidemic proportions. The Department of Justice estimates that fraud costs the Medicare system alone between $30-$60 billion annually. But instead of fines and jail time, fraudsters are frequently rewarded with more government business. And if the U.S. Chamber of Commerce and its allies have their way, these fraudsters will gain enhanced legal protection. The U.S. Supreme Court recently heard oral arguments in a critical case testing the right of citizens to bring suit in the name of the United States in order to recover damages from corporations or individuals that have cheated the government. By taking up the case known as Schindler Elevator, the high court is looking into whether a private citizen can secure information from a Freedom of Information Act request and use that information to form the basis of a qui tam or False Claims Act whistleblower lawsuit…
Read the complete article here: https://www.law.com/corpcounsel/almID/1202489937878/
Oakland, CA based Kaiser Foundation Health Plan has agreed to pay $6.3 million to settle allegations that it submitted false Medicare Advantage patient diagnoses in order to receive inflated payments from Medicare.
Under the Medicare Advantage program, Medicare pays private insurers based on the cost of providing care for all recipients enrolled in their plans. Generally, patients with worse or more numerous diagnoses result in larger payments while healthier patients result in smaller payments.
The suit was brought by a former employee of Kaiser Health foundation. She will receive $1.5 million for her role in the settlement.
Read the full press release here: https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-63-million-settle-false-claims-act-allegations
San Diego based Guild Mortgage Company, participant in the Federal Housing Administration insurance program, has agreed to pay $24.9 million to resolve allegations that it caused the submission of false claims for recovery of defaulted home loans. Guild was accused of violating the False Claims Act by knowingly approving ineligible home ownership loans then recovering the insurance payments when the loans defaulted. Prior to underwriting a federally insured loan, mortgage companies participating in the FHA mortgage insurance program must review it for compliance with FHA rules and loan quality control.
The suit was brought under the qui tam provision of the False Claims Act. The whistleblower, former head of quality control at Guild, will receive nearly $5 million for his role in the case.