Unfortunately, fraud within universities is not uncommon, and today’s case highlights a growing trend of grant fund misuse. Located in the mountains of West Virginia, Wheeling Jesuit University has agreed to pay $2.3 million it is alleged to have misused, all of which was provided by the National Aeronautics and Space Administration (NASA) for purposes of research and development.
Of the various ways in which healthcare providers can violate the False Claims Act, ordering medically unnecessary procedures – particularly those involving the cardiac system – are considered particularly egregious. As opposed to illegal upcoding or kickback schemes, the performance of medically unnecessary procedures actually places patients directly in harm’s way, and all for the purpose of increasing profit margins.
In fiscal year 2014, American taxpayers footed a $554 billion dollar bill for Medicare and Medicaid – two programs that, while essential in nature, are exceedingly strapped for resources. As one of the hallmark goals of the False Claims Act, authorities have worked diligently to ensure providers are billing correctly only for those services actually rendered, or major fines and penalties will ensue.
In yesterday’s post, we explored the concept of implied certification under the False Claims Act – a theory which somewhat eliminates the requirement for explicit false claims activity, but requires evidence that the defendant knew or should have known his activity did not comply with a government contract, but continued to submit invoices nonetheless.
Over the next two posts, we will examine a concept known as “implied certification.” This legal theory has been a part of the False Claims Act landscape for several years and has caused considerable discussion among the circuit courts as to the extent an implied theory works to hold a false claims defendant liable.
Aside from healthcare fraud, defense contractor fraud remains one of the top forms of waste and abuse addressed by the False Claims Act. Too often, big-budget defense contracts serve as fodder for dishonest companies to inflate and exaggerate costs, resulting in unnecessary spending of an already-strained defense budget.
In one recent defense contractor case, the federal government has begun a probe of Sikorsky Aircraft, a defense contractor having previously provided helicopters to the U.S. Navy under a 2006 contractual agreement. The investigation is pursuant to a False Claims Act lawsuit filed last year against Sikorsky’s parent company, United Technologies Corp., which was revealed in the latest filings required by the SEC for purposes of alerting investors as to potential liability and issues.
Berger & Montague, P.C. Settles Whistleblower Lawsuit Involving AstraZeneca, Cephalon, & BioGen, Inc.; Secures $55 Million on Behalf of Taxpayers
As one of the leading and most successful whistleblower law firms in the United States, Berger & Montague, P.C. is pleased to announce its involvement in a $55.5 million settlement involving three major players in the pharmaceutical industry. This past July, Berger & Montague, P.C. announced the settlement against AstraZeneca, Cephalon, Inc., and BioGen, Inc. – three of the largest medication-makers in the world. Specifically, our law firm was integral in securing a victory on behalf of our client, who vows that his quest for victory is far from over.
In yesterday’s post, we introduced an emerging concept known as “balance billing,” which results in skyrocketing medical expenses and increased medical debt for unsuspecting patients. As a brief review, balance billing occurs when a patient seeks treatment from an out-of-network doctor, who then bills the patient for the maximum allowable charges – which are often much higher than the maximum allowable charges for the same treatment in-network. Moreover, doctors are inviting other out-of-network doctors to participate in patient care without the patient’s knowledge or consent, as we will illustrate in today’s post.
At Berger & Montague, P.C., we strive to keep on top of the latest emerging trends in the fraud landscape, particularly when the misconduct drives up the costs of healthcare for policyholders and taxpayers alike. Over the next two posts, we will examine an emerging fraud trend known as “balance billing,” which our firm has tackled head-on and will fight against on behalf of our courageous clients and whistleblowers.
One of the key components of the success of the False Claims Act is its ability to incentivize whistleblowers to come forward by offering up to 30 percent of the total settlement in some cases. In today’s post, we examine an interesting holding by the U.S. District Court for the Eastern District of Pennsylvania, which upheld a 24 percent whistleblower reward over the Department of Justice’s strenuous objections.