HEAT ON GOVERNMENT SPONSORED HEALTH PLANS False Claims Act Litigation
Michael C. Rosenblat Michael C. Rosenblat, PC Chicago, Illinois
$20 Billion Recovered under Federal & State False Claims Acts since 1986
False Claims Act Creates Liability for Knowingly Submitting a False Claim to the Government • Claim is a demand for payment • Liability attaches for: – False claims – False certifications – Kickback & Bribes – Misrepresentation during Contract Negotiations – Causing others to Submit a False Claim
Liability
• Three X Damages • Civil penalties - $5,500 to $11,000 per false claim • Attorneys’ Fees and Costs
Lawsuits Can be Filed By • The Government • Private Individuals – Qui Tam Plaintiff – Relator – Whistleblower
Types of Fraud • • • • •
Billing for Services not Provided Billing for Products not Provided Up coding – Billing at a Higher Rate False Certification – met requirements Tainted Contract – Kickbacks or Bribes
State’s With False Claim Acts • • • • • • • • • • • •
California Delaware District of Columbia Florida Georgia Hawaii Illinois Indiana Louisiana Massachusetts Michigan Montana
• • • • • • • • • • •
Nevada New Hampshire New Jersey New Mexico New York Oklahoma Rhode Island Tennessee Texas Virginia Wisconsin
Lessons from Amerigroup
Lessons from Amerigroup • Listen to Employees
Lessons from Amerigroup • Listen to Employees • Investigate Facts
Lessons from Amerigroup • Listen to Employees • Investigate Facts • Evaluate Liability from a Plaintiff’s Perspective
Lessons from Amerigroup • Listen to Employees • Investigate Facts • Evaluate Liability from a Plaintiff’s Perspective • Make a Reasonable Settlement Offer
Trial Judgment $334 Million Settlement $234 Million
Biggest False Claims Cases Tenet
900,000,000
Jul 2006
HCA
732,400,000
Dec 2000
HCA
631,000,000
Jun 2003
Serono Group
567,000,000
Oct 2005
TAP Pharm
559,483,560
Oct 2001
Schering Plough
435,000,000
Aug 2006
Abbott Labs
400,000,000
Jul 2003
Fresenius Medical Care
385,000,000
Jan 2000
Bristol Myers Squib
338,000,000
Sep 2007
HealthSouth
325,000,000
Dec 2004
SmithKline Beecham Clinical Labs
325,000,000
Feb 1997
State Enforcement of Medicaid Fraud • 23 states have their own version of the false claims act • 49 states have a Medicaid Fraud Control Unit • State Award increased by 10% for having False Claims Act similar to Federal
HEAT ON GOVERNMENT SPONSORED HEALTH PLANS Expect Increased Scrutiny of MCO’s as a Result of The Amerigroup Case and As Their Role Increases in Government Sponsored Health Care Programs