The NY Attorney General announced that it recovered more than $263 million in Medicaid fraud cases in 2008. Whistleblowers helped.
This latest success adds to the already extraordinary track record of whistleblower legislation around the country.
Both the NY Office for the Medicaid Inspector General and the federal OIG talk about working with whistleblowers in their most recent work plans. Some of the targeted investigations common to both OIGs include nursing homes, home health agencies, durable medical equipment, pharmacies, and personal care aides.
Early intervention makes the NY list, an interesting new litigation arena for a potential whistleblower claim because not much has happened in the world of special education fraud under the FCA. Early intervention services are those provided to babies and toddlers with disabilities.
Compliance problems may range from false certifications of qualifications to lying about the provision of a service to over charging to running around and "cleaning up" agency records just before a state or federal audit.
Whistleblowers with inside information about compliance issues in those and several other human service fields can take advantage of the times by coming forward and reporting misuse of government funds. Because of the economy, the Inspectors General are keenly interested in hearing what whistleblowers have to say.
Thursday, April 30, 2009
Monday, April 27, 2009
Fraud Schemes: The Basic 4
While fraud can be complicated, everyone has a basic understanding of what fraud looks like. Did taxpayers get what they paid for, or not?
Under the federal False Claims Act, whistleblowers report defense and other contractors, health providers, nursing homes, school districts - anyone who submits fraudulent claims or causes someone else to submit false bills for federal dollars.
Several states have similar legislation designed to assist in recovering fraudulently obtained dollars for state treasuries.
Examples of the four basic categories of fraud claims include:
Also deserving of mention are schemes that fall under the description of reverse false claims.
Under the federal False Claims Act, whistleblowers report defense and other contractors, health providers, nursing homes, school districts - anyone who submits fraudulent claims or causes someone else to submit false bills for federal dollars.
Several states have similar legislation designed to assist in recovering fraudulently obtained dollars for state treasuries.
Examples of the four basic categories of fraud claims include:
False Certifications - The agency, school, contractor, etc. falsely assures that it meets regulatory or statutory conditions to qualify for government money.
Fraud in the inducement or False Negotiation - Kickbacks or bid rigging fall into the category of inducements. The inducements can range from lunch and golf to several thousands of dollars for consulting fees.
Substandard Product or Service - The service or product provided for government funding is an inferior substitute to the one for which the government contracted.
Mischarges - A claim for service or product is not provided, or someone is overcharging the government for a service or product.
Also deserving of mention are schemes that fall under the description of reverse false claims.
KEMY represents whistleblowers who report fraud against the federal government. If KEMY decides to take the case, the firm represents the whistleblower on a contingency basis. If the whistleblower's complaint results in a recovery for the government, the whistleblower can qualify for 25% to 30%. If KEMY takes the case and no recovery occurs, the whistleblower pays nothing for attorney fees.
Thursday, April 23, 2009
Rewards for All Kinds of Tax Fraud Reports
You pay your taxes, right? But you happen to know that someone at work or down the street isn't paying his fair share, right? Annoying, right? Especially during the bailout, right?
Maybe you know about some corporate highjinks...or Potentially Abusive Tax Shelter use...or a company that is saying people are independent contractors when they're not.
The IRS runs several options for people who want to report tax fraud. First, you can call your local IRS office, report what you think is going on, and be done with it. Second, you can put your reasons in writing and file a claim for a reward.
The IRS has two rewards programs. The first deals with large scale fraud and mandates recovery, meaning that the Service must pay certain whistleblowers a percentage of the recovery in a tax fraud case under certain conditions. The second program gives the Service full discretion over what, if any, reward is given.
To qualify for the mandatory Rewards program, you must report an individual who grosses more than 200 thousand per year in income, and the amount in dispute must be more than two million dollars. The amount in dispute includes taxes owed, penalties, interest, and whatever else the Service can collect.
Wading through the IRS's rewards programs can be difficult and confusing. If you want to discuss reporting tax fraud, even if it's to get the phone number of your local IRS office, give us a call at 610-940-9099. KEMY can help.
Maybe you know about some corporate highjinks...or Potentially Abusive Tax Shelter use...or a company that is saying people are independent contractors when they're not.
The IRS runs several options for people who want to report tax fraud. First, you can call your local IRS office, report what you think is going on, and be done with it. Second, you can put your reasons in writing and file a claim for a reward.
The IRS has two rewards programs. The first deals with large scale fraud and mandates recovery, meaning that the Service must pay certain whistleblowers a percentage of the recovery in a tax fraud case under certain conditions. The second program gives the Service full discretion over what, if any, reward is given.
To qualify for the mandatory Rewards program, you must report an individual who grosses more than 200 thousand per year in income, and the amount in dispute must be more than two million dollars. The amount in dispute includes taxes owed, penalties, interest, and whatever else the Service can collect.
Wading through the IRS's rewards programs can be difficult and confusing. If you want to discuss reporting tax fraud, even if it's to get the phone number of your local IRS office, give us a call at 610-940-9099. KEMY can help.
Monday, April 20, 2009
WSJ Criticizes PA Governor for State Lawsuit Racket
The Wall Street Journal ran editorials on April 8th and 16th alleging that Governor Rendell granted a huge no-bid, no-compete contract to Bailey, Perrin & Bailey of Houston in return for approximately $90,000 in campaign contributions. Rendell's spokesperson acknowledges the contributions but says the money had nothing to do with the decision to hire the Texas law firm.
Rendell appointed the private law firm to represent PA in a fraud case against Janssen Pharmaceuticals, the manufacturer of Risperdal. The WSJ asks why PA would hire a firm on contingency when firms could competitively bid their services to be paid on an hourly basis. A glaring problem for PA is that the Texas firm demands monetary compensation for its services, or PA is barred from settlement under the contract, ruling out many other kinds of relief from which taxpayers may benefit.
Even more curious is these alleged "pay to play" legal dealings when juxtaposed with PA's ongoing failure to pass state FCA legislation. PA could tool up its own legal apparatus under a state FCA and qualify for a share of any federal proceeds from these kinds of Medicaid fraud prosecutions at the same time. There wouldn't be the same level of need to hire Texas lawyers,...and PA taxpayers would get the full benefit of the litigation.
Besides marring public trust in fraud prosecution, the relationship between Rendell and the Houston law firm is impeding the PA Risperdal litigation as well. Janssen has filed a motion in the PA Supreme Court to invalidate the agreement between PA and the Houston firm, laying out in detail the timing of payments by the firm to Rendell's campaign, just before and after the award of the contract.
WSJ calls for reform in the way contracts are awarded to outside firms by state governments. Better yet, Rendell and PA should correct the problem and lessen the need for outside counsel by passing a state FCA.
Rendell appointed the private law firm to represent PA in a fraud case against Janssen Pharmaceuticals, the manufacturer of Risperdal. The WSJ asks why PA would hire a firm on contingency when firms could competitively bid their services to be paid on an hourly basis. A glaring problem for PA is that the Texas firm demands monetary compensation for its services, or PA is barred from settlement under the contract, ruling out many other kinds of relief from which taxpayers may benefit.
Even more curious is these alleged "pay to play" legal dealings when juxtaposed with PA's ongoing failure to pass state FCA legislation. PA could tool up its own legal apparatus under a state FCA and qualify for a share of any federal proceeds from these kinds of Medicaid fraud prosecutions at the same time. There wouldn't be the same level of need to hire Texas lawyers,...and PA taxpayers would get the full benefit of the litigation.
Besides marring public trust in fraud prosecution, the relationship between Rendell and the Houston law firm is impeding the PA Risperdal litigation as well. Janssen has filed a motion in the PA Supreme Court to invalidate the agreement between PA and the Houston firm, laying out in detail the timing of payments by the firm to Rendell's campaign, just before and after the award of the contract.
WSJ calls for reform in the way contracts are awarded to outside firms by state governments. Better yet, Rendell and PA should correct the problem and lessen the need for outside counsel by passing a state FCA.
Thursday, April 16, 2009
Protect Taxpayers' Dollars; Get Busy, and Pass a PA FCA
Why do PA taxpayers have to tighten their belts to bail out large corporations when we could let a state False Claims Act share some of the load? Honestly, why aren't PA's key politicos like Corbett, Rendell, Richmond, and Greenleaf making this happen? Everyone agrees we need the money. Forget poker machines, a PA FCA would bring some big dollars.
A state False Claims Act enables fraud dollars to be recovered for government coffers. 23 states already have them. New York, for example, passed a state FCA in 2007 and recovered 551 million in misspent Medicaid dollars the very next year. The federal False Claims Act has enabled the US treasury to recover more than 200 BILLION since 1986.
Several multi-million and even billion dollar settlements have resulted in tremendous increases in revenue for those states that have been smart enough to cash in. Pennsylvania, because it has no FCA, lost those opportunities.
Rep. Gerber of Montgomery County has repeatedly championed state FCA legislation, and a few versions have passed the PA House. Mysteriously, the Senate lets them die.
In other states, governors and Attorneys General have actively campaigned for passage of state FCAs. Not so in PA. While Governor Rendell gives lukewarm nods in support, a search of his website shows no activity or agenda item mentioning passage of a PA FCA. Same goes for Tom Corbett, except Corbett does not even give a nod.
Hopefully, no one is allowing special interests lobbying against a state FCA to victimize PA taxpayers. We really can't afford it.
A state False Claims Act enables fraud dollars to be recovered for government coffers. 23 states already have them. New York, for example, passed a state FCA in 2007 and recovered 551 million in misspent Medicaid dollars the very next year. The federal False Claims Act has enabled the US treasury to recover more than 200 BILLION since 1986.
Several multi-million and even billion dollar settlements have resulted in tremendous increases in revenue for those states that have been smart enough to cash in. Pennsylvania, because it has no FCA, lost those opportunities.
Rep. Gerber of Montgomery County has repeatedly championed state FCA legislation, and a few versions have passed the PA House. Mysteriously, the Senate lets them die.
In other states, governors and Attorneys General have actively campaigned for passage of state FCAs. Not so in PA. While Governor Rendell gives lukewarm nods in support, a search of his website shows no activity or agenda item mentioning passage of a PA FCA. Same goes for Tom Corbett, except Corbett does not even give a nod.
Hopefully, no one is allowing special interests lobbying against a state FCA to victimize PA taxpayers. We really can't afford it.
Monday, April 13, 2009
IRS Recovery Rewards
About a month ago, the IRS and the tax fraud bar engaged in a sort of summit meeting. The day long event was multipurpose, but overall, the tax fraud attorneys wanted to see if getting the two groups together could lessen bureaucratic hurdles for those who wanted to report tax fraud and claim a reward within a reasonable amount of time.
One IRS representative noted that the new mandatory reward program allows for recovery claims. In other words, the IRS often faces difficulty finding assets when a tax cheat has already been prosecuted. Others in the community will know about the second or third house purchased under a sham name, assets being held by a family member, etc. If the IRS is trying to collect, and you know where assets have been hidden, you may qualify for the IRS rewards program.
Remember that if you do qualify, you should expect a long, long wait before you get answers from the IRS about your claim. At the meeting, the Service reported that it will not pay until the investigation ends, the funds are paid, and the taxpayer has exhausted all possible appeals. That means years - several years.
Surprisingly, a lot of folks don't care much about the wait or the reward. They just want to do the right thing and see that ill gotten fund are returned to the government. If we can help you navigate through an IRS reward claim, please give us a call.
One IRS representative noted that the new mandatory reward program allows for recovery claims. In other words, the IRS often faces difficulty finding assets when a tax cheat has already been prosecuted. Others in the community will know about the second or third house purchased under a sham name, assets being held by a family member, etc. If the IRS is trying to collect, and you know where assets have been hidden, you may qualify for the IRS rewards program.
Remember that if you do qualify, you should expect a long, long wait before you get answers from the IRS about your claim. At the meeting, the Service reported that it will not pay until the investigation ends, the funds are paid, and the taxpayer has exhausted all possible appeals. That means years - several years.
Surprisingly, a lot of folks don't care much about the wait or the reward. They just want to do the right thing and see that ill gotten fund are returned to the government. If we can help you navigate through an IRS reward claim, please give us a call.
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