What Plaintiff’s Attorneys Need to Know About DOJ and OIG Investigations of LTC Facilities

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In a recent post, we wrote about how government funds available for The Health Care Fraud and Abuse Control Account have more than doubled since 2009— going from $465 million to more than $963 million. At the same time, funds dedicated to Department of Justice (DOJ) investigations have more than tripled from $198 million to $681 million. Long-Term Care (LTC) facilities and providers defend against DOJ and Office of Inspector General (OIG) investigations of Medicare/Medicaid fraud, allegations of “worthless care,” allegations related to the False Claims Act, and other similar investigations still in litigation.

Why should Plaintiff’s Attorneys care about this trend in litigation?

Enacted during the Civil War and amended several times, the False Claims Act (FCA), 31 U.S.C. §§ 3729 – 3733 provides that any person who presents a false or fraudulent claim for payment or approval to an officer or employee of the United States government or otherwise engages in certain enumerated fraudulent activities is liable to the government for a civil penalty of not less than $5,000 and not more than $10,000, plus three times the amount of damages which the Government sustains because of the act of that person. The 1986 amendment to the FCA allows private persons to file suit for violations of the FCA on behalf of the government. A suit filed by an individual on behalf of the government is known as a “qui tam” action and the person bringing the action is referred to as a “relator.” If the government intervenes in the qui tam action, the relator is entitled to receive between 15 and 25 percent of the amount recovered by the government. If the government declines to intervene in the action, the relator’s share increases to between 25 to 30 percent.

Early in 2018, the Department of Justice released a memo to give DOJ litigators a “general framework” of factors to consider when deciding whether or not to dismiss False Claims Act cases brought by qui tam relators on behalf of the government due to recent “record increases” in qui tam actions. For this important reason alone, Plaintiff’s Attorneys representing qui tam relators should have solid evidence of fraudulent claims before investing resources in such cases.

ALN Consulting nurses are experienced in such litigation and can provide analysis integral to successfully trying cases related to the False Claims Act. When reviewing allegations of worthless care, ALN Consulting looks at the overall care provided rather than analyzing specific events or breaches from standard care or level of harm — taking a much broader approach than those of typical litigation. In cases where a relator was unable to prove false or fraudulent claims, a sharp and detail oriented legal nurse consultant could have made the difference in the evidence presented.

We’ve done the research, so you don’t have to! ALN Consulting will continue to stay on top of these and other developments.

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