Pittsburgh false claims act

The False Claims Act or FCA provides that any individual who knowingly makes and submits false claims to the government is liable for a fine that is triple the amount in the program plus $11,000 (this amount is linked to inflation) for each filed claim.

In addition to permitting the US government to file suits against fraudulent individuals, the FCA also allows private citizens to press charges on the government’s behalf (called “qui tam” suits) against those who have defrauded the state. These private citizens are also called whistleblowers and they may receive a percentage of the recovered money for bringing “qui tam” suits. 

These false claims act allegations are mostly brought by employees of government contractors and health care providers. Sometimes, the cases may involve inflated or false billing as well as kickbacks. It is illegal to submit fraudulent or false claims to government health coverage programs such as Medicaid or Medicare in order to receive payment.  

There are many cases that arise as a result of qui tam actions. In the fiscal year ending September 30th, 2020, Justice Department recovered over $2.2 Billion from settlements involving false claims and fraud cases.

Health Care Fraud

Department of Justice has a health care fraud enforcement whose aim is to restore funds to health programs like Medicaid, TRICARE, and Medicare. The prevention of health care fraud does not just help in the recovery of money from fraudulent actions, it also saves billions of dollars by deterring others who might have the same bad intentions of cheating the system.

False Claims Act also protects patients who are either Medicare, TRICARE, and Medicaid beneficiaries by protecting and availing funds to take care of their health conditions.

The federal government has also recovered huge funds from kickbacks that are paid by companies to medical providers to favor their medical supplies such as drugs. Kickbacks can be harmful in the healthcare industry because they possess great potential in subverting decision-making in the medical practice areas.   

In a recent case, the University of Pittsburgh Medical Center or UPMC together with UPMC Community Medicine, Inc., Tri-State Neurosurgical Associates-UPMC, and University of Pittsburgh Physicians were forced to pay $2,520,429 in order to settle False Claims Act allegations. The case was filed in Pittsburgh, Pennsylvania by a whistleblower in a federal court.

In this Pittsburgh case, the whistleblower alleged that UPMC submitted false claims to receive payments from the Medicare program. The complaint alleged that UPMC’s neurosurgeons who did not participate in the surgeries claimed otherwise and submitted claims for supervising and assisting in those surgical procedures.

Another complaint is the same case alleged that a specific leading surgeon submitted claims to Medicare for spinal decompression that were not performed in concurrent surgeries that he had participated. These settlements indicated the effectiveness of False Claims Act laws in ensuring health care providers follow the rules while making claims.

Why Choose Our False Claims Act (FCA) Attorneys?

At J.P. Ward & Associates, LLC, we have highly skilled and experienced False Claims Act (FCA) attorneys who advise and help health care providers, government contractors, laboratories, medical device and pharmaceutical companies, and other recipients of federal funding on avoiding and defending False Claims Act litigation.

Most FCA cases include a parallel criminal investigation and we have excellent experience in cooperating with other white-collar litigation attorneys to offer full-service advice for individuals and companies. We’re also experts in matters involving health care regulations and we will provide you with specialized defense and counsel that are specific to this industry. The areas that we provide assistance include:

  • Efficient response to subpoenas and other inquiries that come from state and federal agencies.
  • Advising companies on the appropriate time to make voluntary disclosures
  • Deterring and persuading the Department of Justice to detest from intervening in qui tam actions
  • Crafting  motions that will successfully dismiss FCA  complaints
  • Conducting internal investigations in order to respond to compliance issues or whistleblower complaints
  • Negotiating with counsels from agencies to avert debarment, suspension, or exclusion
  • Providing compliance audits and counseling to prevent False Claims Act litigations
  • Litigating both non-intervened and intervened FCA cases through summary judgment, appeals, trial, and discovery
  • Negotiating global settlements with the state and federal agencies’ counsel, Department of Justice, Medicaid Fraud Control units, relators’ counsel, and state general attorneys.  

We are proactive in all affairs involving the False Claims Act. When our clients receive subpoenas from any government agency or the Department of Justice, we act fast to investigate the allegations and negotiate with the relevant agencies to get a favorable response.

Contact us today for any False Claims Act issues you might be facing. Our multi-disciplinary experience, fair rates, and our high level of proficiency in FCA law and litigation matters have enabled us to resolve our clients’ Federal Claims Act or FCA matters in a timely and economical way.