Articles Tagged with public disclosure

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621493052-300x195Chicago – The Department of Justice issued an internal memorandum on January 10, 2018, which was soon released publicly and can be found here. The memorandum was quickly praised by the False Claims Act defense bar, but a reasoned review of the memorandum shows that the plaintiff bar should also welcome the policy statements outlined in the memorandum.

First, let’s establish a little background. The FCA is a statute that allows people to file a lawsuit on behalf of the government alleging that someone submitted a false claim or false or fraudulent demand for payment. These are typically Medicare or Medicaid claims, Department of Defense claims, or infrastructure projects. A person filing the lawsuit is known as a “relator” and is eligible to receive an award if the claim is successful. A relator is generally entitled to an award of between 15 and 30% of the amount the government recovers.

After a claim is filed the government conducts an investigation and decides whether to join the lawsuit by intervening or not join the lawsuit and file a declination in which case the person who filed the lawsuit can pursue the lawsuit on the government’s behalf without the government’s assistance. Either way, the government is always the real party in interest and must approve all settlements or dismissals and has the ability to seek dismissal of a case under 31 U.S.C. 3730(c)(2)(A).

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man-with-a-megaphone-1-1378633-sChicago – The False Claims Act places several restrictions on a person’s ability to pursue a qui tam case on behalf of the government. One of these restrictions is known as the “public disclosure bar”. The definition of public disclosure was recently addressed in the case of United States, et al. v. Whipple, et al.

In Whipple, the plaintiff alleged that the defendant hospital violated the False Claims Act by knowingly submitting false of fraudulent claims to Medicare and other federally funded health care programs. The relator alleged that the hospital submitted fraudulent claims for inpatient care which should have been billed as outpatient, observation services for same day surgery claims, inpatient admissions for renal-dialysis claims, and for carotid artery stenting without authorization. The relators asserted that he discovered these frauds while working for defendant in 2006.

The relator also claimed that he was unaware of a government audit and investigation against defendant for improper billing of Medicare by defendant. In fact, the government opened an administrative investigation in February 2008 which was resolved in September 2009 after defendant refunded $477,140.42 to the government. Continue reading

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Chicago – In a case that has been before the Court of Appeals for the third time and before the United States Supreme Court twice, the relator appealed the district court’s dismissal of her qui tam case based on the False Claims Act’s public disclosure bar.  Fortunately, for the relator, the Court of Appeals reversed.  United States ex rel. Wilson v. Graham County Soil & Water Conservation District, (4th Cir. Feb. 3, 2015)

The facts of the case begin in February 1995, when a storm caused flooding and erosion in North Carolina.  The United States Department of Agriculture agreed to help through a program known as the Emergency Watershed Protection Program.  The Graham County Soil & Water Conservation District, the Defendant, was responsible for to managing the Emergency Watershed Protection Program.

Karen Wilson, a part-time secretary at Graham County SWCD, and the relator reported her suspected misconduct to the USDA.  The USDA report created in response to Ms. Wilson’s allegations was distributed to several state and federal law enforcement agencies with a warning not to distribute the report outside of your agency without the approval of the USDA.

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