Showing posts with label false claims act. Show all posts
Showing posts with label false claims act. Show all posts

Thursday, June 14, 2018

DOJ: Acting Associate Attorney General Jesse Panuccio Delivers Remarks at the American Bar Association’s 12th National Institute on the Civil False Claims Act and Qui Tam Enforcement Washington, DC

Jesse Panuccio addresses the rare provisions of the False Claims Act through prosecutorial discretions of the Attorney General.


Acting Associate Attorney General Jesse Panuccio Delivers Remarks at the American Bar Association’s 12th National Institute on the Civil False Claims Act and Qui Tam Enforcement
Washington, DC
 ~
Thursday, June 14, 2018
Remarks as prepared for delivery
Thank you, Sara, for that kind introduction.  Sara has been litigator and leader in the Civil Division for nearly twenty years.  You are fortunate to be able to learn from her expertise, and we are fortunate to have her in the Department.

Nominations

Ordinarily at this time, you might be hearing from the Assistant Attorney General for the Civil Division, who has direct oversight over our False Claims Act enforcement.  The President nominated a highly qualified lawyer, Jody Hunt, to serve in that position last September.  Jody has served in the Department for over fifteen years, most recently as Chief of Staff to the Attorney General and, before that, in the Civil Division as the Director of the Federal Programs Branch.  Jody is eminently qualified and deserves swift confirmation.

But he is still awaiting confirmation.  And Jody is not alone in that wait. Of the seven litigating components in Main Justice, only two currently have Senate-confirmed leaders.  This has been the case for a year and a half.  Some nominees have been waiting for over a year. 

While the Senate should act quickly to confirm these nominees, it is worth noting—contrary to some press reports—that these positions are not sitting vacant. Attorney General Sessions has assembled an experienced and talented leadership team, including those who are serving as acting heads of Divisions. Chad Readler has been performing that role for the Civil Division since January of 2017 and he has been instrumental in the Department’s work, including maintaining the False Claims Act and its qui tam provisions as one of the government’s most effective civil tools in protecting vital government programs from fraud schemes.  I’m thrilled to report that, last week, the President nominated Mr. Readler to the Court of Appeals for the Sixth Circuit—a stellar choice, and we appreciate Chad’s continued willingness to serve.

Civil Enforcement Work

As you may know, the Associate Attorney General oversees several litigating components within DOJ, including the Civil Division.

Thus, it is a great pleasure to be here today to speak to you about the critical False Claims Act work being done to protect taxpayer funds from fraud.  I am continually impressed by what the Department and its partners have achieved.

As we all know, the federal qui tam statute has long and honorable roots dating back to efforts to fight rampant and harmful fraud on the Union Army during the Civil War.

Today, the need for the Department to remain vigilant and active in its efforts to combat fraud within taxpayer-funded programs remains as strong as ever.  Just this past year, the Department opened 815 new fraud matters, which includes 675 qui tam matters filed by relators.  That brings the total filings by relators since the 1986 amendments to more than 11,900.

The Department’s recoveries are equally impressive. Since 1986, the Department has recovered more than $56 billion in False Claims Act matters.  Relators have been awarded more than $6.6 billion in the matters they have brought to us.

Protecting the Public

So long as greed remains a human vice, fraud will persist—and even as we close down one scheme or another, fraudsters are always finding new ways to cheat the taxpayer. For example, I vividly recall that when, during my years as Florida’s labor secretary, we developed a system to quickly detect and shut down unemployment insurance fraud.  It was alarming to watch, in real time, as fraudsters would shift tactics to get around each new road block we established.  That’s why vigilant and rigorous anti-fraud work is so vital to good government: the fraudsters will never stop and neither can enforcement efforts.

Here at the federal level, some of our recent False Claims Act successes illustrate the startling variety and breadth of fraudulent schemes used against the government.  They also demonstrate that, in many cases, fighting fraud is not just about dollars, but also is critical to ensuring public health, the safety of our men and women in uniform, and the well-being of members of the public.   

For example, in the public health arena, a national electronic health records software vendor and certain of its employees paid $155 million to resolve allegations that they concealed that the company’s electronic health records software did not comply with the requirements that go to the reliability of electronic health records.  The United States alleged that in order to obtain the necessary certification for the software, instead of programming the capability to retrieve any drug code from a complete database, the vendor hardcoded the only drug codes that would be used in the certifying entity’s test—essentially, the company was cheating for the test.

Likewise, in early 2017, a pharmaceutical company paid $350 million to settle federal and state False Claims Act allegations that it used kickbacks and other unlawful methods to induce clinics and physicians to use or overuse its product, which was a bioengineered human skin substitute.

Also last year, a pharmaceutical company paid $465 million to resolve False Claims Act allegations that it treated its product, which is used to treat anaphylactic shock, as a generic drug for Medicaid rebate purposes. The company’s scheme enabled it to raise its prices dramatically while avoiding paying additional rebates it owed for its product that would have insulated Medicaid from these price hikes.

In another example, the Civil Division recently filed a suit against a leading compounding pharmacy and several of its executives alleging that the pharmacy grossly inflated the price of compound medications reimbursed by TRICARE, a federally-funded health care program for military personnel and their families.

Outside of the healthcare space, the False Claims also serves a critical function.  For example, in the public safety space, since 2007,  body armor companies have paid the United States more than $132 million to resolve allegations that they knowingly manufactured and sold defective bulletproof vests for use by law enforcement officers.  Our most recent recovery was for $66 million from a manufacturer that produced allegedly defective material in the vests.

This recovery will help purchase approximately 18,700 additional bullet-resistant vests for state, local, and tribal law enforcement officers through the Department’s Bulletproof Vest Partnership Program.  According to the International Association of Chiefs of Police, in the past 30 years, over 3,000 cases have been reported where law enforcement officials survived ballistic and nonballistic incidents because they were wearing bulletproof vests.  It is simply unconscionable for a company to cheat or cut corners in the production of life-saving equipment for the brave men and women of law enforcement. These cases are about saving officers’ lives and protecting our communities.

In still another context, the False Claims Act is being used to help protect and ensure fair competition for American businesses.   We are actively pursuing those fraudsters who are misrepresenting their eligibility for small business contracts and denying these opportunities for legitimate small businesses.  We are also using the Act to prevent companies from flouting our customs laws.  Over the last five years, the Department has recovered more than $100 million in settlements involving the evasion or underpayment of import duties for a wide variety of merchandise.

Affirmative Priorities

The False Claims Act has also proven to be a vital tool in our efforts to advance important Department of Justice priorities. 

One of Attorney General Sessions’ top priorities is to combat the nation’s opioid crisis.  Opioid abuse has become one of country’s most pressing public health and safety crises.  Indeed, we’re in the midst of one of the worst drug epidemics in our country’s history.  An estimated 64,000 Americans lost their lives to drug overdoses in 2016, about two-thirds of them as a result of opioids.  A new study published in the Journal of the American Medical Association found that one in five deaths among adults age 25 to 34 is opioid-related.

In addition to our criminal enforcement efforts across the country, the Department is relying on its civil remedies to combat the opioid epidemic.  In April of this year, for example, the Department intervened in five lawsuits against the manufacturer of an opioid product—a sublingual spray that contains fentanyl, one of the most highly addictive and deadly opioid products available.  For this reason, fentanyl is approved by the FDA only for patients with cancer who are suffering from otherwise uncontrollable pain.  The Department has alleged in its complaint that the company used a variety of illegal means to increase prescriptions of its product, including paying kickbacks and lying about patients having cancer.

Let me be clear: the Department of Justice will actively employ the False Claims Act, as well as any other available civil or criminal statute, against any entities involved in the opioid distribution chain who engage in the abuse and illegal diversion of opioids—from pharmaceutical manufacturers and distributors, to pharmacies, to pain management clinics and physicians.

Another major priority for Attorney General Sessions is protecting our nation’s elders from fraud and abuse.   The False Claims Act continues to play an integral role in support of that goal.  For example, in November, the Department secured a False Claims Act settlement from a nursing home management company, its owner, and others for grossly substandard nursing home care.  The defendants allegedly diverted Medicare and Medicaid funds from the facility in question, leaving it unable to pay for basic needs of patients like food, heat, air conditioning, pest control, and cleaning.

We also have pursued hospice companies that enroll patients who aren’t terminally ill, inducing them to prematurely abandon curative care.  And we have pursued skilled rehabilitation facilities that subject elderly patients to physical therapy that’s not medically warranted in order to increase Medicare billings.

Policy Initiatives

As these and other recent matters illustrate, this Administration is committed to pursuing vigorous False Claims Act enforcement.

We are also committed to enforcement that is fair and consistent with the rule of law.  Attorney General Sessions has stressed, since his first day in office, that the Department must pursue its work consistent with the plain meaning of the law, with respect for democratic accountability, and with an unwavering commitment to the first principles of our Constitution.

Accordingly, under his leadership, the Department has instituted a number of litigation policies and reform efforts.  One example is the ban on certain third-party payments in settlement agreements; another is the use of our rights under the Class Action Fairness Act to object to unfair settlements of class action cases; and still another is the directive to reexamine consent decrees with local law enforcement agencies to ensure they enforce the law and promote effective, constitutional policing while respecting local control and accountability.

Several new policies and reforms relate specifically to the False Claims Act. We have many attorneys who have done great work on these policies in the Civil Division; on the Attorney General’s Advisory Committee of U.S. Attorneys; on the Corporate Enforcement and Accountability Working Group; and on the Regulatory Reform Task Force.  In my office, my deputy Steve Cox, who is with us today, has taken a leading role in developing and implementing significant and just FCA enforcement policies.  Let me walk through some of them now.

Qui Tam Dismissals

One important development relates to the dismissal of qui tam actions that the Department determines are not in the public interest and therefore should not proceed.  The number of qui tam suits has grown considerably since 1986 and now routinely clocks in at over 600 per year.  And while the Department does not have the resources to pursue every meritorious qui tam case, it is also true that the Department declines to intervene in some cases due to the lack of legal or factual support.  In these circumstances, if the relator nevertheless elects to pursue the matter, the Department should consider whether the relator’s continued pursuit of the case is warranted or whether the Department should exercise its dismissal authority to advance the interests of the United States.
Let me stress here that the Department appreciates the risks that relators may take in coming forward to expose fraudulent conduct. And we understand the dedication and skill that is necessary for a successful qui tam lawyer to prevail to judgment in a declined matter.  And we acknowledge that there have been matters in which that dedication and skill resulted in large recoveries for the taxpayers of this country.

But when declined cases go forward, they often require that the Department—and our client agencies—devote significant resources to monitoring them.  We are often called upon to participate in such cases by responding to discovery requests or filing statements of interest to help courts get the law right.  And these cases also impose substantial costs on defendants and the judiciary.

When these cases lack merit or are otherwise contrary to the interests of justice, they consume limited resources that could be used to pursue other meritorious cases and priorities.  Frivolous cases can also lead to bad case law, which can undermine enforcement of the False Claims Act generally.  Thus, when declining intervention, and even throughout the life of the case, we have now instructed our attorneys to consider whether moving to dismiss an action would be an appropriate exercise of the Department’s prosecutorial discretion under the False Claims Act.  Although this authority has previously been used only rarely, the Department’s use of the dismissal option has a pedigree goes back to 1986.  Drawing on that experience and exercising this authority more consistently, but judiciously, will free up Department resources for important matters like the ones I’ve already mentioned, and will ultimately make our efforts to fight fraud on the public fisc all the more effective.

Guidance

Another area that has been of concern across the Administration is the problem of regulation by guidance. Guidance documents can be helpful in educating the public about statutes, regulations, and legal developments.  But it is improper to try to use guidance to bind those outside the Executive Branch by imposing legal obligations beyond those already enshrined in existing statutes or properly promulgated regulatory provisions.  Put simply, agency guidance should educate, not regulate.  Guidance should not be used to evade lawful legislative and regulatory processes, which are designed to ensure accountable and limited governance.

Attorney General Sessions announced in November that the Department will no longer issue any kind of binding sub-regulatory guidance. We hope other agencies will follow this example, and in the affirmative litigation context, we have instructed DOJ attorneys not to use our enforcement authority to convert sub-regulatory guidance into rules that have the force or effect of law.

Now, as Attorney General Sessions made clear, guidance documents can be used to simply explain existing law.  Therefore, in the False Claims Act arena, where the allegations are that a party falsely certified to the government that it complied with certain laws, it is fully consistent with Department policy to use a party’s receipt of a guidance document as probative evidence of knowledge of the law that the document explains.  But guidance documents that expand upon statutory or regulatory requirements should not be used by Department attorneys as the basis for contending that legal violations have occurred.  That policy keeps government restrained and promotes the rule of law, fair notice, and due process.

Cooperation

Let me turn to another reform project at the Department.  The Deputy Attorney General has spoken in the past about incorporating into one place Department policies that now are found scattered throughout numerous memoranda and internal guidance issued by various DOJ components.  This process of formalizing our policies is now underway and, with input from stakeholders within and outside the Department, will result in modifications to past practices.  Let me assure you, however, that there are certain principles from which we will not stray.

We will continue, for example, to expect and recognize genuine cooperation of corporate entities accused of wrongdoing in both civil and criminal matters.  We want to create incentives for companies to help us identify the individuals responsible for wrongdoing, because we remain steadfast in our resolve to hold such individuals accountable.

I want to make perfectly clear that False Claims Act investigations are no exception to this policy on cooperation.  Corporate defendants can receive a more favorable resolution for providing meaningful assistance to our False Claims Act investigations – from voluntary disclosure, which is the most valuable form of cooperation, to other efforts such as sharing information gleaned from an internal investigation and making witnesses available.  Because the False Claims Act allows recovery of treble damages and civil penalties, the Department has tremendous enforcement discretion with respect to structuring settlements that make the government whole while also providing a material discount based on a defendant’s cooperation.  Of course, the extent of the discount will depend on the nature of the cooperation and how helpful it is to the Department’s investigation, including our pursuit of individual wrongdoers.

Compliance

As we deter fraud by holding individuals accountable, we also want to be sure that we continue to reward companies that invest in strong compliance measures.

The challenge of corporate compliance is especially acute in large and diverse organizations.  I empathize: every day at DOJ we face the challenges of an organization with 115,000 employees.  Things go wrong in every organization.

When something does go wrong, however, the greatest consideration should be given to companies that do not just adopt compliance programs on paper, but incorporate them into the corporate culture.

Lawyers have an important role to play in ensuring compliance.  Just as relator’s counsel in this room are important partners for us in protecting taxpayer funds, compliance counsel can be as well, by working on the front lines to provide the advice that prevents fraud in the first place and redressing it when it happens.

Competition requires a level playing field.  If some businesses evade the rules, others lose out by following them.  We recognize that and it motivates our False Claims Act enforcement and our partnership with all of you.

Piling On

One last policy issue I want to discuss today is the topic of multiple law enforcement and regulatory agencies pursuing a single entity for the same or substantially similar conduct.  When those agencies impose unwarranted and disproportionate penalties for that conduct, some people refer to it as “piling on.” 

When a company engages in wrongdoing, we should enforce the law and punish the wrongdoers.  And it is also appropriate to ensure that the victim is fully compensated for its losses, including through enforcement under the False Claims Act or other available remedies.

But we also recognize that repeated and unwarranted punishment for the same conduct has the potential to undermine the spirit of fair play and the rule of law.  Multiple punishments can also deprive a company, as well as its employees, customers, and investors, of the benefits of certainty and finality ordinarily available through a full and final settlement.  For that reason, the Department just recently announced a new policy designed to avoid piling on by promoting coordination within the Department and with other regulators to apportion penalties and fines where appropriate, to ensure that defendants are subject to the appropriate, not just the highest, level of punishment that is available.

The same policy also reminds our attorneys not to use the Department’s criminal enforcement authority against a company for purposes unrelated to the investigation and prosecution of a possible crime. Department attorneys may not invoke the threat of criminal prosecution solely to persuade a company to pay a larger settlement in a civil case.  Parallel investigations involving the False Claims Act, both within DOJ and with other enforcement agencies, may present conditions in which you will see this policy at work.

I appreciate the opportunity you have given me today to explain our views on many of the important issues that arise in the False Claims Act arena.  I have no doubt that during the course of this conference, these and other issues will be debated by you and that Department attorneys in attendance will report back with suggestions on how we can better do our job.  We welcome that.  Indeed, that is the great value in gatherings such as these.

So let me conclude by encouraging you to take part in these discussions and by thanking you for letting me play a role in them.

Thank you.  

Voting is beautiful, be beautiful ~ vote.©

Monday, June 5, 2017

How Detroit Land Bank Authority Michael Brady Bribed Attorney Crystal Hopkins To Drop A Federal Fraud Case Against Them


Displaying 20170508_154907.jpg

Principal Attorney for the Detroit Land Bank Authority/Building Detroit, Michael Brady, defendants of a federal case represented by Crystal Hopkins, signs over the property of 1207 Longfellow, below, over to the resident agent of the Michigan corporation of Solis Estates, LLC, where it is alleged that Crystal Hopkins, a licensed Michigan Attorney, impersonated her twin sister, stealing her identity, to secure $125,000 mortgage, with the assistance of Michael Brady, as a bribe to get a federal case dismissed.


Voting is beautiful, be beautiful ~ vote.©

Michigan Attorney General Bill Schuette Did Not File To Dissolve My Detroit Land Bank Authority Corporation

Here is a enigma wrapped in a conundrum:

Q: How did I have the LLC?

A: Because the corporation never existed.
How can Michigan Attorney General Bill Schuette, who is running for the Office of Michigan Governor, file an action of quo warranto, to dissolve my LLC of the Detroit Land Bank Authority, 6 days after the modified Order of the federal court to lift the seal on my action of qui tam , under the False Claims Act when, the defendants claim to be operating through federal grants and contracts as a legitimate corporation, which has no affiliation, whatsoever, with the City of Detroit?
ANSWER:  Bill Schuette knows nothing about this.  This was filed by the rogue Michigan Assistant Attorney General D.J. Pascoe, who is covering the arses of the people who are running that criminal operation of the non-corporate Detroit Land Bank Authority, under the guise of the now, defunct, Detroit Land Bank Community Development Corporation.
As you peruse through the fillings, you shall witness fraudulent deeds, and other fraudulent quiet title actions of which you may cross check with the Michigan Attorney Grievance Commission filings, below.

Voting is beautiful, be beautiful ~ vote.©

No Money, No Justice: Beverly Tran v. Detroit Land Bank Authority

Well, for the first time in history, we shall respect the reduction of paperwork and make litigious filing economical.

In this instance, I am publishing my unsealed federal action, pursuant to the False Claims Act, on how a group of nefariously, black hearted individuals who allowed, blatantly fraudulent filings from bogus ass out of state corporations to set up mortgages, then go behind the Detroit homeowner borrowers back and leverage the property, 4, 5, 10 times, through more bogus out of state corporations, where, even when the Detroit homeowner paid off the original mortgage, still lost the house.

Then, the Clinton Global Initiative, now shuttered and under federal, criminal investigation, promoted banking fraud to steal the houses from the people they made poor from their decades of perniciously pervasive domestic polices of snatching kids and privatizing the last unraveled threads of the social safety net, for these non-profits, NGOs to take the money and fund their own investment fraud schemes, which included political campaigns.


Now, the reason why my complaint is unsealed is because the attorney of record, Crystal Hopkins, P70792, who agreed to represent me, even though I did all the work and research, decided to break the seal of the complaint and start flipping properties for the non-corporation of this so-called work group of the Detroit Land Bank Authority, got a house in the Detroit Boston-Edison Area, 1207 Longfellow, where these historic homes were not to be auctioned under the federal grant of the Hardest Hit Fund, signed over to her from the head attorney of this so called Detroit Land Bank Authority, then, filed jack-legged paperwork on the home to secure a $125,000.00 mortgage.

Since Crystal Hopkins P70792, never lifted a finger to file an amended complaint to just tell the court that she was representing me in the matter, as I am disallowed to represent the United States, under the statute, I thought it best to preserve the public record in this matter and publish, here, on my blog, and make her famous as to why the Court ordered the seal to be lifted.

Hopkins & Associates PC


Now, back to the story of how the Clinton Foundation used Detroit as a pilot test city for its operations of forced migration, because, we all know....

It takes a village...then pillages the resources.



Where did this, more than $800 million dollars for Detroit go?

Ask Dan Gilbert, Mike Duggan and Hillary Clinton, the latter two had political campaigns to fund.  The former needed to leverage for more projects.

So, without further adieu, I present to you, one of my greatest masterpieces, well, every revolution deserves an epic romance, so this is really a love story, why people lost their homes and voting rights.

As you read this unsealed action and the Orders, below, my plan is to force the United States Department of Justice to intervene on my behalf because Crystal Hopkins, if anyone can find her, is probably doing something she is not supposed to be doing, under color of law, of course.

Besides, I cannot afford an attorney nor have I been able to find an attorney, with hutzpah, from the date the Order to lift the seal was issued, April 18, 2017, well, I found out May 1, 2017.

Stay tuned.  More filings to come.

I will get into the bogus property tax schemes of the so-called Detroit Land Bank Authority levying magically conjured taxes upon the desperately homeless, funneling the proceeds through Title Source, Inc., volleying back to the City of Detroit Treasurer's Office, then sliding it over to the so-called Detroit Land Bank Authority, through the back door of the Wayne County Prosecutor's Office, Property Deed Fraud Unit.



And you wonder why Detroit has the highest concentration of child poverty and child mortality for a major city in North America.





Voting is beautiful, be beautiful ~ vote.©

Thursday, February 4, 2016

Is Michigan Speculating On Medicaid Marijuana For Agra-Pharm Industry?

Whenever I see amending of the Michigan False Claims Act, I seem to take a pause.

I remember well the last time the Act was reviewed by HHS because it was addressed to the previous attorney general and I called for correction.

This was done in 2011 and Michigan has yet to bring the Act into federal compliance.

Now, there is a Bill to build an exception being offered for one specific condition which sounds really fishy.

For the benefit of the doubt of being ethical and knowing how sneaky Michigan is, I did a cursory backgrounder.

Marijuana has been known to provide a wide array of health benefits so I would understand why the state would want to preemptively adopt the medicinal purposes into billing law, but why the State False Claims Act when it has yet to come into federal compliance?

This is the legislative analysis of the Health Care False Claims Bill and I have reservations:
The bill would amend the Health Care False Claim Act to include a payment from a drug manufacturer for a health care service associated with the use of a multiple sclerosis drug in an exception to a prohibition against kickbacks, bribes, and rebates for furnishing health care goods, services, and benefits.
Is this the agricultural-pharmaceutical industry's way of getting into the Medicaid billing game by qualifying medical marijuana through the back door of this Act?

Michigan is known for experimenting with socio-economic policy.

One would think the legislators would want to first bring the Act into federal compliance and include provisions for Medicaid fraud in child welfare, but what do I know?

Voting is beautiful, be beautiful ~ vote.©

Wednesday, October 7, 2015

Will U.S. Courts Accept Statistics in False Claims Cases?

Many years ago, when I was wet behind the ears in applying quantitative methodologies to policy
making, I came up with an interesting approach to examine the validity of a system which was closed to public scrutiny.

That system was child welfare.

Grabbing hold to my beliefs that laws, any type of laws (i.e. theoretical, statutory) were made to be challenged, either through alternative models, robust testing, or the democratic process, I went about my merry way to prove that the level of fraud in child welfare was statistically significant through sampling.

Using extapolated data of Wayne County, Michigan expenditures, not only did I find a positive, direct correlation in the rate of poverty with the rate of child welfare cases, but I also found unique cost-reimbursement patterns paralleling child welfare campaign months.

Stochastic analyses took the statistical significance to entirely different levels of reliability.

Parsimony led me to Medicaid fraud in child welfare because its homogeneity reeked the loudest.

If the federal administrations do not have the resources to go after Medicaid fraud in child welfare, then the courts should listen to data from an original source.

The technology of statistics should be adopted as an evidentary standard in a court of law.  It is time to get rid of the horse and buggy.

Stay tuned for further iterations, ha ha.

Fourth Circuit to Rule on Use of Statistical Sampling to Prove FCA Liability

The U.S. Court of Appeals for the Fourth Circuit has agreed to hear an interlocutory appeal on the use of statistical sampling as a means of proving liability under the False Claims Act (FCA). While statistical methods of proof have been used with respect to damages, relatively few courts have considered whether such methods are ever appropriate to establish liability under the FCA. Thus, the court’s ruling has the potential to shape practice in this area moving forward.

The case, United States ex rel. Michaels v. Agape, concerns allegations that a network of 24 nursing homes throughout South Carolina submitted fraudulent claims to Medicare, Medicaid and Tricare for care that was not medically necessary. Due to the large volume of potentially fraudulent claims—over 50,000 claims were submitted during the relevant time period—relators sought to use statistical sampling to prove that defendants had submitted false claims. Specifically, the relators sought to have their experts review a small percentage of the claims, determine what percentage of those claims were fraudulent and extrapolate over the entire universe of submitted claims. The district court rejected the approach but certified the question for interlocutory appeal.

The district court was correct to be skeptical of statistical sampling to prove liability, and the relators will have an uphill battle to convince the appeals court that their proposed method of proof is sound.
First, as the district court noted, this is not a case where the relevant evidence is unavailable and statistical sampling presents the only possible method of proof.  In fact, all the documentation concerning the allegedly fraudulent claims exists and is fully accessible. The relators’ argument is simply that it would take too much time to review such a large volume of data. As the district court stated, such shortcuts are inappropriate in a case where the alleged fraud is that services provided were not medically necessary—a “highly fact intensive inquiry involving medical testimony after a thorough review of the detailed medical chard of each individual patient.”

Second, the use of statistical sampling is not guaranteed to shorten the trial because the defendants still retain the right to present evidence on each individual claim. To force the defense to also rely on a sample of the claims and prevent the presentation of evidence on the remainder of the individual claims would, as the defendants argued, deny them of their constitutional right to a jury trial on the facts.

The Fourth Circuit’s ruling on this issue has the potential to either settle the law in this area or open the door to speculative methods of proof in a number of areas of FCA litigation.

Voting is beautiful, be beautiful ~ vote.©

Wednesday, January 30, 2013

Is Michigan To Have A False Claims Act?

Do mine eyes deceiveth me?  Could it be that there are people who have heeded my advice.  Is Michigan to finally have an official, living, breathing false claims act?

Will Medicaid fraud in child welfare be referred to the Attorney General?

Will Michigan have its first Qui Tam?

I quiver with anticipation.

Introduced by Rep. Kurt Heise (R) on January 22, 2013, to create a new “false claims” cause of action, in which an individual or the Attorney General could sue a person who performs one of a wide range of actions that constitute a false or fraudulent monetary claim against the state or a local government. A court would be authorized to award triple damages against the perpetrator, and the individual who brought the suit (or the Attorney General’s office) would be eligible to receive a portion of the damages.
  • Referred to the House Judiciary Committee on January 22, 2013.

Does a Michigan House Representative dare to challenge his colleagues and Governor in demanding a fully compliant state false claims act?

Well, my dear Representative Heise, allow me to tell you a story...

Michigan has a long history of allowing the filing of false claims in child welfare.  Just ask Maura Corrigan.  

Michigan just granted, by statute, civil immunity to child welfare organizations.  False claims in child welfare can never be prosecuted for contractual debarment, license revocation, let alone recovery.

In child welfare, there exists no referral process to the Attorney General Medicaid Fraud Control Unit in the suspected filings of false claims against the state.

The U.S. HHS OIG has been trying to get Michigan up to speed for some time.  Unfortunately, it just may take longer than expected, all because of that infamous middle of the night lame duck session.

Please note that Attorney General Mike cox was no longer in office at the time of generation. I called from the Congressional Office to correct the Inspector General on the seriousness of this error. I could not get too mad. She called back and was really regretful for the oversight.

Michigan has until March 31, 2013 to come into compliance.
Stay tuned.  The show is about to begin.

Voting is beautiful, be beautiful ~ vote.©

Thursday, November 1, 2012

Leader of Myrtle Beach youth mentoring agency wants fraud charges dropped

Congratulations to U.S. Attorney's Office for stepping up to the plate and taking action against Medicaid fraud in child welfare.

Come visit Wayne County, Michigan.  The level of Medicaid fraud in child welfare will knock your socks off.

Leader of Myrtle Beach youth mentoring agency wants fraud charges dropped

Read more here: http://www.myrtlebeachonline.com/2012/10/31/3146086/leader-of-myrtle-beach-youth-mentoring.html#storylink=cpy


MYRTLE BEACH -- The former director of an area youth mentoring agency accused of Medicaid fraud wants the criminal charges dropped because he says prosecutors withheld information from a grand jury that might have shown he was innocent of any wrongdoing.

Truman Lewis – who founded the Helping Hands Youth and Family Services agency, with offices in Conway and Georgetown – said in court documents this week that his agency already had entered into an agreement with the S.C. Department of Health and Human Services to pay back Medicaid overbilling when federal prosecutors sought the criminal charges.
“The fact that the prosecution did not inform the grand jury that an equitable arrangement had been created . . . was the difference between the defendant being indicted and not being indicted,” Lewis stated in the court documents.

Read more here: http://www.myrtlebeachonline.com/2012/10/31/3146086/leader-of-myrtle-beach-youth-mentoring.html#storylink=cpy

Lewis said prosecutors were “totally cognizant that complete repayment was on schedule” yet failed to provide that exculpatory evidence to the grand jury.
The U.S. Attorney’s office in Columbia has until Nov. 9 to respond to the accusations. Spokeswoman Beth Drake could not be reached for comment. The U.S. Attorney’s office typically does not comment on pending legal matters.
Lewis and two family members who helped operate Helping Hands were indicted in June on six felony charges apiece of health care fraud, wire fraud and money laundering. Prosecutors say the family members fraudulently billed Medicaid for $8.9 million and then used that money to buy luxury automobiles, a beachfront condominium, homes, private investments and other personal items. The agency, which also had offices in Columbia and Rock Hill, closed in early 2011.
Documents filed this week show the state’s Health and Human Services agency – which administers the federal Medicaid program – audited Helping Hands twice in 2010. Those audits led to a compromised settlement in which both sides agreed that Medicaid had been overbilled by $1.2 million. The state’s Health and Human Services agency agreed on Aug. 30, 2010, to let Helping Hands repay that money in monthly installments of $50,478 – including interest of 5.25 percent – beginning in September 2010. Helping Hands had made all payments due – including two payments in December 2010 – before investigators shut down the agency and seized its bank accounts.
Kim Cox, a spokeswoman for the state’s Health and Human Services agency, said she cannot comment on pending legal matters.
The $1.2 million agreement reached following the state agency’s administrative investigation is far short of the $8.9 million that federal prosecutors say Helping Hands overbilled Medicaid between January 2009 and November 2010.
Prosecutors say Helping Hands officials falsified records and submitted bills for ineligible or non-existent clients in order to boost Medicaid payments. Helping Hands officials then transferred that money to personal bank accounts and purchased items including 10 automobiles, among them an $89,000 Bentley and a $55,900 Mercedes.
Lewis, in his court filing, said he should not be prosecuted because Medicaid overbilling is common and usually does not result in criminal charges if the money is paid back.
“It should be noted that in the U.S., hundreds of Medicaid service providers have been found to have over-billed Medicaid,” Lewis stated. “In the large majority of those cases, if a valid and acceptable repayment plan is agreed upon by Medicaid and adhered to by the Medicaid service provider, no charges are forthcoming.”
However, once the federal criminal investigation began, it voided the previous agreement Helping Hands had with the state.
No court date has been set to hear Lewis’ request for a dismissal.
Also facing criminal charges are Norman Lewis, who ran the Georgetown office, and his wife, Melanie Lewis. In August, Norman Lewis was ordered to undergo a psychiatric examination after refusing a court-appointed lawyer and telling Judge Richard Gergel that he instead will be represented by God and Jesus. The results of that examination are pending.
An eight-month investigation into Helping Hands started in 2010 with a confidential complaint to state officials alleging that the agency’s counselors were not licensed and that some Lewis family members had criminal records.
The Internal Revenue Service served search warrants on the Helping Hands offices early last year, when the government seized nearly $1.2 million in cash and certificates of deposit that Lewis family members had at area banks.
Helping Hands – which was supposed to provide mentoring services to low-income children with family or behavioral problems – had hundreds of youth clients in Horry and Georgetown counties. Those clients were referred to the agency by the state’s Department of Social Services and area school officials, even though the agency’s counselors were not licensed.
Helping Hands counselors told The Sun News last year that agency leaders overloaded them with clients to increase the amount of Medicaid billings. The counselors said agency leaders told them to report hours spent with clients even if they had not been with the children, and told them to falsify reports sent to Medicaid.
Bank records included in court documents show Helping Hands billed Medicaid a steadily increasing amount starting in January 2009, when the agency received $13,500 from the federal health program. By April 2010, Helping Hands was billing Medicaid for $1 million per month.
The Helping Hands group run by the Lewises – which was a for-profit agency – is not affiliated with nonprofits with similar names, including Helping Hand of Myrtle Beach and South Strand Helping Hand.

Read more here: http://www.myrtlebeachonline.com/2012/10/31/3146086/leader-of-myrtle-beach-youth-mentoring.html#storylink=cpy

Voting is beautiful, be beautiful ~ vote.©

Friday, September 28, 2012

Maine Claims Medicaid Fraud Does Not Exist

Since Maine seems to be all freed up with investigations of medicaid fraud, perhaps Michael Miller's Medicaid Fraud Control Unit can finally start looking into Medicaid fraud in child welfare.

Statewide Medicaid fraud probe ends with no charges

ROCKLAND, Maine — A wide-ranging investigation into possible Medicaid fraud involving health care providers that extended tangentially to a midcoast Maine Drug Enforcement agent has ended without anyone being charged.
Michael Miller, director of the Healthcare Crimes Unit at the Maine Attorney General’s Office, said Thursday that the investigation ended in May 2012. Miller said no charges were filed and that no civil actions have been taken by the state agency against anyone.
The investigation had been focused on prescription practices of pharmacies.
Miller would not discuss any other aspects of the investigation.
The investigation came to light when defense attorneys sought to use one report within the wide-ranging statewide probe to challenge the credibility of former MDEA agent Kirk Guerrette.
Guerrette, who is now a lieutenant with the Knox County Sheriff’s Office, has maintained since the issue was raised publicly that he had not done anything wrong. On Thursday, he issued a written statement, after being told by the BDN that the investigation was over.
“I am glad the truth has finally been revealed and that my family and I can finally put this behind us as my family has been so negatively affected by all the controversy surrounding the AG investigation,” Guerrette said. “It would have been courteous and considerate to hear from the AG’s office personally regarding its conclusion to this investigation.”
Guerrette’s name first surfaced publicly during a March 2011 hearing in Knox County Superior Court, when investigators revealed that 4,200 pages and 42 compact discs of information already had been compiled from the investigation, which had been ongoing since at least 2010.
Miller argued at the March 2011 hearing that the records should not be given out to defense attorneys who wanted them in an effort to find evidence that might discredit Guerrette, who was to be a witness in 44 criminal drug cases.
Miller said last year that a single report that referred to Guerrette was part of a complicated investigation that was far from complete. She said it involved numerous parties.
“In direct competition with defendant’s rights is the compelling interest of HCU in maintaining the confidentiality of its intelligence and investigative information,” Miller wrote in court documents. “Disclosure of the HCU information would prematurely reveal the scope, nature and direction of HCU’s case, allow suspects to construct defenses, and create a possibility of evidence destruction, witness harassment or intimidation.”
The investigation was complex and involved many people, Miller wrote. Even if the people who saw it were sworn to secrecy, it could still get leaked and foil the unit’s work, she wrote last year.
The Healthcare Crime Unit investigates MaineCare fraud and crimes committed by health care providers. The unit would investigate a law enforcement officer only if he were involved in a larger “criminal scheme or conspiracy” that involved a MaineCare provider, Miller said back in March 2011.
Justice Jeffrey Hjelm later ordered that some of the material be turned over to defense attorneys but said it could not be released publicly.
Guerrette had worked as an agent for MDEA, assigned from the Knox County Sheriff’s Office, until December 2010. That December, MDEA Director Roy McKinney sent Guerrette back early to the sheriff’s office for unspecified reasons. He was cleared of any wrongdoing after an internal sheriff’s office investigation, according to Sheriff Donna Dennison, who promoted him to lieutenant.
In his statement on Thursday, Guerrette said, “It would have been courteous and considerate to hear from the AG’s office personally regarding its conclusion to this investigation … but again … as they told me all along … I was just a witness in this investigation. If this is what witnesses have to endure … I do not wish this on anyone. So now that my duties as a ‘witness’ have ended, I look forward to restoring my career, my reputation and family which was so negatively impacted by all of this.”
Defense attorney Jeremy Pratt, who represented some of the defendants on the list of 44 cases, said he thought someone should have been charged as a result of the state investigation. He declined to say who should have been charged.
Defense attorney Joseph Steinberger, who represented one of the drug defendants on the list, said he feels there is a double standard being used by government on drug laws.
“There’s a double standard. If you have enough money, you can get a doctor to write you a prescription, but if you buy the same drug on the black market, you become a felon,” Steinberger said.
He said police officers have a lot of power.
Guerrette said in March that all but three of the 44 criminal cases that were on the list in which he was a witness had been resolved. Pratt said Thursday that he knows most of the cases were settled.
One of the pending cases is that of Christian Neils, 35, of Hope, who is charged with aggravated trafficking in marijuana at his home in Hope in September 2010.
Neils’ attorney Leonard Sharon had sought to throw out a search warrant, arguing that it may not have been granted if the person approving the search warrant had known of Guerrette’s use of prescription drugs.
Justice Hjelm disagreed, however, and in June rejected a request by Sharon to have a full hearing to try to throw out the search warrant. Hjelm stated in his ruling that the only evidence provided was affidavits filed by Sharon that refer to claims by others about Guerrette and his alleged excessive use of the sleep aid Ambien. The judge ruled that some of the information in Sharon’s filings were about Guerrette’s alleged Ambien use at a time that had no bearing on the September 2010 search.

Voting is beautiful, be beautiful ~ vote.©