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False Claims Act Archives

The University of Rochester is ordered to repay Medicaid $100,000

The University of Rochester's Medical Center (URMC) has agreed to reimburse both the state and federal governments the $113,722.10 that they are alleged to have illegally pocketed. URMC is alleged to have violated both the New York False Claims Act as well as federal law when it improperly used a billing code in filing claims through its Flaum Eye Institute.

New York False Claims Act and tax fraud Qui Tam litigation, P.2

Last time, we mentioned that some states are currently looking at New York's whistleblower statute as a possible model for prosecuting tax fraud. As we noted, there are currently nine states which allow whistleblowers to pursue Qui Tam cases based on tax fraud. Not surprisingly, efforts to expand False Claims Act coverage to tax code violations are not universally supported.

New York False Claims Act and tax fraud Qui Tam litigation

As we've previously written on this blog, whistleblower or Qui Tam litigation is a means for those who have inside information regarding fraud to file a claim on behalf of the government. Qui Tam litigation allows whistleblowers to assist in holding the offending business liable for fraud and to obtain a reward for doing so.

Qui tam plaintiffs have legal protections

One of the greatest legal tools in the arsenal of the federal government is the False Claims Act, which is often referred to as "Lincoln's Law." This law allows the federal government to combat fraud, which is a difficult undertaking for such a large entity that contracts with myriad parties and other entities. It would be impossible for the federal government to do this without whistleblowers -- and that is what the False Claims Act is all about.

What is actually 'worthless' under the FCA?

One of the key questions in qui tam cases is whether the services the federal government was billed for were “worthless.” Essentially, the question examines whether the entity at issue provided services that were worth less than they should have cost, or whether they had no value whatsoever. This is a question that has vexed a number of appeals courts that have grappled with qui tam cases involving a worthless services theory.

What can motivate a whistleblower?

While national news headlines focus on divisive politics and ineptness, fraud against the federal government remains a pervasive problem. In fact, healthcare based FCA cases have garnered quite a bit of interest from federal officials in the past few years. Since 2009, the U.S. Department of Justice has recovered more than $24 billion in funds from providers, with a majority coming as settlements (and verdicts) based on fraud perpetrated through federal health care programs. Additionally, the Justice Department announced that healthcare related FCA cases would be reviewed by the Criminal Division for prosecution.

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