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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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Book: New Pretrial Advocacy Book Addresses New Norms in Transformed Field of Litigation

A new book on pretrial advocacy, published this week by the National Institute for Trial Advocacy (NITA) and Wolters Kluwer, takes on a world of litigation that has been radically transformed in recent years by remote proceedings and other practice norms that often deliver resolution long before litigants face off in the courtroom. (Available in print and e-book here.)

In Pretrial Advocacy, authors Reuben A. Guttman and J.C. Lore address the challenges of litigating in a civil justice system that is overburdened yet essential to implementation of the rule of law. Even as nearly 90% of all civil matters never come before a jury, lawyers must nevertheless prepare cases as though they will. Because modern civil litigation is, the authors say, “front loaded,” lawyers are challenged early on in the pretrial process to consider the rules of evidence and civil procedure as they gather information to plead a plausible complaint.

“The pretrial process is laden with unwritten norms. All parties, from litigants to jurists, struggle to provide efficient resolutions while balancing due process,” said Lore, a Distinguished Clinical professor and Director of Trial Advocacy at Rutgers Law School. “We wanted to write something that explains it all.” The strategies and techniques outlined in Pretrial Advocacy put forward responsive new approaches to teaching advocacy in both law school and continuing legal education settings.

In addition to practical tips and insights from some of the nation’s foremost jurists and practitioners, Pretrial Advocacy features a foreword by retired U.S. District Court Judge for the District of Massachusetts and Harvard Law faculty member Nancy Gertner. “Pretrial Advocacy fills an important space for litigators,” Gertner said. “It teaches how to try cases from the moment  a client contacts the lawyer through the trial, encouraging lawyers to engage in strategic decisions about pretrial discovery and motion practice. Why depose this witness rather than another?  What is the purpose? What are the salient documents—not every single one, not just the few ‘gotcha’ documents, but those that build the narrative.”

Pretrial Advocacy closes with chapter dedicated to public interest litigation. “We thought a chapter on public interest litigation was necessary because there are too many people—from immigrants to victims of race and gender discrimination and whistleblowers—seeking to have their voice heard, and they need competent representation,” said Guttman. Guttman is a founding partner of the Washington, D.C. law firm of Guttman, Buschner & Brooks, PLLC, where he has represented clients in False Claims cases in matters returning more than $6 billion to the United States government.

Guttman and Lore are available to the media to comment on matters in civil litigation and the civil justice system.


Book Available HerePretrial Advocacy is the ideal textbook for law school clinics, law school  pretrial litigation courses, and practicing lawyers. Both practical and theoretical, it teaches litigation as a process informed by rules and cases, but also by strategic considerations. Its hands-on and accessible text makes it a perfect reference for learning skills and a continuing reference.

Learn more 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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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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Texas Heart Hospital to Pay $48 million to Resolve Allegations of False Claims

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

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