A task force to help combat health care fraud involving programs intended to help Veterans was announced in October 2019. The U.S. Department of Justice and the Office of Inspector General of the U.S. Department of Veterans Affairs are undertaking a joint effort to focus attention on the increasing harm to the financial viability of its Veterans’ health care programs.
Veterans are entitled to health care services under a program called the Community Care program, which offers fee-for-service care. It allows non-VA health care providers in the Veteran’s community to provide health care services to the Veteran and, in turn, submit claims for payment to the VA. Under this program, Veterans who do not have access to care at a VA facility, may be entitled to care through a nearby community provider (a doctor’s office). To be eligible, the Veteran must meet special eligibility requirements. In addition to this unique program, the VA also provides other health care options for the families of Veterans through programs like the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
The authors of this blog are former prosecutors who now represent whistleblowers: Renée Brooker (former Assistant Director for Civil Frauds) firstname.lastname@example.org (202) 288-1295 and Eva Gunasekera (former Senior Counsel for Health Care Fraud) email@example.com
The False Claims Act is the whistleblower law. It provides a mechanism for a whistleblower to report fraud, waste and abuse of a VA health care program. If you think a provider in your community has taken unfair advantage of this VA program, and caused the VA to pay more money to the health care provider than it was entitled to receive, you may have a case under the False Claims Act. And you could be entitled to a whistleblower award for reporting this direct or indirect harm to Veterans.
The Department of Veterans Affairs OIG also participated in investigating a successful whistleblower lawsuit in February 2019 involving renal and specialized pharmacy compounding services and administering the drug Proplete and intradialytic parenteral nutrition (IDPN) and intraperitoneal nutrition (IPN) to patients who had end stage renal disease. The settlement resulted in a $17 million payment to the federal health care programs by Pentec Health, Inc. The whistleblower was a former employee of the company and she received a percentage of the $17 million recovery. The U.S. Attorney in the case was quoted as saying, “We thank the relator [whistleblower] for her invaluable contribution in this case. Without information from citizens like the relator, detecting fraud and conserving government program funds would be far more difficult.”
Addressing fraud involving harm or abuse to Veterans has been a top priority for this Administration. The announcement of the joint DOJ-VA OIG task force came at the same time that the Washington Post in a report on October 5, 2019, uncovered suspicious deaths of Veterans at a VA hospital. According to reports at one VA facility, patients died after being injected with unprescribed overdoses of insulin. Such troubling reports appear to result from extreme negligence, abuse, intentional infliction of harm to patients, or homicide. While a criminal investigation will need to be conducted, such extreme conduct also suggests a complete lack of oversight of these facilities.