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KeyPoint, Whistleblower Settle SecurityClearance Fraud Suit

KeyPoint Government Solutions Inc. and a whistleblower settled a False Claims Act lawsuit alleging improper high-level security clearance investigations under an Office of Personnel Management contract, a district court said.

Judge Christine M. Arguello of the U.S. District Court for the District of Colorado dismissed the suit in a Monday order.

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[ADDITIONAL COVERAGE]

Long-running False Claims Act lawsuit against Peraton subsidiary dismissed following settlement

From FedScoop (April 12, 2022)

A federal judge on Monday dismissed a long-running lawsuit against a Peraton subsidiary over the provision of background investigation services to the Office of Personnel Management.

It ends an eight-year dispute following which KeyPoint Government Solutions agreed to settle with the U.S. government for an undisclosed sum. According to attorneys for the plaintiff, 29% of the settlement figure will be paid to whistleblower Julie Reed who initially a qui tam lawsuit against the company in 2014. KeyPoint has also agreed to pay an additional sum towards Reed’s legal fees.

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“Ms. Reed’s position allowed her to see investigators falsely reporting applicants’ backgrounds as ‘clean’ and omitting information showing otherwise, completing fewer than the required number of interviews, and generally cutting corners,” Court of Appeal judges Mary Beck Briscoe, Stephanie K. Seymour and Jerome Holmes wrote in their 2019 opinion.

“Ms. Reed also believed that she witnessed rampant violations of the TTP and a scheme by KeyPoint management to hide the violations by submitting knowingly false corrective action reports to OPM,” they added in the opinion.

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Whistleblower in Security Clearance Fraud Case Receives Reward from Federal Government

From ClearanceJobs (April 12, 2022)

It’s not always easy to say something when you see something. But when you work in national security, it’s important to make sure that rules are followed as intended. When one former defense contractor thought her employer was lying about the completeness of its high-level security clearance background investigations, she reported it.

In her complaint, whistleblower Julie Reed accused federal contractor, KeyPoint Government Solutions, of misrepresenting its highest-level security clearance investigations, which she believes failed to meet strenuous government requirements. She described her growing concern, which she reported internally, that dozens of KeyPoint investigators were failing to report negative investigatory information — and that KeyPoint managers weren’t conducting reviews that would have caught such failures.

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Longtime Whistleblower Suit Against Colorado Company Settles

From Law Week Colorado (April 20, 2022)

KeyPoint Government Solutions settled an eight-year-old whistleblower action brought by a Colorado resident and former employee. The False Claims Act qui tam lawsuit was dismissed in the U.S. District Court for the District of Colorado on April 11 after KeyPoint, the U.S. government and Julie Reed, the plaintiff and whistleblower, reached an undisclosed settlement.

[….]

The agreement closes out a lengthy case that stemmed from fraud claims. Janel Quinn, principal at The Employment Law Group, P.C., represented Reed and said this was one of the longest qui tam cases she’s worked on. In part, Quinn said, because Reed’s suit was dismissed then reinstated by the 10th Circuit Court of Appeals.

[….]

According to Quinn, Reed brought the lawsuit from a place of passion. “She was steeped in this industry, she was trained in this industry, she had dedicated her life to this industry, her career to this industry,” said Quinn. “Many of my whistleblower clients are passionate, but Julie [Reed] was dedicated to this and to raising this issue and righting this wrong from the outset and she really brought that passion to this case.”

Qui tam cases like Reed’s are a way for taxpayers to hold industries accountable, according to Quinn. “They do allow private parties to provide that check, that counterbalance, that question ‘Hey, is something wrong here? I think that we need to look into this,’” Quinn said. “I think it’s really commendable when people do that and come forward and raise their hand. Because it’s not an easy road for them, it’s a long road, it can be a frustrating road, it can often lead to retaliation in the workplace, potentially alienation from coworkers and colleagues and friends. But the work is important and I think the work that Julie [Reed] did here was really important.”

>> View full story on Law Week Colorado

Bloomberg Law

U.S. Government Rewards Whistleblower For Role in Security Clearance Fraud Case

Former Employee Alleged that Federal Contractor Lied About Completeness of Its High-Level Investigations

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WASHINGTON, D.C. (April 11, 2022) — Whistleblower Julie Reed will receive a 29 percent share of a payment to the U.S. government that resolves her claims that a federal contractor, KeyPoint Government Solutions, defrauded taxpayers and endangered national security by failing to conduct proper high-level security clearance investigations.

Ms. Reed’s share of the settlement amount — close to the statutory maximum of 30 percent — was set by the U.S. Department of Justice as a reward for her significant contribution to the case over its eight-year lifespan. The amount of the payout wasn’t disclosed publicly; KeyPoint also agreed to pay an additional sum for her legal fees.

KeyPoint has changed ownership several times since Ms. Reed filed her original complaint; it is now called Peraton Risk Decision Inc. and is a subsidiary of Northern Virginia-based Peraton Inc., which is owned in turn by private-equity giant Veritas Capital. The long-running lawsuit included a two-year spell at the U.S. Court of Appeals for the Tenth Circuit, which granted Ms. Reed a favorable ruling and ordered the case to proceed.

In light of the settlement, a federal judge today dismissed Ms. Reed’s complaint in the U.S. District Court for the District of Colorado.

Ms. Reed was represented in the matter by The Employment Law Group® law firm and Mehri & Skalet, PLLC. She blew the whistle on KeyPoint, her former employer, by filing a complaint in January 2014 under the federal False Claims Act. The statute, originally signed into law by President Abraham Lincoln in 1863, makes it illegal to deceive the federal government for financial gain. The FCA includes a “qui tam” provision that allows whistleblowers to file a legal complaint on behalf of the government and — if they prevail — to receive a share of the proceeds.

In her complaint, Ms. Reed accused KeyPoint of misrepresenting its highest-level security clearance investigations, which she believes failed to meet strenuous government requirements. She described her growing concern, which she reported internally, that dozens of KeyPoint investigators were failing to report negative investigatory information — and that KeyPoint managers weren’t conducting reviews that would have caught such failures.

The settlement covers conduct by KeyPoint over a period of six years, from 2011 through 2016.

“Julie fully deserves this reward for her integrity,” said Janel Quinn, a principal of The Employment Law Group, one of the whistleblower attorneys who represented Ms. Reed. “She held KeyPoint accountable for delivering proper value to taxpayers, and she knew that the impact of substandard investigations wasn’t just financial — she was standing up for national security.”

“Being a whistleblower was never my aim, but it became my duty because of the oath I took to protect the public trust,” said Ms. Reed. “I continue to believe that KeyPoint and the United States Government have an obligation to protect access to classified information. When contractors like KeyPoint don’t take that responsibility seriously, it puts us all at risk. Unfortunately, the industry has failed to make improvements since 2016 and I fear there is additional wrongdoing yet to be discovered.”

“We are proud to have helped Julie in her battle to ensure the quality of security clearance investigations,” said Richard Condit, a partner at Mehri & Skalet who also represented Ms. Reed. “She spoke out to protect national security and feels it was her patriotic duty to do so. We hope that other whistleblowers will follow her example.”

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Case Information

United States ex rel. Reed v. KeyPoint Government Solutions
No. 1:14-cv-00004, U.S. District Court for the District of Colorado
Original complaint filed on January 2, 2014 (available here); second amended complaint filed on December 5, 2016 (available here)
Opinion from the U.S. Court of Appeals for the Tenth Circuit, where the case was docketed as No. 17-1379, delivered on April 30, 2019 (available here)

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About The Employment Law Group
The Employment Law Group® law firm represents whistleblowers and other employees who stand up to wrongdoing in the workplace. Based in Washington, D.C., the firm takes cases nationwide.

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About Mehri & Skalet

Mehri & Skalet, PLLC is a public-spirited law firm that pursues high-impact cases in areas ranging from civil rights to whistleblower protection to consumer protection. The firm is based in Washington, D.C.

Threat To False Claims Act Lurks In High Court PAGA Case

By R. Scott Oswald

Do the ever-growing tentacles of the Federal Arbitration Act endanger the U.S. government’s ability to pursue fraud under the False Claims Act?

That question didn’t arise squarely in today’s arguments before the U.S. Supreme Court in Viking River Cruises, Inc. v. Moriana, a California labor-law dispute — but it lurked in the shadows, as the justices debated whether employees may waive their right to pursue representative actions under the state’s 2004 Private Attorneys General Act.

PAGA’s enforcement mechanism, which empowers workers to litigate companywide labor-law violations against their employers on behalf of California authorities, is a kissing cousin to the FCA’s qui tam provision, which encourages individuals — usually employees with insider knowledge — to step into the shoes of the U.S. Department of Justice and file claims against entities that are defrauding taxpayers.

While they have important differences, both statutes allow individuals to litigate on behalf of the government, with the government remaining the real party in interest; both allow such a claimant to share in a resulting recovery.

If the Supreme Court finds that PAGA representative actions can be waived, or forced into arbitration without the consent of the government, it would hand another victory to corporations that already have used the FAA to avoid courtroom accountability on everything from race discrimination cases to consumer class-action lawsuits.

Worse, it might offer logic that would help employers to target FCA qui tam actions next, threatening a form of anti-fraud lawsuit that returned more than $1.6 billion to the U.S. Treasury in the most recent fiscal year.

No Barking Dogs?

Several briefs in Viking River Cruises drew a direct comparison between PAGA and the FCA, with amicus Taxpayers Against Fraud Education Fund urging the justices to warn against any application of the current case to FCA litigation. A decision holding that employees can waive a claim that is truly held by the government without somehow distinguishing FCA law “could threaten to undermine the public-private partnership that Congress crafted” under the FCA, TAFEF said.

Today’s arguments included several invocations of the FCA but no clear statements by the justices about how it interacts with the FAA. Appearing for Viking River Cruises, former Solicitor General Paul Clement implicitly distinguished PAGA and brushed off the FCA as one of several “dogs that aren’t barking here,” claiming that the DOJ would have gotten involved in the case if it was truly worried.

Justice Stephen Breyer, however, may have jangled some nerves when he said, early in arguments, that he sees no reason “you couldn’t … agree to have an arbitration in a qui tam action — why not?” (Depending on who he meant by “you,” it’s actually a very contentious issue.)

The likely disposition of the case wasn’t clear: While Justices Breyer, Sonia Sotomayor, and Elena Kagan appeared to support the decision below, which allowed the PAGA case to proceed in California state court notwithstanding an explicit waiver, their conservative brethren were quieter and harder to read.

In any event, when it comes to FCA, the exact wording of an opinion will matter intensely.

Who Is Being Represented?

In Mr. Clement’s framing today, the real problem with PAGA’s “representative” nature isn’t an employee’s representation of the California government in the action — it’s the employee’s representation of fellow employees.

“It’s not the state’s involvement here [that’s] the gravamen of our concern,” he said, focusing instead on the practicalities of arbitrating a PAGA claim. “The gravamen of our concern is that this action is not just trying to litigate [former Viking employee Angie] Moriana’s Labor Code violation, but the Labor Code violation[s] of essentially the entire salesforce.”

And while California provides PAGA as a tool to pursue such violations, he said, that option “has to yield” to the FAA’s supremacy if it’s waived in a valid arbitration agreement — just as the Supreme Court previously ruled in AT&T Mobility LLC v. Concepcion that otherwise valid consumer class actions must fall before an arbitration clause.

Ms. Moriana’s agreement had purported to send all her individual claims to arbitration — and to waive all “class, collective, representative or private attorney general” actions, regardless of forum. Arguing for Ms. Moriana, Scott Nelson of Public Citizen warned that many qui tam claims would be jeopardized by the enforcement of such a waiver against an FCA whistleblower, known as a relator.

“Because of the … contractual privity between many potential qui tam relators and defendants, because they’re often … employees who are in a position to be relators … if the potential defendant were to put in a properly worded arbitration agreement …, it could bar the assertion of a representative claim in exactly the same way, if [Viking’s] argument is accepted,” he said in response to a question from Justice Kagan.

Key Distinctions

Of course, there are important differences between PAGA and the FCA that should give any court pause before concluding that even an opinion here that’s favorable to employers — no matter its wording — applies to the FCA:

PAGA is a state law that is, in theory, subject to federal preemption doctrine; an FCA analysis would necessarily be very different;
An FCA claim is not brought on behalf of other employees, and isn’t comparable to a class or collective action;
All PAGA actions will arise in part from an employee’s employment, whereas few if any FCA claims will, even where the employee is a direct witness to fraud;
Under PAGA, the employee plaintiff controls the litigation; under the FCA, the DOJ can step in and take it over — and can limit the relator’s role even where it declines to intervene;
Under PAGA, the employee plaintiff can reach a settlement without government consent; under the FCA, written consent is required even in a declined case.

What’s more, the FCA was signed by Abraham Lincoln — and its qui tam provision was rejuvenated long before the Supreme Court’s recent flood of anti-employee FAA jurisprudence, with 35 years of very active use now under its belt. FCA cases are clearly not an end-run around the court, as Mr. Clement portrayed PAGA litigation.

“Before Concepcion [subordinated class actions to the FAA], PAGA was the statute nobody paid too much attention to,” Mr. Clement said, in a seeming appeal to the justices’ irritation at a Supreme Court ruling being circumvented. “After Concepcion, 17 PAGA complaints are being filed every day. These actions look, in every practical effect, just like class actions.”

Of course, as Justice Sotomayor had earlier observed, PAGA was passed before the crucial Concepcion decision.

“I’m having a series of problems with all your answers,” she told Mr. Clement. “PAGA came eight years before Concepcion … So it’s not California creating an intentional evasion …, correct? It didn’t intentionally predict that what we were going to do there and say now we got to find a way to get around [it]?”

Clement parried — and by the end of arguments, mostly due to a lack of engagement from the court’s conservatives, it was unclear who would prevail.

At least until the decision is handed down, the FCA’s fate remains in play.

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R. Scott Oswald is managing principal of The Employment Law Group, P.C. He is also a member of the Taxpayers Against Fraud Education Fund, which submitted an amicus brief in Viking River Cruises, Inc. v. Moriana, but was not involved in the production of that brief.

(Note: This version has been edited slightly from the version published by Law360.)

Lockheed Can’t Evade All Of Black Ex-Exec’s Bias Suit

A Texas federal court held that Lockheed Martin Corp. must face part of a Black former manager’s suit alleging she’d been demoted and suspended as punishment for speaking up about a supervisor’s request that she keep quiet about workplace discrimination, determining that a jury might find Lockheed’s explanation was false.

In Thursday’s memorandum opinion, U.S. District Judge Reed O’Connor partially granted Lockheed Martin’s bid for summary judgment of Keishonna Harper’s amended complaint against the aerospace company. The judge allowed her Title VII retaliation claim to proceed to trial, but tossed her federal race discrimination claims and Family and Medical Leave Act retaliation claim.

[….]

In determining that Harper’s Title VII retaliation claim should proceed to trial, the court found Thursday that Lockheed Martin didn’t sufficiently rebut the former employee’s argument that the explanation the company gave for getting rid of her supervisory duties and temporarily suspending her was pretext for discrimination.

Harper plausibly connected her demotion and suspension to her protected human resources complaints, the court found. The company’s adverse actions occurred four months after her complaint, Judge O’Connor pointed out, and she’d shown that the company had previously treated her differently from white colleagues.

Bad bosses? 5 rotten apple red flags and what to do next

Whether you’re a brand new agent or an agent who has just signed on with a new brokerage, you’re probably looking to your leadership for a host of benefits, including professional development, additional training, lead generation opportunities and more. However, all brokerages are not created equal — some brokers and leadership teams may be more of a hindrance than a help to your professional growth.

[….]

We reached out for some insights on your legal and ethical options when it comes to bad leadership along with common sense solutions for the more everyday challenges you may face. Keep in mind, you may incur liability if you are aware of violations and don’t report them. Make sure that you have a trusted legal adviser so that you can ensure that you’re always on the right side of these issues.

[….]

Discriminatory leadership

Different states have different rules when it comes to the treatment of independent contractors and employees, according to Nicholas Woodfield, a principal at The Employment Law Group, P.C., located in Washington, D.C.

The line between abusive behavior and actionable, discriminatory behavior comes down to whom it’s aimed at and how it’s targeted.

Example: Your broker lets you know that you, a female agent, will be getting a few extra leads this month since the men in your office have been closing so many deals lately. After all, the ladies have to stick together, right?

A manager can dislike someone for talking too much about their favorite TV show or talking too much in general. A manager may then be rude to or harass an employee or contractor based on personal dislike.

“If you’re a jerk, it’s bad management, but you have to have a protected class for discrimination or harassment to be illegal,” Woodfield said.

Woodfield suggests a number of recourses for those who believe they are being discriminated against or for those who are seeking to advocate for others in their brokerage who are experiencing discriminatory behavior:

If your brokerage is part of a larger corporate entity, complain to the corporate head office. That way, limitations within the state won’t impact your ability to report discriminatory behavior.
If your brokerage company is publicly traded, you can complain to the company’s general counsel and say, “I am an agent and there is systemic discrimination here. I looked at the firm’s public postings that say we are an equal opportunity employer. If shareholders knew about this, they would think they were being defrauded.” Under the Sarbanes-Oxley Act, publicly traded companies must meet certain obligations. This provides added motivation for the corporate office to get a handle on the local brokerage.
Harness the power of public opinion through Yelp or Glassdoor. “Companies are very sensitive to how they’re perceived and to things blowing up out of control,” Woodfield said.
Don’t work for a franchise? “An independent brokerage is still subject to EEOC,” Woodfield said. “Just treating you like a jerk is not illegal, but action against a protected class is illegal.”

Inman

Our Lawyers Can Help You to Report Nursing Home Fraud

Can nursing home whistleblowers get a reward?

Yes. As an inducement for people to expose fraud against programs such as Medicare, the False Claims Act allows whistleblowers to receive up to 30 percent of any money the U.S. government recovers as a result of their lawsuit. Since many elderly patients are Medicare beneficiaries — and since the federal government is mobilized against exactly this sort of wrongdoing — the FCA is a powerful tool for elder-care whistleblowers. Depending on your state, other rewards statutes may also apply.

Please note, however, that the government generally supports FCA lawsuits only where they are filed by people who can provide concrete evidence of a relatively large or especially harmful scheme. Smaller scale claims — particularly those made by or on behalf of individual Medicare recipients — generally are not pursued under the FCA, and are unlikely to generate a reward.

What counts as Medicare fraud at a nursing home? How about Medicaid fraud?

Medicare is a government health insurance program that’s mostly for older people. It generally doesn’t cover “custodial” care, which is care needed for daily living — bathing, dressing, using the bathroom, eating, and the like. It does cover necessary medical care and supplies that may be used at a nursing home or an assisted living facility.

In brief, a Medicare claim is likely fraudulent if the facility asks to be reimbursed by taxpayers for services that weren’t delivered, that weren’t necessary, that weren’t delivered in the way described, that weren’t delivered by an approved provider, or that otherwise weren’t delivered under proper circumstances.

Medicare also covers certain care that’s delivered in an inpatient “skilled nursing facility” or SNF, which is a facility that has been certified as such by Medicare. SNF coverage is fairly generous and includes most aspects of a patient’s stay, including a semi-private room, physical and/or occupational therapy, speech-language pathology services, meals, social services, medications, medical equipment and supplies, and ambulance transportation if necessary.

SNF care may be covered for up to 100 days when a person is admitted following a qualifying hospital stay (3 or more days as an inpatient) and a doctor has ordered such care. Treatment must start within 30 days of leaving the hospital and cover the same conditions for which a patient was initially hospitalized or any new conditions that a patient develops during the SNF stay. After the initial benefit period ends, a patient must have another 3-day qualifying hospital stay in order to meet the Medicare requirements for another 100-day benefit period.

Facilities can’t legally claim reimbursement for SNF care if they aren’t properly certified or haven’t met these admission criteria; such claims would likely count as Medicare fraud.

Medicaid, meanwhile, is a joint federal and state program that helps with medical costs for some people with limited income and resources. If a patient qualifies for both Medicare and Medicaid, then most of their health care costs are covered. Many patients who enter a nursing home will “spend down” their assets and become eligible for Medicaid over the course of their stay.

In addition to all the same fraud seen with Medicare, therefore, a facility may be liable for Medicaid fraud if it misrepresents its patients’ eligibility for taxpayer help.

What are some specific examples of nursing home fraud?

If you work in a nursing home, assisted living facility, or skilled nursing facility, you may have witnessed some of these practices:

False certification: A claim may be considered false if it is submitted based on a materially false certification — a doctor’s certification that the patient qualifies for SNF care, for instance. Additionally, because a Medicare SNF benefit period can end if the patient hasn’t received care in at least 60 days, staff may falsify treatment plans or prescribe unnecessary testing or medication simply to keep patients in the facility.
Kickbacks: Some skilled nursing facilities, nursing homes or assisted living facilities may offer money, gifts, or other favors to doctors or others who refer lucrative patients to their facilities. All reimbursement claims that arise from such a kickback may be considered fraudulent.
Billing fraud: Some SNFs and nursing homes bill for services they did not deliver, such as physical or occupational therapy services, or for equipment or supplies that weren’t used; or they bill for higher levels of care than they delivered, a practice known as upcoding. Such practices are illegal.
Fraudulent treatment plans: Some facilities may falsify patient records to justify unneeded services such as stronger painkilling regimes — even if a patient is showing no discomfort.
Negligent or abusive care: A skilled nursing facility or nursing home’s claims for reimbursement may be considered fraudulent if it isn’t providing diligent care overall — or worse, if it is abusing patients. The use of physical restraints on patients, a failure to administer medications as prescribed, a failure to provide infection control, a failure to prevent pressure ulcers, and a failure to meet basic nutrition and hygiene requirements, all have been found to be violations of the False Claims Act, for example.
Self-referrals: Some doctors may have an ownership stake in a skilled nursing home facility, nursing home, or assisted living facility — or one of their family members may have a stake. This is legal, but such doctors aren’t allowed to refer their own patients to these facilities, because it is a conflict of interest.

How do I report nursing home fraud to the government?

If you’re aware of individual examples of Medicare fraud but don’t have concrete evidence of a broader scheme (via insider knowledge of billing fraud, for instance), it’s likely best to call the government directly at 1-800-MEDICARE; to submit a complaint to the HHS Office of Inspector General; or to get help from the Senior Medicare Patrol in your state.

If you are a healthcare worker who knows about serious nursing home fraud — or if you have faced retaliation in connection with such fraud — you may want to file a whistleblower lawsuit under the False Claims Act, a state equivalent, or both. There are strict standards for such suits: You must supply important information that the government doesn’t already know, for example, and you shouldn’t be a participant in the fraud yourself. You will need a lawyer to help you.

Blowing the whistle on fraud at a nursing home, SNF, or assisted living facility isn’t a simple matter. If you’d like to have an experienced law firm on your side, please contact us.

FBA’s 2022 Qui Tam Conference Puts Annual Spotlight on FCA Enforcement Trends and Developments

On February 23, 2022, the Federal Bar Association (FBA) kicked off its fifth annual Qui Tam Conference to highlight key areas for False Claims Act (FCA) enforcement in the coming year. The conference opened with a keynote address by Gregory E. Demske, Chief Counsel to the Inspector General, Department of Health and Human Services (HHS), Office of Inspector General (OIG). Then, a series of panels analyzed the FCA-related developments from the prior year, recent efforts by the U.S. Department of Justice (DOJ) to combat cybersecurity fraud, and some of the schemes promoting alleged telehealth fraud during the ongoing COVID-19 public health emergency. Based on the comments of government speakers, all speaking in their individual capacities, below are key takeaways of what we expect the government to prioritize in 2022:

Pandemic-related fraud and telehealth fraud are key targets

>> View full story on Lexology

[ADDITIONAL COVERAGE]

Telehealth Fraud Not An Easy FCA Target, DOJ Attys Say

From Law360 (February 23, 2022)

The False Claims Act will increasingly be wielded against bogus billing for telehealth services that surged in popularity amid COVID-19, but the law’s use has been hindered by complex and sophisticated fraud schemes, U.S. Department of Justice attorneys said Wednesday.

The DOJ lawyers outlined their forecast and frustrations at the Federal Bar Association’s 2022 Qui Tam Conference during a session focused on “the rapidly increasing problem of telehealth fraud” in Medicare since the coronavirus pandemic began two years ago.

David Wiseman, an assistant director in the fraud section of the DOJ’s Civil Division, said during Wednesday’s virtual session that such scams have been spreading “like wildfire.” The ripoffs frequently stem from convoluted arrangements in which sham telemedicine companies get doctors to write unwarranted prescriptions that are sold and used to bill Medicare for medically unnecessary goods, Wiseman said.

>> View full story on Law360

Investigations Newsletter: DOJ Attorneys Comment on the Rise of Telehealth Fraud During the COVID-19 Pandemic

From JD Supra (February 28, 2022)

During the 2022 Qui Tam Conference of the Federal Bar Association, DOJ attorneys commented on the dramatic rise in the use of remote health care services during the COVID-19 pandemic, and the difficulty in bringing civil False Claims Act (FCA) actions against fraudulent telehealth schemes. The number of telehealth users increased from around one million unique users between March 2019 to February 2020, to 28 million unique users in the following year. According to DOJ attorneys, this increase in the use of remote health care services also brought a significant increase in fraudulent schemes that often involve the use of sham companies having doctors write unnecessary prescriptions that are billed to Medicare. DOJ attorneys noted that the use of complex agreements and the frequent involvement of cross-border syndicates make it difficult to bring successful civil FCA actions against these schemes.

>> View full story on JD Supra

Covid Aid, Managed Care Top Fraud Priorities for HHS Watchdog

From Bloomberg Law (February 23, 2022)

Health-care providers who unlawfully claim Covid-19 relief funds, managed care companies that overbill Medicare, and telemarketers that talk patients into services they don’t need are all investigative priorities for the Department of Health and Human Services’ top watchdog.

The HHS Office of Inspector General is pursuing civil monetary penalty cases for fraud on the Covid-19 Provider Relief Fund, Gregory Demske, chief counsel to the HHS IG, said during the Federal Bar Association’s 2022 virtual qui tam conference on Wednesday. It already has settled five such cases, he said.

“People had false certifications; they were not entitled to money that they received,” he said.

>> View full story on Bloomberg Law