The federal government has sued Lance Armstrong, alleging the former cyclist committed fraud through cheating and false statements.
In a shocking report prepared by the Department of Defense for Vermont Senator Bernie Sanders, it was revealed that hundreds of defense contractors who defrauded the U.S. military ended up receiving more than $1.1 trillion in Pentagon contracts during the past decade.
One day after the United States government accused Wall Street’s biggest credit rating agency, Standard & Poor’s Financial Services LLC, of ratings inflation on mortgage-backed securities, the California Attorney General filed an additional suit claiming the credit ratings company violated the state’s False Claims Act (FCA). California joins twelve other states and the District of Columbia in following the Justice Department’s lead. California, however, is the only state to allege violations of its False Claims Act. The FCA, typically a law used by company whistleblowers, is now seeing its scope of practice stretched into new areas according to some experts.
On Friday, February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) published a long-delayed final rule for the Physician Payments Sunshine Act. The Sunshine Act requires all drug, medical device, and biological or medical supply manufacturers to carefully track and report all payments made to physicians and teaching hospitals. The Act also requires manufacturers and group purchasing organizations (GPOs) to disclose any ownership or investment interests that physicians and their immediate family members have in those entities. The purpose of The Act is to shed light on any potential conflicts of interest that could potentially affect treatment decisions and health care costs. The goal is to increase overall transparency, while also reducing the potential for healthcare fraud by gathering data about financial relationships between healthcare providers and manufacturers, then making it available to the public.
Yet another former manager with Orthofix pled guilty to forging former patient medical records in an attempt to justify reimbursement for procedures involving bone growth products.
After cracking down on Medicaid fraud for over a decade, The Texas Attorney General’s Office recently reached two historic milestones. Since 2002, the Civil Medicaid Fraud Division’s recoveries in the State of Texas passed the $400 million mark, while total recoveries for the state and federal governments presently exceed $1 billion. Because the Medicaid program is co-funded by both the State and the federal government, fraudulent over-payments recovered by the Attorney General’s Office are shared with the Federal Treasury Department.
The Securities and Exchange Commission (SEC) is the federal agency responsible for regulating the securities industry and for enforcing federal securities laws. The SEC protects the public against fraudulent and manipulative practices in the securities markets. Congress created the SEC Whistleblower Program as a way to offer incentives to those people who have knowledge about securities fraud. The program encourages individuals to report fraudulent activity and present evidence to the SEC. Under the Dodd-Frank Act, Congress authorized the SEC Whistleblower Program to provide monetary awards to eligible individuals who come forward with useful and original information that leads to a successful enforcement action resulting in at least one million dollars ($1,000,000) in sanctions. The whistleblower is entitled to an award of between 10 and 30 percent of total money collected. In addition, the SEC Whistleblower Program prohibits any retaliation by employers against employees who provide securities violations information to the SEC. The SEC has been receiving an average of eight tips each day from whistleblowers residing in both the United States and abroad.
The United States Department of Health and Human Services (HHS) announced on January 2, 2013 the first settlement involving potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule involving less than 500 patients. An Idaho-based hospice provider was found at fault due to the theft of an unencrypted laptop computer containing the electronic protected health information (ePHI.) of 441 patients. The $50,000 settlement is due in large part to the hospice provider’s failure to apply adequate policies or procedures to address mobile device security as required by the HIPAA Security Rule. In addition, the HHS Office for Civil Rights found the hospice provider did not conduct a proper and thorough assessment of potential risk to the security of ePHI on an ongoing basis or as part of a security management process.
On December 4, 2012, Acting Associate Attorney General Tony West announced that during the fiscal year 2012, The Department of Justice (DOJ) recovered a record $4.9 billion in settlements and judgments as a result of fraud prosecuted under the False Claims Act (FCA).