Whistleblower Lawyer Blog

Today saw a major development that could affect every whistleblower, whistleblower attorney, and whistleblower case involving the False Claims Act, the nation's primary whistleblower law. The U.S. Senate Judiciary Committee today approved new legislation to restore the False Claims Act to its originally intended strength, by eliminating a series of "loopholes" that dishonest government contractors had used to avoid liability.

Our whistleblower lawyer blog has written extensively about the False Claims Act, the qui tam statute that allows private citizens to report fraud as whistleblowers or "relators," and to share in the government's recovery of damages. We have followed the development of the new whistleblower law amendments, the False Claims Act Correction Act (S. 2041), since it was introduced last September by a bipartisan group of Senators (Grassley, Durbin, Leahy, and Specter).

The advocacy group Taxpayers Against Fraud (with which I am proud to be associated) describes the new law as "A Better Rat Trap" designed to put more "snap" into the False Claims Act, and summarizes its key provisions as follows:

--to clarify that False Claims Act liability protects all federal funds;

--to solely vest the Government with the power to dismiss whistleblower- filed False Claims Act lawsuits that are based on public allegations;

--to remove confusion over the statute of limitations period;

--to explicitly clarify that the False Claims Act applies to those who discover an overpayment and decide to pocket the funds; and

--to provide strengthened employment protection for whistleblowers.

According to Jeb White, President of Taxpayers Against Fraud, "[t]his is common sense legislation that we expect to sail through the House and Senate. . . . It's hard to be opposed to building a better rat trap to catch corporate cheats, chiselers, and con artists."

The bill passed the Judiciary Committee overwhelmingly, and moves forward in the legislative process.

We congratulate everyone who had a part in moving the new law forward, so that these loopholes for dishonest contractors may finally be closed.

The Justice Department has announced that Besler & Company, Inc., a New Jersey health care consulting firm, and its principal Philip Besler, have agreed to settle allegations of fraud against the federal Medicare program, which were initiated by two qui tam whistleblower cases. The settlement is for $2.875 million, plus interest, paid to the federal government.

The settlement concludes that the Besler firm counseled hospital clients to improperly increase charges to Medicare patients, so that they would obtain enhanced reimbursement from Medicare.

Medicare pays supplemental reimbursements or "outlier payments" to hospitals when the cost of care is unusually high. Congress enacted the supplemental outlier payment system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs.

The Justice Department's announcement alleged that, "between January 2001 and August 2003, Besler & Company advised hospitals to purposefully inflate charges for inpatient and outpatient care to make these cases appear more costly than they actually were, and thereby augment their outlier reimbursements."

We congratulate those involved for bringing about this result!

Tomorrow, the Senate Judiciary Committee will hold a hearing on a much-needed bill that will restore to its intended effectiveness the government's primary law for combating fraud.

Our whistleblower lawyer blog has written previously about the "False Claims Act Correction Act." The Act is one of the most significant developments in whistleblower law since the 1986 amendments that created the modern False Claims Act.

This is a bipartisan bill designed to restore the government's "primary" tool for fighting fraud against taxpayers, the False Claims Act, to its intended usefulness. Several court decisions have weakened the False Claims Act and inhibited its effectiveness in fighting fraud.

The publication Legal Times contacted me last week to discuss the bill's importance. In its February 25, 2008 issue, Legal Times (http://www.law.com/jsp/dc/PubArticleDC.jsp?id=1203508156014&hub=TopStories) includes only one comment from a "whistleblower" lawyer, my comment that:

"'This would remove a series of technicalities for those who get away with stealing taxpayer funds,” says Michael Sullivan, a plaintiffs lawyer at Atlanta’s Finch McCranie."

What was edited out is that those who have succeeded in defrauding the public now often take advantage of a series of "technical" defenses that allow them to escape accountability--defenses that were never intended by Congress in enacting the current version of the False Claims Act.

No contractor who has not committed fraud will have any concerns about the new bill.

We will continue to report on the bill's progress!

The trend of new state False Claims Acts with qui tam whistleblower provisions continues, as Louisiana considers whether to adopt its own version of the federal False Claims Act.

The growing number of state False Claims Acts has been a frequent topic of this whistleblower lawyer blog. In 2007, New York, Georgia, and Oklahoma joined the 16 other states that have enacted versions of the federal False Claims Act, the government's primary weapon for fighting fraud against taxpayers.

New Jersey enacted its new False Claims Act in January 2008. It became the 20th state with such a qui tam whistleblower law.

We applaud Louisiana's progress with its new False Claims Act!

Whistleblowers and their attorneys filing suit under the False Claims Act helped federal authorities recover $2.2 billion in Medicare and Medicaid fraud cases in fiscal year 2006, according to a government report just released. The whistleblowers or "relators" received $140 million of the proceeds for their efforts, under the qui tam provisions of the False Claims Act.

As this whistleblower lawyer blog has written about extensively, the federal False Claims Act is the government's "primary" weapon for combating fraud. As health care expenditures have grown as a share of the federal budget, health care fraud now accounts for more than 70% of the government's annual fraud recoveries.

It was encouraging to see the new "Health Care Fraud and Abuse Control Program Annual Report For FY 2006." This report by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS), and the Department of Justice, summarizes both organization's FY 2006 results in battling Medicare and Medicaid fraud and recovering money improperly obtained from these programs.

In 2006, DOJ and OIG surpassed their 2005 recoveries totalling $1.47 billion in cases involving health care fraud and abuse.

This report cited 836 new investigations begun during 2006, for a total of 1,677 active investigations. 547 defendants in heath care fraud cases were convicted in criminal prosecutions in 2006.

In civil cases, DOJ took on 915 new health care fraud cases, which raised the total to more than 2000 in 2006.

The largest single recovery was a $900 million settlement Tenet Healthcare Corp. Whistleblowers came forward to report that Tenet was abusing Medicare and paying kickbacks to physicians to send patients to Tenet hospitals.

Other notable recoveries from hospital systems in FY 2006 included St. Barnabas Health Care System in New Jersey ($265 million), Beth Israel Medical Center in New York ($73 million), the Chattanooga-Hamilton County Hospital Authority in Tennessee ($37 million), University Hospitals Health System in Ohio ($13.8 million), Our Lady of Lourdes Regional Medical Center in Louisiana ($3.8 million) and the Milton S. Hershey Medical Center in Pennsylvania ($2.9 million).

Pharmaceutical fraud recoveries included $704 million from drug manufacturer Serono, and $435 million from Schering-Plough.

Durable medical equipment (DME) fraud also resulted in significant recoveries.

For those wishing to review the complete report, it is at http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2006.pdf.

We congratulate OIG and DOJ on their successful efforts in recovering more than $2 billion of money fraudulently obtained from health care programs in FY 2006.

If an organization or individual is receiving a federal subsidy of any kind and makes false statements to the Federal Government with respect to such subsidies, such false statements could subject the receiver of the subsidy to liability under the Federal False Claims Act. In short, if a recipient of a federal subsidy makes false statements concerning eligibility for the subsidy and/or the amount of the subsidy sought or obtained, the recipient could be sued for fraud by a whistleblower with knowledge of the false statements. In some cases, the recipient of a subsidy may not be legally entitled to receive it or even if they are, they may not be entitled to receive the amounts being sought. In short, false statements made in connection with an application for or receipt of federal funds are actionable under the False Claims Act and if someone receiving a federal subsidy is proven to have made such false statements, they can be liable for three times the amount of the subsidy received plus statutory penalties as set forth under the Federal False Claims Act.

The Cato Institute oftentimes blogs about government fraud, abuse and waste. There are many entries in that firm’s website about federal give-away programs and “unnecessary” or wasteful subsidies. Many federal subsidies are doled out without any follow-up accounting and/or audit of whether the entity or person applying for the subsidy is entitled to receive it and/or is entitled to receive a subsidy in as great an amount as is involved. This lack of administrative oversight, therefore, opens up virtually every federal subsidy program to fraud, waste and abuse.

Any person with knowledge of such fraud could qualify for a reward under the Federal False Claims Act if they blow the whistle on fraud in connection with federal subsidy programs. Since there is little federal oversight in many of the federal subsidy programs, it is apparent that fraud occurs in these federal programs, as in any other, and that whistleblowers would be doing all taxpayers a service if they came forward exposing it.

Two days ago on 1/28/08 President Bush signed into law the National Defense Authorization Act for the fiscal year 2008. This legislation includes a provision protecting defense contractor employees who blow the whistle on contracting fraud. 10 U.S.C. § 2409 has specifically been amended via Section 846 to protect employees for disclosing “information that the employee reasonably believes is evidence of gross mismanagement of a Department of Defense contract or grant, a gross waste of Department of Defense funds, a substantial and specific danger to public health or safety, or a violation of law related to a Department of Defense contract (including the competition for or negotiation of a contract) or grant.” Obviously, this new whistleblower protection encourages defense contractor employees to come forward if they have knowledge of such misconduct.

The new whistleblower law is intended to protect all defense contract employees to come forward in good faith so that they need not fear reprisal if they do so. If the employee who blows the whistle on contractor fraud is retaliated against, the affected employee may file a complaint with the Inspector General of the Agency and unless the complaint is determined to be frivolous, the Inspector General will conduct an investigation. If the employee is not satisfied with the Inspector General’s handling of the complaint, the employee may bring an action in federal court and is entitled to a jury trial. If the complainant is retaliated against for bringing legitimate good faith complaints of government contract fraud out in the open, then his or her remedies would include reinstatement, back pay, compensatory damages, attorneys fees and costs.

This new law is a giant step forward when it comes to protecting whistleblowers who are brave enough to come forward and expose defense contractor misconduct. By protecting such employees from retaliation, the law is intended to encourage their coming forward to expose waste, fraud and mismanagement. If the employee who does come forward is retaliated against as a result of blowing the whistle, this law is intended to make sure that they will be fully compensated for any damages sustained as a result of such retaliation including reinstatement of the job taken from them or reimbursement for wages and benefits lost as a result of any retaliation. As stated, the employee is also entitled to have his or her attorneys fees and costs paid should they be retaliated against for blowing the whistle.

This is an excellent piece of legislation which is good for the country and hopefully will help to reduce defense contractor fraud and abuse.

The "Big Dig" collapse has led to a $458 million settlement by contractors responsible for the Boston Central Artery/Tunnel highway project. Whistleblowers using the federal and state False Claims Acts helped bring about that result.

Of the $458 million settlement, $23 million is being paid to the United States under the federal False Claims Act, and $40 million will go to Massachusetts under its state False Claims Act, as a result of qui tam whistleblower litigation. (As we have written about extensively on this whistleblower lawyer blog, more and more states are enacting state versions of the federal False Claims Act to recover damages for fraud against the government. Private citizen whistleblowers or "relators" can receive up to 25 or 30% of the recovery.)

Congratulations to Massachusetts and the Justice Department for concluding this settlement.

This whistleblower lawyer blog reported earlier that the New Jersey Assembly had passed the New Jersey False Claims Act, which provides incentives to whistleblowers ("relators") to expose fraud affecting state funds--much like the federal False Claims Act does.

Governor Jon Corzine signed the new bill into law yesterday, which makes New Jersey the 20th state to enact a state False Claims Act with qui tam whistleblower provisions similar to those of the federal False Claims Act. (Click here for a detailed explanation of the False Claims Act and why states are passing their own False Claims Acts.)

New Jersey's citizens should be proud that their taxpayer dollars have the additional protection of the new statute. Congratulations to all who accomplished this result!

Some of the many types of health care fraud that this whistleblower lawyer blog has followed involves "durable medical equipment" (DME). The sale of wheelchairs, walkers, oxygen supplies and equipment, hospital beds, orthotics, prosthetics, and various medical devices is yet another opportunity for dishonest suppliers to defraud taxpayers.

This week, the Centers for Medicare & Medicaid Services (CMS) announced an initiative designed to improve care, save $1 billion annually, and lower Medicare beneficiaries’ out-of-pocket costs--by promoting competition in the sale of durable medical equipment.

Seventy new areas across the country have been added to the second phase of a competitive bidding program. One goal is to "prevent unscrupulous suppliers from participating in Medicare."

According to CMS Acting Administrator Kerry Weems,“Competitive bidding means that Medicare beneficiaries will have access to these products at substantially lower costs.” Mr Weems noted that “[s]ince all successful bidders will be required to meet quality standards and be accredited by Medicare, people with Medicare in these 70 new areas can be assured of access, low prices and high quality."

The new program is also intended to provide another layer of protection against Medicare fraud. As our whistleblower clients and other whistleblower attorneys know too well, fraud in health care is bleeding our nation's precious health care resources--and cost taxpayers millions each year.

We congratulate CMS for its ongoing efforts to to root out health care fraud.

The wave of new state False Claims Acts with qui tam whistleblower provisions has been a frequent topic of this whistleblower lawyer blog. In 2007, New York, Georgia, and Oklahoma joined the 16 other states that have enacted versions of the federal False Claims Act, the government's primary weapon for fighting fraud against taxpayers.

Today, New Jersey's Assembly unanimously passed the New Jersey State False Claims Act, which upon signature by the Governor will make New Jersey the 20th state to have a state version of the venerable qui tam whistleblower statute.

We congratulate New Jersey for taking the prudent action of passing a state False Claims Act. As we have written about extensively, Congress through the Deficit Reduction Act of 2005 has created financial incentives for states that pass such qui tam whistleblower laws that are at least as effective as the federal False Claims Act.

The New Jersey False Claims Act expands on the federal Act. It also includes criminal provisions as well as civil liability for treble damages and civil penalties. The text of the Act passed today is reprinted below:

Continue reading "False Claims Act Passed in New Jersey Continues Trend of New State Qui Tam Whistleblower Statutes" »

2007 has been a most significant year for whistleblowers. The whistleblower lawyer blog attorneys look back on some of the milestones:

1. As soon as Congress authorized the first meaningful IRS Whistleblower Rewards Program to pay tax whistleblowers 15-30% of IRS recoveries from those who violate the tax laws by statue effective on December 20, 2006, beginning in January our whistleblower lawyers submitted some of the first IRS Whistleblower claims in the nation under the new law. Our IRS Whistleblower cases have continued to grow throughout the year.

2. Our IRS whistleblower submissions have led to criminal and civil investigations over tax cheating, and our whistleblower clients are in a position to receive 15-30% of the amount of collected proceeds (including penalties, interest, additions to tax, and additional amounts) recovered by the IRS.

3. This Spring, legislative officials requested that one of our whistleblower lawyer blog co-authors help draft a state False Claims Act for Georgia, and then invited him as the only private attorney to testify at the legislative hearings to explain the federal False Claims Act, and how the new state False Claims Act will operate. The new Georgia State False Medicaid Claims Act was signed into law on May 24, 2007, and early results show that it already has been effective in uncovering and stopping Medicaid fraud.

Participating in the signing ceremony with Governor Sonny Perdue were (shown above from left to right) Carrie Downing, Director of Legislative and External Affairs of the Georgia Department of Community Health; Dr. Rhonda Medows, Commissioner of the Georgia Department of Community Health; Inspector General Doug Colburn; Governor Perdue; Rep. Edward Lindsey, sponsor of the State False Medicaid Claims Act; whistleblower lawyer blog author Michael A. Sullivan of Finch McCranie, LLP; and Philip Consuegra, Legislative Assistant to Rep. Lindsey.

4. As the new IRS Whistleblower Program took shape during 2007, our whistleblower lawyer blog followed each development to educate the public and other attorneys about the new IRS Whistleblower Rewards.

5. At a national conference sponsored by Taxpayers Against Fraud in September, whistleblower lawyer blog author Michael A. Sullivan joined IRS Whistleblower Office Director Stephen Whitlock, Professor Dennis Ventry, and fellow IRS whistleblower attorneys Paul Scott and Erika Kelton for a panel discussion to explain how the new IRS Whistleblower Program will operate.

6. To educate other professionals about developments with the False Claims Act and the wave of new state False Claims Acts, whistleblower lawyer blog attorneys published articles in journals that included Compliance Today, a publication of the Health Care Compliance Association. Our whistleblower lawyer blog attorneys also chaired the Whistleblower Law Symposium, and were invited to lead panel discussions and give presentations at the Southeastern Health Care Fraud Conference and various other conferences.

7. Of course, like other whistleblower law attorneys, our firm has continued to represent whistleblowers to recover damages for fraud in health care programs inclluding Medicare and Medicaid, Hurricane Katrina federal disaster relief, government procurement, and other matters affecting federal and state tax dollars.

We are continually inspired by our clients for their commitment to honesty and integrity in the use of government funds. We look forward to another successful year keeping you informed with this whistleblower lawyer blog!

At a conference on False Claims Act Litigation on November 30, attorneys representing the government, relators or whistleblowers, and defendants gathered to discuss whistleblower law issues. The conference was organized by the law firm of Balch & Bingham LLP.

This whistleblower lawyer blog writer had the pleasure of appearing on a panel with the Chief of the Civil Division of the U.S. Attorney's Office in Atlanta, Amy Berne, and with Balch & Bingham's John Markus.

Amy Berne opened with an overview of how the government handles False Claims Act cases, and answered many questions about what affects the government's assessment of an FCA case. It is always informative to be able to ask the chief prosecutor what influences her decisions.

John Markus offered a very interesting perspective on compliance issues. From 2004 to 2007, John served as Executive Vice President and Chief Compliance Officer for HealthSouth Corporation, where he directed the development of a regulatory compliance program as part of a comprehensive restructuring initiative. He also negotiated and directed the implementation of Corporate Integrity Agreement with the Office of Inspector General for the Department of Health and Human Services.

This whistleblower lawyer spoke on some of the reasons whistleblowers come forward and report fraud; goals in representing whistleblowers or relators; and new legal developments such as the wave of new State False Claims Acts, and proposed dramatic changes to the federal False Claims Act.

I appreciated the opportunity to join this group of accomplished lawyers, and thank Balch & Bingham's Mike Bowers, Rich Saunders, John Markus, and Christopher S. Anulewicz for organizing the seminar.

Two important topics of this whistleblower lawyer blog are addressed in a recent Government Accounting Office (GAO) Report on tax cheating by Medicaid providers. The Report shows the wisdom of the new IRS Whistleblower Program, which fills a "gap" in the coverage of the major whistleblower statute, the False Claims Act.

GAO reports that thousands of Medicaid providers collect large amounts of federal dollars each year, while cheating the government by failing to pay taxes owed--usually payroll taxes and personal income taxes. In testimony before the Permanent Subcommittee on Investigations, Senate Committee on Homeland Security and Governmental Affairs, GAO's Gregory D. Kutz, described these abuses.

These tax abuses reportedly included:

• The owner of a chain of nursing homes, who owed more than $14 million in taxes, while having a $2 million home with crystal chandeliers, porcelain china, and Oriental rugs.

• The owners of a hospital, who owed $5 million in payroll taxes, but who bought a vacation home worth $1 million.

• A medical-clinic owner, who owed more than $1 million to the IRS, had a $4 million house, luxury vehicles, and a pleasure boat.

According to the Report, "[r]ather than fulfill their role as 'trustees' of federal payroll tax funds and forward them to IRS, these providers diverted the money for other purposes. Willful failure to remit payroll taxes is a felony under U.S. law. Individuals associated with some of these providers diverted the payroll tax money for their own benefit or to help fund their businesses. Many of these individuals accumulated substantial assets, including million-dollar houses and luxury vehicles, while failing to pay their federal taxes. In addition, some case studies involved businesses that were sanctioned for substandard care of their patients. Despite their abusive and related criminal activity, these 25 providers received Medicaid payments ranging from about $100,000 to about $39 million in fiscal year 2006." (http://www.gao.gov/new.items/d08239t.pdf, at 2).

The new IRS Whistleblower Program may provide a means to stop this abuse. Authorized by Congress in December 2006 (with the new regulations due to be issued by December 20, 2007), the new IRS Whistleblower Program established an enforceable right for "whistleblowers" or informants to receive 15-30% of money recovered by the IRS, including interest and penalties.

The federal False Claims Act, which was invigorated in 1986 with provisions that have made it the government's "primary" weapon against fraud, allows rewards for whistleblowers who report Medicare fraud, Medicaid fraud, and most other types of fraud and false claims against the federal government. The False Claims Act expressly does not apply to IRS obligations, however. Thus, the new IRS Whistleblower Program allows whistleblowers to help stop tax fraud and evasion by Medicaid providers, and to receive a share of the recovery.

Our whistleblower attorneys will continue to work both with the IRS and with the Department of Justice in representing whistleblowers who bring such fraud to light.