false claims actaapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c...the false claims act...
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FALSE CLAIMS ACT
(WHISTLEBLOWER) 101
Presented by:
Jeffrey W. Dickstein and Amy L. Easton
Phillips and Cohen LLP
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Origin of the FCA
Enacted in 1863 in response to rampant fraud against the Government committed
during the Civil War:
“For sugar, it often got sand; for coffee, rye; for leather, something no better than
brown paper; for sound horses and mules, spavined beasts and dying donkeys; and
for serviceable muskets and pistols, the experimental failures of sanguine inventors
or the ruse of shops and foreign armories.”
Originally Known As Lincoln’s Law
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The FCA 31 U.S.C. §§3729 et seq. essentially imposes liability for:
(A) presenting, or causing to be presented, a false or fraudulent claim for payment
or approval;
(B) making, using, or causing to be made or used, a false record or statement
material to a false or fraudulent claim;
(C) conspiring to commit a violation of the FCA; and
(G) Making, using or causing to be made or used a false record or statement
material to an obligation to pay or knowingly conceal or knowingly and improperly
avoid or decrease.
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The False Claims Act
•Imposes treble damages and civil penalties; and
•Actions under the FCA can be initiated by
whistleblowers who are entitled to a share
between 15-30%
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DOJ Healthcare Fraud Statistics—FY 2016
Department of Justice recovered $4.7 billion from FCA cases (settlements and
judgments) in 2016
• $2.6 billion from the health care sector
• most--all but $100 million recovered in the health care cases are from qui tam actions
501 FCA health care fraud cases filed by whistleblowers
• $ 2.5 billion recovered from health care whistleblower cases
• $ 450 million paid in whistleblower awards
• $ 71 million recovered from whistleblower cases declined by the Government
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Types of Healthcare Cases
• Kickbacks
• Upcoding
• Pharma
• Devices
• Medically unnecessary services
• Cost report fraud
• Hospice and home health
• Skilled nursing facilities
• Nursing homes/worthless services
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What does it mean to be a whistleblower?
• Risks and rewards
• Good information; don’t have to be an insider, but
must have knowledge
• Evidence to prove your case
• Specific examples of the fraud
• An issue that matters to the Government
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Dynamics with Defendants
• Defendants dislike whistleblowers
• Legal protection from retaliation, 31 U.S.C. 3730(h), but may lose employment
• May bring counterclaims
• Confidentiality agreements and severance package agreements
• Defendants delay and deflect
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Dynamics with Government
• It is the Government’s case
• They investigate with assistance from CMS and OIG
• They determine whether to pursue the case
• Whistleblowers can still pursue without DOJ, but success is more difficult
• Most cases are not pursued by DOJ- only about 20%
• Cases on average take several years or more
• Rewards are not always large
• But can really right wrongs!
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Questions?
Jeffrey W. Dickstein Amy L. Easton
Phillips and Cohen LLP Phillips and Cohen LLP
[email protected] [email protected]
(305) 372-5200 (202) 833-4567