Last week's Department of Justice (DOJ) Catch of the Week goes to Dallas-based architecture and engineering firm AECOM. Last Tuesday (October 24), the company agreed to pay$11.8 million to settle charges it violated the False Claims Act by improperly billing the Federal Emergency Management Agency (FEMA) for disaster assistance funding in the wake of Hurricane Katrina.
Under the Robert T. Stafford Disaster...
State and local governments play a critical role in ensuring that businesses and individuals are held accountable if they commit healthcare fraud, financial fraud, government contract fraud, and more. For whistleblowers, state governments can offer additional opportunities to report wrongdoing.
Where government funds are at stake – and state and local government spending reaching $3 trillion annually – more...
Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...
Catch of the Week: Archdiocese of New Orleans pays $1 million to Resolve Katrina-Related Allegations, Highlighting Importance of Enforcement in Disaster Recovery Fraud
Posted 11/19/21
We’ve covered this before: natural disasters and fraud against the government often go hand in hand. The government, through agencies and programs such the FEMA and the federally-backed flood and crop insurance programs, can distribute enormous sums of money very quickly in the wake of hurricanes, floods, tornadoes, and the like.
Distributing lots of money quickly after natural disasters gets immediate help to...
Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme
Posted 10/8/21
Former professional basketball players, including Terence Williams, "Big Baby" Glen Davis, Sebastian Telfair, and Tony Allen, have been indicted for submitting fraudulent claims for reimbursement of medical and dental services not actually rendered.
From 2017 through last year, defendants' scheme caused the N.B.A. Players' Health and Welfare Benefit Plan ("the Plan") to pay out nearly $4 million in false claims....
Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance
Posted 08/13/21
The manager of a California fruit broker learned the hard way that it doesn’t pay to assist in defrauding the Federal Crop Insurance Program. The manager, at the behest of a grape farmer who sold crops through the broker, altered the farmer’s records to reflect lower-than-actual sales. The falsified records assisted the farmer to claim crop-losses falsely and receive insurance-reimbursements funded by the...
New Settlement Shows the Power of Whistleblowers to Root out Fraud against Private Insurers
Posted 08/6/20
The nation’s biggest insurers, Medicare, Medicaid, and TRICARE already incentivize whistleblowers to report fraud. Because those programs are federally-funded, a whistleblower can bring suit under the False Claims Act and share in 15-30% of the recovery. The FCA is a law that allows private individuals alleging fraud against the government to bring a lawsuit in the name of the United States. The law leads to about...
You know about fraud, waste, abuse, or corruption by an individual or a company. Someone is getting by with cheating -- taking money from the government, taxpayers, or investors, or even harming others, such as patients. You are deeply troubled about it and want the proper authorities to stop it. You are worried whether you will be heard, taken seriously, and protected. You wonder if your information fits within a...
Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help
Posted 04/25/19
Whistleblowers with information about healthcare fraud look first to the False Claims Act, and the impact that healthcare fraud has on Medicare, Medicaid, and other government healthcare spending.
But, healthcare fraud that harms private insurance companies – as opposed to government payors – also attracts government enforcement attention.
Several recent criminal prosecutions in Texas and elsewhere...
Healthcare Fraud: it’s not just Medicare and Medicaid
Posted 10/17/18
Last year, the U.S. Department of Justice recovered $2.4 billion in settlements and judgments involving fraud in the healthcare industry perpetrated against government payors. But government programs like Medicare and Medicaid aren’t the only targets of massive healthcare fraud schemes. A recent Department of Justice press release announced the unsealing of a 32-count indictment containing charges against four...