A Whistleblowers Journey

Size: px
Start display at page:

Download "A Whistleblowers Journey"

Transcription

1 A Whistleblowers Journey John W Schilling EthicSolutions LLC

2 Health Care Fraud Medicare spending in FY 2008 exceeded $450 billion According to Taxpayers Against Fraud (TAF), the U.S. Government estimates 9% of all Medicare spending is paid in error. Simply stated, healthcare is where the money is! The magnitude of this expenditure will create fraudulent activities.

3 False Claims Act (FCA) The False Claims Act is the number one tool the U.S. Government has to fight fraud. Since 1986, the FCA has returned $22 Billion to the U.S. Government, the majority of which comes from health care

4 False Claims Act History Qui Tam Latin Phrase Meaning He Who proceeds For the King as Well as For Himself Also known as Whistleblower Law or Lincoln s Law Enacted in 1863 Civil War Union Army Allows Private Citizens (Relators) to Sue on Governments Behalf

5 False Claims Act Currently, the Act provides that successful Relators shall receive between 15% -30% of the Government's recovery. Defendants found to have defrauded the Government are liable for Treble Damages and a $5,000 - $10,000 Penalty for each False Claim. The lawsuit is filed Under Seal The Act provides Whistleblower Protections from retaliation for those coming forward with evidence of fraud.

6 Qui Tam Actions A qui tam complaint is filed under seal in Federal Court Copies are provided to the Department of Justice, and the assigned Federal District Court Judge May have Parallel Proceedings Civil Criminal Remain under seal for a period of 60 days

7 Qui Tam Actions After 60 days the Government must file a motion requesting an extension The Government will conduct an investigation to include subpoenas for documents, witness interviews, and consultations ti with experts.

8 Qui Tam Actions At the conclusion of the investigation, the Government must choose between one of three options under the FCA. 1. Intervene in one or more counts of the qui tam complaint 2. Decline to intervene 3. Move to dismiss the complaint

9 Qui Tam Actions If the Government intervenes they serve as the Plaintiff and prosecute the case If the Government declines to intervene, the relator may prosecute on behalf of the Government The Government may also attempt to settle the pending action prior to or simultaneous to intervention

10 Qui Tam Actions The relator may receive 15-25% of the recovery or judgment if the Government intervenes. The average is 17% If the relator pursues the case without Government intervention, ti he/she h can receive 25-30% of any recovery

11 Whistleblower Protection Strong anti-retaliation provisions against whistleblowers were made part of the 1986 Amendments to the FCA A private cause of action was created for employees who are victims of retaliation

12 Whistleblower Protection Any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against, shall be entitled to relief Such relief shall include reinstatement with the same seniority status, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys fees.

13 FCA Stats Average of 400 FCA cases filed each year 80% are Declined (320) Of the Declined only 20% move forward Average case takes 39 months An Average of 100 cases are settled each year 50 will settle for less than 2 million 50 will settle for more than 2 million Of those 4 to 7 will settle for more than 50 million In 2008, 7 cases settled for more than 50 million with 3 of them settling for more than 100 million

14 WHAT IS A COST REPORT A report of operating costs for a specific time period Year end reconciliation of interim payments to actual costs A Summary Claim against the Government Sets the Part A provider payment rate (some providers)

15 Medicare Settlement Medicare Costs (Less) Medicare Payments (Equals) Under or Overpayment

16 Treatment of Genuinely Disputed Areas Mandatory Procedures Cost Reports filed under protest Provider disclosure of protest

17 Pre - Test How would you defraud Medicare and Medicaid through the cost report? That s Right Overstate the Cost

18 FRAUDULENT PRACTICES Costs Not Related to Patient Care Costs Not Allowable Improper Cost Shifting Pass Through Costs Overstating Bad Debts Overstating Disproportionate p Share (DSH) Overstating IME/GME Overstating Organ Acquisiton

19 Cost Report Fraud Historically Inadequate Enforcement Providers Maintain Aggressive reporting strategies Financial i Reporting Requirements Contingencies Reserve Cost Reports

20 Reserve Cost Report A reserve cost report is a second Medicare cost report that is more conservative than the as filed Medicare report Utilized by providers as a financial tool to determine potential ti Medicare liabilities

21 A WHISTLEBLOWER S JOURNEY

22 A SERIOUS ISSUE? New Job with Great Earning Potential & Career Growth Auditor Phone Call The Meeting Gut Instincts

23 Are Reserves A Problem? Overwhelming Evidence Reserve Cost Reports New Management Voiced Concerns No Action Taken No Compliance Officer

24 DILEMMA: WHAT WOULD YOU DO? Be Silent Continue To Voice Concern Notify Intermediary/Government Contact Attorney For Advice

25 Things to Consider Implications of Career Safety Altering Friendships Do you Have Enough Evidence? Are you Prepared to Testify?

26 WHAT I DID! Contacted Law Firm Do I have Exposure? Are These Reserves Criminal? Is This a False Claims Case? Copied Some Documents Found New Job (August 1995)

27 MY DECISION Prominent Whistleblower Law Firm - Informed of Jim Alderson Educate My Attorneys of the Fraud Travel to D.C. With Evidence

28 WHAT HAPPENED NEXT Complaint Filed in June of Months Later DOJ Civil Meeting Meet with FBI & Criminal AUSA Grand Jury Testimony Seal Extensions Numerous Follow up Meetings with Government

29 UNDERCOVER

30 CRIMINAL INVESTIGATION HEATS UP! Confidential Informant Undercover Operative Meetings Observations Tape Recordings Search Warrants (July 1997) Indictments

31 ESCAPE TO WISCONSIN Civil Case Slows Down Concerns of Retaliation Publicity of Criminal Trial New Job

32 CRIMINAL TRIAL NEARS Various Delays In Criminal Trial Trial Is Moved From Ft Myers To Tampa Judge Sets Trial For May 1999 Civil Case At A Standstill Awaiting Outcome of Criminal Case

33 New Years Celebration /30/98 Government Intervenes 12/31/98 Media Reports Unsealing Government Requests Me To Remain Silent To Media

34 MAY 1999 TRIAL BEGINS Witness Preparation FBI AUSA Attorney

35 GAME DAY Full Courtroom Defendants Are Present Jury Watches/Listens Intently 3 1/2 Days On The Stand KPMG Case Is Unsealed Defense Attorneys Cross Examination / Personal Attacks

36 CONVICTIONS Convictions (July 1999) My Civil Cases Can Move Forward More Criminal Trials Likely

37 Civil Update May, 2000 Partial Columbia/HCA Settlement of 745 Million & 95 Million in Criminal penalties (does not include cost reports). Company Pleads Guilty October, 2001 KPMG Case Settles for 9 Million Settlement Negotiations continue on cost reports but stall

38 Criminal Update Criminal investigations continue Further assistance is provided d to law enforcement No New Indictments Convictions are overturned Government ends criminal investigation

39 HOW IT ENDED Depositions begin after criminal investigation is over December, 2002 HCA Agrees To Pay A Million Settlement Alderson and Schilling are Awarded The Largest Relator s Share (Reward) in US History No Rose Garden Ceremony

40 MAKING A DIFFERNCE Formed EthicSolutions, LLC Author Undercover How I Went From Company Man to FBI Spy and Exposed the Worst Healthcare Fraud in US History

41

UPDATED. OIG Guidelines for Evaluating State False Claims Acts

UPDATED. OIG Guidelines for Evaluating State False Claims Acts UPDATED OIG Guidelines for Evaluating State False Claims Acts Note: These guidelines are effective March 15, 2013, and replace the guidelines effective on August 21, 2006, found at 71 FR 48552. UPDATED

More information

A Bill Regular Session, 2015 SENATE BILL 830

A Bill Regular Session, 2015 SENATE BILL 830 Stricken language would be deleted from and underlined language would be added to present law. State of Arkansas 90th General Assembly A Bill Regular Session, 2015 SENATE BILL 830 By: Senator D. Sanders

More information

DEVELOPMENTS IN QUI TAM WHISTLEBLOWER SUITS. September 15, 2011. Daniel M. McClure Fulbright & Jaworski L.L.P. Houston, Texas dmcclure@fulbright.

DEVELOPMENTS IN QUI TAM WHISTLEBLOWER SUITS. September 15, 2011. Daniel M. McClure Fulbright & Jaworski L.L.P. Houston, Texas dmcclure@fulbright. DEVELOPMENTS IN QUI TAM WHISTLEBLOWER SUITS September 15, 2011 Daniel M. McClure Fulbright & Jaworski L.L.P. Houston, Texas dmcclure@fulbright.com 77185431 1 QUI TAM Qui Tam Pro Domino Rege Quam Pro Se

More information

AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA

AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA To amend the District of Columbia Procurement Practices Act of 1985 to make the District s false claims act consistent with federal law and thereby qualify

More information

HP0868, LD 1187, item 1, 123rd Maine State Legislature An Act To Recoup Health Care Funds through the Maine False Claims Act

HP0868, LD 1187, item 1, 123rd Maine State Legislature An Act To Recoup Health Care Funds through the Maine False Claims Act PLEASE NOTE: Legislative Information cannot perform research, provide legal advice, or interpret Maine law. For legal assistance, please contact a qualified attorney. Be it enacted by the People of the

More information

FALSE CLAIMS ACT PRIMER

FALSE CLAIMS ACT PRIMER FALSE CLAIMS ACT PRIMER HCCA Compliance Institute Sunday, April 29, 2012 I. Elements of a False Claims Act Violation A. A Direct (Affirmative) False Claim Most False Claims Act cases involve direct or

More information

METHODIST HEALTH SYSTEM ADMINISTRATIVE TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS

METHODIST HEALTH SYSTEM ADMINISTRATIVE TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS METHODIST HEALTH SYSTEM ADMINISTRATIVE Formulated: 6/19/07 Reviewed: Revised: Effective: 10/30/07 TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS PURPOSE: Methodist

More information

FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS

FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS False Claims Act (31 USC 3729-3733) The False Claims Act ("FCA") provides, in pertinent part, that: (a) Any person who (1) knowingly

More information

CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656

CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656 CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656 12650. (a) This article shall be known and may be cited as the False Claims Act. (b) For purposes of this article: (1) "Claim" includes any

More information

Minnesota False Claims Act

Minnesota False Claims Act Minnesota False Claims Act (Minn. Stat. 15C.01 to.16) i 15C.01 DEFINITIONS Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim.

More information

Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005

Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005 POLICY/PROCEDURE NO.: B-17 Effective date: Jan. 1, 2007 Date(s) of review/revision: Nov. 1, 2015 Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005

More information

MINNESOTA FALSE CLAIMS ACT. Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them.

MINNESOTA FALSE CLAIMS ACT. Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. As amended by Chapter 16 of the 2013 Minnesota Session Laws. 15C.01 DEFINITIONS MINNESOTA FALSE CLAIMS ACT Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings

More information

Representing Whistleblowers Nationwide

Representing Whistleblowers Nationwide Minnesota False Claims Act Minnesota Stat. 15C.01 to 15C.16) 15C.01 DEFINITIONS Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim.

More information

A summary of administrative remedies found in the Program Fraud Civil Remedies Act

A summary of administrative remedies found in the Program Fraud Civil Remedies Act BLACK HILLS SPECIAL SERVICES COOPERATIVE'S POLICY TO PROVIDE EDUCATION CONCERNING FALSE CLAIMS LIABILITY, ANTI-RETALIATION PROTECTIONS FOR REPORTING WRONGDOING AND DETECTING AND PREVENTING FRAUD, WASTE

More information

Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 KD_4901979

Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 KD_4901979 False Claims Act Update Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: bwade@kdlegal.com KD_4901979 1 The FCA is the Fraud Enforcement

More information

NewYork-Presbyterian Hospital Sites: All Centers Hospital Policy and Procedure Manual Number: D160 Page 1 of 9

NewYork-Presbyterian Hospital Sites: All Centers Hospital Policy and Procedure Manual Number: D160 Page 1 of 9 Page 1 of 9 TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005 FRAUD AND ABUSE PROVISIONS POLICY: NewYork- Presbyterian Hospital (NYP or the Hospital) is committed to preventing and detecting any fraud, waste,

More information

55144-1-5 Page: 1 of 5. Pharmacy Fraud, Waste and Abuse Policy. 1.0 Compliance Assurance. 2.0 Procedure

55144-1-5 Page: 1 of 5. Pharmacy Fraud, Waste and Abuse Policy. 1.0 Compliance Assurance. 2.0 Procedure Pharmacy Fraud, Waste and Abuse Policy 1.0 Compliance Assurance This Fraud Waste and Abuse Policy ( Policy ) reiterates the commitment of this pharmacy to comply with the standards of conduct established

More information

FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE

FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE FEDERAL CIVIL FALSE CLAIMS ACT The federal civil False Claims Act, 31 U.S.C. 3729, et seq., ( FCA ) was originally enacted in 1863 to combat fraud perpetrated

More information

The Whistleblower Stampede And The. New FCA Litigation Paradigm. Richard L. Shackelford. King & Spalding LLP

The Whistleblower Stampede And The. New FCA Litigation Paradigm. Richard L. Shackelford. King & Spalding LLP The Whistleblower Stampede And The New FCA Litigation Paradigm Richard L. Shackelford King & Spalding LLP Actions under the qui tam provisions of the False Claims Act ( FCA ), 31 U.S.C. 3730(b)-(h), are

More information

MINNESOTA FALSE CLAIMS ACT

MINNESOTA FALSE CLAIMS ACT . MINNESOTA FALSE CLAIMS ACT Sec. 24. [15C.01] DEFINITIONS. Subdivision 1. Scope. For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim. "Claim" includes

More information

BILL ANALYSIS. Senate Research Center C.S.S.B. 1309 By: Wentworth Jurisprudence 4/5/2007 Committee Report (Substituted)

BILL ANALYSIS. Senate Research Center C.S.S.B. 1309 By: Wentworth Jurisprudence 4/5/2007 Committee Report (Substituted) BILL ANALYSIS Senate Research Center C.S.S.B. 1309 By: Wentworth Jurisprudence 4/5/2007 Committee Report (Substituted) AUTHOR'S / SPONSOR'S STATEMENT OF INTENT C.S.S.B. 1309 gives the State of Texas civil

More information

Chapter No. 367] PUBLIC ACTS, 2001 1 CHAPTER NO. 367 HOUSE BILL NO. 779. By Representatives Briley, Hargett, Pleasant

Chapter No. 367] PUBLIC ACTS, 2001 1 CHAPTER NO. 367 HOUSE BILL NO. 779. By Representatives Briley, Hargett, Pleasant Chapter No. 367] PUBLIC ACTS, 2001 1 CHAPTER NO. 367 HOUSE BILL NO. 779 By Representatives Briley, Hargett, Pleasant Substituted for: Senate Bill No. 261 By Senator Cohen AN ACT to amend Tennessee Code

More information

ADMINISTRATION POLICY MEMORANDUM

ADMINISTRATION POLICY MEMORANDUM ADMINISTRATION POLICY MEMORANDUM POLICY TITLE: FRAUD AND ABUSE POLICY NUMBER: JCAHO FUNCTION AREA: POLICY APPLICABLE TO: POLICY EFFECTIVE DATE: POLICY REVIEWED: MCH-1083 Leadership All Employees January

More information

FCA* for BEGINNERS. *FALSE CLAIMS ACT 31 U.S.C 3729 et seq. L. TIMOTHY TERRY THE TERRY LAW FIRM, LTD. CARSON CITY, NEVADA

FCA* for BEGINNERS. *FALSE CLAIMS ACT 31 U.S.C 3729 et seq. L. TIMOTHY TERRY THE TERRY LAW FIRM, LTD. CARSON CITY, NEVADA FCA* for BEGINNERS *FALSE CLAIMS ACT 31 U.S.C 3729 et seq. L. TIMOTHY TERRY THE TERRY LAW FIRM, LTD. CARSON CITY, NEVADA An Affiliate of the WhistleBlower Action Network www.theterrylawfirm.com www.whistlebloweraction.com

More information

FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS. 1) Federal False Claims Act (31 USC 3729-3733)

FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS. 1) Federal False Claims Act (31 USC 3729-3733) FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS 1) Federal False Claims Act (31 USC 3729-3733) II. NEW YORK STATE LAWS A. CIVIL AND ADMINISTRATIVE LAWS 1) New York False Claims

More information

FALSE CLAIMS ACT STATUTORY LANGUAGE

FALSE CLAIMS ACT STATUTORY LANGUAGE 33 U.S.C. 3729-33 FALSE CLAIMS ACT STATUTORY LANGUAGE 31 U.S.C. 3729. False claims (a) LIABILITY FOR CERTAIN ACTS. (1) IN GENERAL. Subject to paragraph (2), any person who (A) knowingly presents, or causes

More information

Title: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs. Area Manual: Corporate Compliance Page: Page 1 of 10

Title: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs. Area Manual: Corporate Compliance Page: Page 1 of 10 Title: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs Area Manual: Corporate Compliance Page: Page 1 of 10 Reference Number: I-70 Effective Date: 10/02 Contact Person:

More information

POLICY AND STANDARDS. False Claims Laws and Whistleblower Protections

POLICY AND STANDARDS. False Claims Laws and Whistleblower Protections POLICY AND STANDARDS Corporate Policy Applicability: Magellan BH (M) NIA (N) ICORE (I) Magellan Medicaid Administration (A) Corporate Policy: Policy Number: Policy Name: Date of Inception: January 1, 2007

More information

Coffee Regional Medical Center FALSE CLAIMS EDUCATION

Coffee Regional Medical Center FALSE CLAIMS EDUCATION Policy/Procedure Department Administration Effective 08/15/2008 Scope Organization Cross Reference Review Date 08/14/2008,12/18/2013 Revision History Signatures Date 12/18/2013 Prepared by Lavonda Cravey

More information

Federal and State Laws Relating to False Claims and False Statements

Federal and State Laws Relating to False Claims and False Statements Federal and State Laws Relating to False Claims and False Statements The federal False Claims Act, the federal Program Fraud Civil Remedies Act, New York State's False Claims Act and certain other New

More information

HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual

HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual Fraud and Abuse Prevention DRA Compliance Policy #: 1521 Original Issue: December, 2007 Page 1 of 6 Policy It is the policy of Hackensack

More information

False Claims and Whistleblower Protections All employees, volunteers, students, physicians, vendors and contractors

False Claims and Whistleblower Protections All employees, volunteers, students, physicians, vendors and contractors Policy and Procedure Title: Applies to: False Claims and Whistleblower Protections All employees, volunteers, students, physicians, vendors and contractors Number: First Created: 1/07 SY-CO-019 Issuing

More information

This policy applies to UNTHSC employees, volunteers, contractors and agents.

This policy applies to UNTHSC employees, volunteers, contractors and agents. Policies of the University of North Texas Health Science Center 3.102 Detecting and Responding to Fraud, Waste and Abuse Chapter 3 Compliance Policy Statement UNTHSC developed and implemented a Compliance

More information

INDIANA FALSE CLAIMS AND WHISTLEBLOWER PROTECTION ACT. IC 5-11-5.5 Chapter 5.5. False Claims and Whistleblower Protection

INDIANA FALSE CLAIMS AND WHISTLEBLOWER PROTECTION ACT. IC 5-11-5.5 Chapter 5.5. False Claims and Whistleblower Protection As amended by P.L.79-2007. INDIANA FALSE CLAIMS AND WHISTLEBLOWER PROTECTION ACT IC 5-11-5.5 Chapter 5.5. False Claims and Whistleblower Protection IC 5-11-5.5-1 Definitions Sec. 1. The following definitions

More information

Deficit Reduction Act Employee Information Requirements

Deficit Reduction Act Employee Information Requirements November 9, 2006 Deficit Reduction Act Employee Information Requirements The Deficit Reduction Act ( DRA ) requires states participating in the Medicaid program to amend their State Plans to mandate that

More information

A BILL TO BE ENTITLED AN ACT. relating to false claims against the state and actions by private

A BILL TO BE ENTITLED AN ACT. relating to false claims against the state and actions by private By:AAMowery H.B.ANo.A00 A BILL TO BE ENTITLED 0 AN ACT relating to false claims against the state and actions by private persons to prosecute those claims; providing a civil penalty. BE IT ENACTED BY THE

More information

HERITAGE FARM POLICY AND PROCEDURES. Policy: False Claims Act and Whistleblower Provisions

HERITAGE FARM POLICY AND PROCEDURES. Policy: False Claims Act and Whistleblower Provisions HERITAGE FARM POLICY AND PROCEDURES Policy: False Claims Act and Whistleblower Provisions Date: October 8, 2013 Rationale: It is Heritage Farm s intent to make sure all claims are submitted in a timely

More information

BILL ANALYSIS. C.S.S.B. 1309 By: Wentworth Civil Practices Committee Report (Substituted) BACKGROUND AND PURPOSE

BILL ANALYSIS. C.S.S.B. 1309 By: Wentworth Civil Practices Committee Report (Substituted) BACKGROUND AND PURPOSE BILL ANALYSIS C.S.S.B. 1309 By: Wentworth Civil Practices Committee Report (Substituted) BACKGROUND AND PURPOSE C.S.S.B. 1309 gives the State of Texas civil remedies to be invoked by the attorney general

More information

NORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy

NORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy NORTHCARE NETWORK POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy RESPONSIBLE PARTY: Chief Executive Officer/Compliance Officer CATEGORY: Compliance BOARD APPROVAL

More information

The Federal False Claims Act: An Opportunity for Justice. By C. Dean Furman 2006

The Federal False Claims Act: An Opportunity for Justice. By C. Dean Furman 2006 The Federal False Claims Act: An Opportunity for Justice By C. Dean Furman 2006 Using a rarely invoked federal statute, the False Claims Act, attorneys can help our clients be private attorney generals,

More information

VILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL ORIGINAL EFFECTIVE DATE: JANUARY 1, 2007

VILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL ORIGINAL EFFECTIVE DATE: JANUARY 1, 2007 VILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL SUBJECT: COMPLIANCE WITH FEDERAL AND STATE FALSE CLAIMS LAWS AND DETECTION AND PREVENTION OF FRAUD, WASTE AND ABUSE LAST POLICY REVISION EFFECTIVE

More information

Fraud, Waste and Abuse Prevention and Education Policy

Fraud, Waste and Abuse Prevention and Education Policy Corporate Compliance Fraud, Waste and Abuse Prevention and Education Policy The Compliance Program at the Cortland Regional Medical Center (CRMC) demonstrates our commitment to uphold all federal and state

More information

Preparing for the Impact of the Alaska False Claims Act

Preparing for the Impact of the Alaska False Claims Act Preparing for the Impact of the Alaska False Claims Act Alaska State Hospital and Nursing Home Association Webinar Presented by Stephen D. Rose 425.278.9337 srose@hallrender.com Barbra Z. Nault 907.258.2587

More information

COUNTY OF ORANGE. False Claims Act and Whistleblower Provisions Policy and Procedures

COUNTY OF ORANGE. False Claims Act and Whistleblower Provisions Policy and Procedures COUNTY OF ORANGE False Claims Act and Whistleblower Provisions Policy and Procedures COUNTY OF ORANGE FALSE CLAIMS ACT AND WHISTLEBLOWER PROVISIONS POLICY AND PROCEDURES I. Purpose. The County of Orange

More information

Federal False Claims Act

Federal False Claims Act Page 1 of 5 False Claims Recovery Policy HMSA must provide information about the following subjects to all HMSA employees and HMSA contractors and agents, who, on behalf of The HMSA Plan for QUEST Members,

More information

Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act

Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act SCOPE OF POLICY This policy applies to all CFS employees, including trainees, volunteers,

More information

SOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572

SOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572 SOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572 POLICY TITLE: Compliance with Applicable Federal and State False Claims Acts POLICY NUMBER: OF-ADM-232 DEPARTMENT: Hospital-wide CROSS-REFERENCE:

More information

Texas Medicaid Fraud Prevention Act

Texas Medicaid Fraud Prevention Act Texas Medicaid Fraud Prevention Act 36.001. Definitions In this chapter: (1) Claim means a written or electronically submitted request or demand that: (A) is signed by a provider or a fiscal agent and

More information

ADMINISTRATIVE POLICY SECTION: CORPORATE COMPLIANCE Revised Date: 2/26/15 TITLE: FALSE CLAIMS ACT & WHISTLEBLOWER PROVISIONS

ADMINISTRATIVE POLICY SECTION: CORPORATE COMPLIANCE Revised Date: 2/26/15 TITLE: FALSE CLAIMS ACT & WHISTLEBLOWER PROVISIONS Corporate Compliance Plan AD-819-0 Reporting of Compliance Concerns & Non-retaliation AD-807-0 Compliance Training Policy CFC ADMINISTRATIVE POLICY AD-819-1 SECTION: CORPORATE COMPLIANCE Revised Date:

More information

Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures

Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY and TOOMEY RESIDENTIAL AND COMMUNITY SERVICES Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures Purpose:

More information

ADMINISTRATIVE POLICY MANUAL

ADMINISTRATIVE POLICY MANUAL SUPERSEDES: New PAGE: 838.00 POLICY: 1. It is the policy of Onondaga County hereinafter referred to as the County, to comply with all applicable federal, state and local laws and regulations, both civil

More information

Fraud and Abuse in the Sale and Marketing of Drugs

Fraud and Abuse in the Sale and Marketing of Drugs American Conference Institute s 11 th National Forum on: Fraud and Abuse in the Sale and Marketing of Drugs MANAGING, DEFENDING AND CURTAILING WHISTLEBLOWER AND RELATOR ALLEGATIONS UNDER ANEXPANDED FALSE

More information

Page 291 TITLE 31 MONEY AND FINANCE 3730

Page 291 TITLE 31 MONEY AND FINANCE 3730 Page 291 TITLE 31 MONEY AND FINANCE 3730 and consistency and to eliminate unnecessary words. The words officer or employee of the Government or a member of an armed force are substituted for officer in

More information

Deficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery

Deficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery DMH S&P No. 1 Revision No. N/A Effective Date: 01/01/07 COMPLIANCE STANDARD: Deficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery BACKGROUND AND PURPOSE As stated in its Directive

More information

VNSNY CORPORATE. DRA Policy

VNSNY CORPORATE. DRA Policy VNSNY CORPORATE DRA Policy TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005: POLICY REGARDING THE DETECTION & PREVENTION OF FRAUD, WASTE AND ABUSE AND APPLICABLE FEDERAL AND STATE LAWS APPLIES TO: VNSNY ENTITIES

More information

THE FEDERAL FALSE CLAIMS ACT

THE FEDERAL FALSE CLAIMS ACT Executive Summary THE FEDERAL FALSE CLAIMS ACT The Federal False Claims Act ( FCA ), 31 U.S.C. 3729-3733, helps the federal government combat fraud and recover losses resulting from fraud in federal programs,

More information

HB 2845. Introduced by Representative Patterson AN ACT

HB 2845. Introduced by Representative Patterson AN ACT REFERENCE TITLE: state false claims actions State of Arizona House of Representatives Fiftieth Legislature Second Regular Session HB Introduced by Representative Patterson AN ACT AMENDING TITLE, ARIZONA

More information

Prevention of Fraud, Waste and Abuse

Prevention of Fraud, Waste and Abuse Procedure 1910 Responsible Office: Yale Medical Group Effective Date: 01/01/2007 Responsible Department: Administration Last Revision Date: 09/20/2013 Prevention of Fraud, Waste and Abuse Policy Statement...

More information

Last Approval Date: May 2008. Page 1 of 12 I. PURPOSE

Last Approval Date: May 2008. Page 1 of 12 I. PURPOSE Page 1 of 12 I. PURPOSE The purpose of this policy is to comply with the requirements in Section 6032 of the Deficit Reduction Act of 2005 (the DRA ), which amends Section 1902(a) of the Social Security

More information

NC General Statutes - Chapter 1 Article 51 1

NC General Statutes - Chapter 1 Article 51 1 Article 51. False Claims Act. 1-605. Short title; purpose. (a) This Article shall be known and may be cited as the False Claims Act. (b) The purpose of this Article is to deter persons from knowingly causing

More information

GOVERNMENT PROSECUTIONS AND QUI TAM ACTIONS

GOVERNMENT PROSECUTIONS AND QUI TAM ACTIONS GOVERNMENT PROSECUTIONS AND QUI TAM ACTIONS DISTRICT OF COLUMBIA OFFICIAL CODE DIVISION I. GOVERNMENT OF DISTRICT. TITLE 2. GOVERNMENT ADMINISTRATION. CHAPTER 3B. OTHER PROCUREMENT MATTERS. SUBCHAPTER

More information

North Shore LIJ Health System, Inc.

North Shore LIJ Health System, Inc. North Shore LIJ Health System, Inc. POLICY TITLE: Detecting and Preventing Fraud, Waste, Abuse and Misconduct POLICY #: 800.09 System Approval Date: 6/23/14 Site Implementation Date: Prepared by: Office

More information

MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS

MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS OWNER: DEPARTMENT OF COMPLIANCE EFFECTIVE: REVIEW/REVISED: SUPERCEDES:

More information

63rd Legislature AN ACT REVISING THE MONTANA FALSE CLAIMS ACT; REVISING CIVIL PENALTIES TO PROVIDE FOR

63rd Legislature AN ACT REVISING THE MONTANA FALSE CLAIMS ACT; REVISING CIVIL PENALTIES TO PROVIDE FOR 63rd Legislature HB0345 AN ACT REVISING THE MONTANA FALSE CLAIMS ACT; REVISING CIVIL PENALTIES TO PROVIDE FOR INFLATION ADJUSTMENTS; REVISING PUBLIC DISCLOSURE PROVISIONS; REVISING THE STATUTE OF LIMITATIONS;

More information

EXECUTIVE SUMMARY Compliance Program and False Claims Recovery

EXECUTIVE SUMMARY Compliance Program and False Claims Recovery EXECUTIVE SUMMARY Compliance Program and False Claims Recovery INTRODUCTION: The Federal Deficit Reduction Act of 2005, also known as the DRA, requires that providers give their employees, medical staff,

More information

Reports of Compliance Concerns and Violations

Reports of Compliance Concerns and Violations The University of Chicago Medical Center Compliance Manual (UCHHS;BSD;UCPP) Reports of Compliance Concerns and Violations Issued: November 1, 1999 Reports of Compliance Concerns and Violations Revised:

More information

BLESSING CORPORATE SERVICES QUINCY, ILLINOIS

BLESSING CORPORATE SERVICES QUINCY, ILLINOIS BLESSING CORPORATE SERVICES QUINCY, ILLINOIS Policy No. BCSCGR.015 Policy Title: Section/Function: 2: Compliance & Government Regulations Administrative Responsibility: VP, Corporate Compliance & Organizational

More information

I. PURPOSE The purpose of this policy is to ensure University HealthCare Alliance ( UHA ) complies with Federal and California False Claims Acts.

I. PURPOSE The purpose of this policy is to ensure University HealthCare Alliance ( UHA ) complies with Federal and California False Claims Acts. Page 1 of 7 I. PURPOSE The purpose of this policy is to ensure University HealthCare Alliance ( UHA ) complies with Federal and California False Claims Acts. II. POLICY STATEMENT UHA will not knowingly

More information

To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center

To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center From: Corporate Compliance Department Re: Deficit Reduction Act of 2005 Dear Vendor/Agent/Contractor: Under the Deficit Reduction

More information

And you can receive a substantial reward for doing so.

And you can receive a substantial reward for doing so. Who is a whistleblower under the False Claims Act? Anyone who sees a Government contractor cheating the United States and wants to do something about it can blow the whistle. If you d like to put a stop

More information

Broward County False Claims Ordinance. (a) This article shall be known and may be cited as the Broward County False Claims Ordinance.

Broward County False Claims Ordinance. (a) This article shall be known and may be cited as the Broward County False Claims Ordinance. Broward County False Claims Ordinance Sec. 1-276. - Short title; purpose. (a) This article shall be known and may be cited as the Broward County False Claims Ordinance. (b) The purpose of the Broward County

More information

The False Claims Act: A Primer

The False Claims Act: A Primer The False Claims Act: A Primer The False Claims Act (FCA), 31 U.S.C. 3729-3733 was enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding

More information

The False Claims Act: An Example of U.S. Whistleblower Laws

The False Claims Act: An Example of U.S. Whistleblower Laws The False Claims Act: An Example of U.S. Whistleblower Laws Gerald S. Reamey, J.D., LL.M. Professor of Law Co-Director of International Legal Programs St. Mary s University School of Law San Antonio, Texas

More information

0 HealthAlliance. of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH

0 HealthAlliance. of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH 0 HealthAlliance of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH Policy: Compliance with Applicable Federal and State False Claims Acts Initiated: January 1,2010 Reviewed: Revised: Reference: Responsible

More information

Cuellar, Coleman, Maxey, Dukes ORGANIZATION bill analysis 4/30/97 (CSHB 820 by Berlanga) Civil actions to recover fraudulent Medicaid claims

Cuellar, Coleman, Maxey, Dukes ORGANIZATION bill analysis 4/30/97 (CSHB 820 by Berlanga) Civil actions to recover fraudulent Medicaid claims HOUSE HB 820 RESEARCH Cuellar, Coleman, Maxey, Dukes ORGANIZATION bill analysis 4/30/97 (CSHB 820 by Berlanga) SUBJECT: COMMITTEE: VOTE: Civil actions to recover fraudulent Medicaid claims Public Health

More information

Federal False Claims Act

Federal False Claims Act An Examination of the Federal False Claims Act Self Study Module for CPSA and Provider Staff July 2010 Module Contents Module Objectives Overview of the False Claims Act Violations of the Act Reporting

More information

IC 5-11-5.7 Chapter 5.7. Medicaid False Claims and Whistleblower Protection

IC 5-11-5.7 Chapter 5.7. Medicaid False Claims and Whistleblower Protection IC 5-11-5.7 Chapter 5.7. Medicaid False Claims and Whistleblower Protection IC 5-11-5.7-1 Application; definitions Sec. 1. (a) This chapter applies only to claims, requests, demands, statements, records,

More information

STATEN ISLAND UNIVERSITY HOSPITAL ADMINISTRATIVE POLICY AND PROCEDURE MANUAL

STATEN ISLAND UNIVERSITY HOSPITAL ADMINISTRATIVE POLICY AND PROCEDURE MANUAL Page 1 of 10 POLICY: It is the obligation of the North Shore-Long Island Jewish Health System, Inc. 1 ( Health System ) and Staten Island University Hospital ( SIUH ) to prevent and detect any fraud, waste

More information

False Claims Act Update

False Claims Act Update False Claims Act Update Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: bwade@kdlegal.com KD_4901979 1 The FCA is the Fraud Enforcement

More information

Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS]

Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS] Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS] POLICY PURSUANT TO THE FEDERAL DEFICIT REDUCTION ACT OF 2005: Detection and Prevention of Fraud, Waste, and Abuse and

More information

Fraud Against Taxpayers Act

Fraud Against Taxpayers Act Fraud Against Taxpayers Act A New Chapter in Whistleblower New Mexico School Boards Association 2014 School Law Conference John F. Kennedy M. Karen Kilgore T. W. Foster Cuddy & McCarthy, LLP 1701 Old Pecos

More information

Accountability Report Card Summary 2013 New Mexico

Accountability Report Card Summary 2013 New Mexico Accountability Report Card Summary 2013 New Mexico New Mexico has a pretty strong state whistleblower law: Scoring 72 out of a possible 100 points; Ranking 4 th out of 51 (50 states and the District of

More information

THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES FALSE CLAIMS AND WHISTLEBLOWER PROTECTIONS

THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES FALSE CLAIMS AND WHISTLEBLOWER PROTECTIONS THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES POLICY It is the obligation of the County of Montgomery (the County ) to prevent and detect any fraud, waste and abuse in its organization related to Federal

More information

Cardinal McCloskey Services Corporate Compliance False Claims Act and Whistleblower Provisions

Cardinal McCloskey Services Corporate Compliance False Claims Act and Whistleblower Provisions Cardinal McCloskey Services Corporate Compliance False Claims Act and Whistleblower Provisions Purpose: Cardinal McCloskey Services is committed to prompt, complete and accurate billing of all services

More information

False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed TITLE. Apr13. LD, CP Corporate Wide TJC FUNCTIONS APPLIES TO I.

False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed TITLE. Apr13. LD, CP Corporate Wide TJC FUNCTIONS APPLIES TO I. ADMINISTRATIVE TITLE False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed Effective Date: TJC FUNCTIONS APPLIES TO LD, CP Corporate Wide Apr13 I. SCOPE / PURPOSE It is the policy of Novant Health

More information

OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS

OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS POLICY: CC-109 It is the policy of OSF HealthCare (OSF) that false, inaccurate or improper claims will not be submitted to any payer.

More information

Whistleblower Retaliation & Qui Tam Litigation Successfully Litigating False Claim Act Claims

Whistleblower Retaliation & Qui Tam Litigation Successfully Litigating False Claim Act Claims Whistleblower Retaliation & Qui Tam Litigation Successfully Litigating False Claim Act Claims Amy Walker Wagner Partner, Stone & Magnanini LLP Short Hills, NJ A live 90-minute CLE webinar with interactive

More information

False Claims Laws and Whistleblower Protections. Date Compliance Officer

False Claims Laws and Whistleblower Protections. Date Compliance Officer Policy and Standards Line of Business Applicability: Behavioral Health (B) NIA (N) ICORE (I) MMA (A) Physical Health (P) Product Applicability: Commercial Medicaid Medicare Magellan Pharmacy Solutions

More information

SECTION XII: Fraud, Waste and Abuse

SECTION XII: Fraud, Waste and Abuse FRAUD AND ABUSE Arizona Revised Statute ARS 36-2918.01 requires providers to immediately report suspected fraud and abuse. Members or providers who intentionally deceive or misrepresent in order to obtain

More information

Oklahoma FALSE CLAIMS LAWS

Oklahoma FALSE CLAIMS LAWS Oklahoma Company-affiliated facilities in Oklahoma must ensure that all employees, including management, and any contractors or agents are educated regarding the federal and state false claims statutes

More information

Why Alabama Needs A State False Claims Act. Don McKenna Hare, Wynn, Newell & Newton Birmingham, Alabama 800-568-5330 Don@hwnn.com

Why Alabama Needs A State False Claims Act. Don McKenna Hare, Wynn, Newell & Newton Birmingham, Alabama 800-568-5330 Don@hwnn.com Why Alabama Needs A State False Claims Act Don McKenna Hare, Wynn, Newell & Newton Birmingham, Alabama 800-568-5330 Don@hwnn.com AThere is no kind of dishonesty into which otherwise good people move easily

More information

USC Office of Compliance

USC Office of Compliance PURPOSE This policy complies with requirements under the Deficit Reduction Act of 2005 and other federal and state fraud and abuse laws. It provides guidance on activities that could result in incidents

More information

NEW YORK FALSE CLAIMS ACT

NEW YORK FALSE CLAIMS ACT NEW YORK FALSE CLAIMS ACT STATE FINANCE LAW, ART. XIII (2013) 187. SHORT TITLE This article shall be known and may be cited as the "New York false claims act". 188. DEFINITIONS As used in this article,

More information

SCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005

SCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Approver Approval Stage Date Chris Zorn Approval Event (Authoring) 12/09/2013 Nancy Monk Approval Event

More information

Risk Manager As Whistleblower

Risk Manager As Whistleblower The Risk Manager as a Whistle Blower Panel Moderator: John Metcalfe, JD, FASHRM Panelists: Dan Groszkruger, JD, MPH, DFASHRM Andrew (Andy) Oppenberg, MPH,CPHRM,DFASHRM Josh Hyatt, DHSc (c), MHL, CPHRM

More information

The False Claims Acts What you need to know

The False Claims Acts What you need to know The False Claims Acts What you need to know Why have this training? Required by federal law Employees have a duty to identify and report fraud, waste and abuse By safeguarding Medi-Cal and Medicare funding,

More information

Newport Subacute Healthcare Center

Newport Subacute Healthcare Center Title: False Claims Act Policy Manual: Administrative Policy Manual Category: Business function Approval Signatures: Newport Subacute Healthcare Center Document #: Original Issue: 02/01/2006 Revision Date:

More information

fraud, waste, abuse, compliance, integrity, Integrity Help Line

fraud, waste, abuse, compliance, integrity, Integrity Help Line Policy / Procedure: KEY TERMS: fraud, waste, abuse, compliance, integrity, Integrity Help Line I. PURPOSE: To help our employees, agents and contractors understand the methods to prevent and detect fraud,

More information

policy (C) Deficit Reduction Act of 2005 and the Federal False Claims Act

policy (C) Deficit Reduction Act of 2005 and the Federal False Claims Act Name of Policy: Detecting and Preventing Fraud, Waste and Abuse Policy Number: 3364-15-02 Issuing Office: President Responsible Agent: Compliance/Privacy Officer Revision date: July 5, 2011 Original effective

More information

Upper Peninsula Health Plan Policy & Procedure

Upper Peninsula Health Plan Policy & Procedure Upper Peninsula Health Plan Policy & Procedure Index #: Effective: 01/01/07 Subject: State and Federal False Claims Revised: 05/18/11 Act, Whistleblower Protections CEO Approval: 01/01/07 Authorized By:

More information