The U.S. Department of Justice’s Civil Division remains focused on prosecuting healthcare fraud despite a changing of the guard in Washington, a DOJ official told a group of lawyers in late June.
In an address to the American Health Law Association’s Annual Meeting, Michael Granston, deputy assistant general for the DOJ’s Commercial Litigation Branch, emphasized that prosecuting such cases remains a top priority for the department under the Biden Administration.
That’s a continuation from 2020, in which the DOJ both filed and settled a record number of health care fraud cases.
Granston told the organization that of the more than 900 new matters the DOJ opened in 2020, 580 were health fraud matters. Most claims were brought under the False Claims Act, a law originally signed into law in 1863 to help combat fraud by suppliers to the U.S. government during the Civil War.
Today, the Act remains one of the federal government’s most effective weapons in fighting fraud on the government. It incentivizes whistleblowers, or Relators, as they’re known, to report a fraud on the government by rewarding them with a percentage of the amount the government successfully recovers because of the whistleblower’s False Claims Act case.
During his presentation, Granston also said that the DOJ settled 366 False Claims Act cases in 2020, 265 of which were related to health fraud.
Granston emphasized that the department intends to focus on misuse of electronic health records, manipulation of Medicare’s managed care program and improper claims for COVID-19 relief funds.
Like 2020, this year has proven to be an active year for False Claims Act activity.
On July 30, the DOJ announced that it had intervened in six lawsuits in the U.S. District Court for the Northern District of California alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees to receive higher reimbursements.
Whistleblower cases require lawyers litigating them to prove a fraud while protecting their client who typically learns of the fraud at work. While many law firms have experience dealing with fraud cases or employment issues, few are experienced enough to handle both issues together.
With more than 25 years of experience litigating both fraud and employment matters, Keller Grover is uniquely qualified to represent whistleblowers.
One of Keller Grover’s whistleblower clients recently reached a record $90 million False Claims Act settlement with Sutter Health.
The client, Kathy Ormsby, brought allegations that Sutter committed massive Medicare Advantage fraud over the course of roughly six years. The settlement is the largest False Claims Act settlement against a hospital system involving allegations of fraud on the Medicare Advantage program, and the second-largest reported Medicare Advantage fraud settlement ever.
Ms. Ormsby alleged that Sutter, through several affiliates including the Palo Alto Medical Foundation, intentionally or recklessly submitted inaccurate and unsupported medical diagnosis codes that inflated Sutter’s reimbursements from the Medicare Advantage Program.
The Department of Justice intervened in a portion of Ms. Ormsby’s case relating to the foundation. She continued to pursue non-intervened claims related to alleged fraud at other Sutter affiliates.
The parties reached a settlement, which the parties announced Aug. 30, after Sutter unsuccessfully sought to dismiss both the government’s complaint and Ms. Ormsby’s.
Under the False Claims Act’s whistleblower reward provision, Ms. Ormsby is entitled to receive 15 to 30 percent of the settlement amount for her role in the case.
We are here to help those who want to report wrongdoing. If you want advice about how to handle suspected fraud, contact Keller Grover for a free consultation. We can help you understand your options, applicable protections and steps you should take. In more than 25 years litigating fraud and employment cases, Keller Grover has recovered billions for its clients.