DEFENSE OF FALSE CLAIMS ACT (QUI TAM) CASES
In South Carolina, our attorneys have dealt with False Claims Act (FCA)/Qui Tam cases for the past 20 years. These case often start as “Whistleblower” type allegations that are subsequently pressed forward in the name of the United States Government. We help hospitals, doctors, ambulance services, hospice organizations, government contractors and more avoid and deal with False Claims Act cases in Federal Court.
Defending the Medical Industry Against False Claims Act Investigations
HOSPITALS & DOCTORS – One frequent target of FCA litigation is the medical industry including hospitals and doctors. Our firm is no stranger to defending hospitals and individual doctors in cases alleging violations of the Anti-Kickback and Stark laws. FCA claims can range from the obvious, like explicit kickback offers, to more nuanced theories like inflated medical practice value appraisals, to seemingly small-scale allegations such as payment of speaking fees, conference expenses, and paid advisory positions.
AMBULANCE SERVICES – Ambulance services have also been a frequent target of Government investigations. The Government has targeted ambulance services, at one point calling them “high paid taxi rides.” Ambulances are not, of course, intended as a taxi for the healthy. To qualify for a Medicare or Medicaid paid ambulance transport, documentation must exist showing the patient is “bedridden” and not able to travel to health care providers by traditional means. Ambulance reimbursement rates are quite high so there is obviously an incentive for the unscrupulous to falsify ride logs or falsify medical condition certifications. The Government has fought back and aggressively gathered evidence, including in some cases video of patients riding in the front seat of an ambulance and stopping for lunch! As before, where the Government has investigated, Hair and Van Raalte have defended.
HOSPICE CARE – Hospice fraud investigations are yet another favorite target of the Government. Hospice services are, generally speaking, a covered expense if a Medicare patient is diagnosed as having six months or less to live. Hospice providers are paid based on days of care, so there is an incentive for them to try to have patients under care for as long as possible. Providers occasionally cross the line. In some instances the Government has found Hospice companies billing for services provided to patients for more than a year! Again, where the Government has investigated, Hair and Van Raalte have defended.
The firm has also handled many other types of health care matters. Doctors and other providers are often accused of “up-coding” and billing for medically unnecessary services. Where the Government has investigated, Hair and Van Raalte have defended.
Defending Government Contractors Against False Claims Act Investigations
False Claims Act/ Qui Tam cases brought by “whistleblowers” are not limited to the Health Care Industry. Government contracting is a very detailed and it can be extremely challenging for contractors to be compliant, or to convince the Government they are compliant, even when everything is in proper order. Hair and Van Raalte have handled a number of such cases.
The stakes are high when dealing with FCA / Whistleblower type allegations. Such cases can be serious threats to the continued survival of companies that do business with the Federal Government. Companies and their executives not only face potential criminal penalties and huge civil fines, but they also face losing their privilege to bill the Government for their services.
The rules that govern doing business with the Government are complicated. That is why our attorneys advise companies and individuals about what the rules require. We also review compliance programs to help you avoid the cost and the risks associated with a False Claims Act investigation.
Our attorneys have experience in all of it. We’ve been called in by companies to conduct internal investigations. We’ve helped clients move forward after a “knock at the door” by federal agents armed with search warrants and copy machines. We’ve worked with companies to respond to Government document production demands. We’ve responded to criminal investigations. We’ve defended these matters civilly. In all, we’ve helped numerous clients through these make-or-break crises and we stand willing to help you too.