For years, courts have held that it is a violation of the False Claims Act (FCA) when a provider has concealed or improperly avoided or decreased its obligation to pay the government, by failing to disclose and refund clear overpayments.
Nolan Auerbach & White is an experienced Medicare Fraud Law Firm helping courageous whistleblowers.
Liability is founded on the basis that the provider has an obligation to notify Medicare, of the overpayment, in its annual cost reports or otherwise.
With the enactment of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. § 1320a-7k(d), federal law explicitly provides for liability of providers when overpayments are retained. For purposes of subsection 1320a-7k(d), “overpayments” are defined as “Medicare funds received or retained to which a person is not entitled, after applicable reconciliation.” Such overpayments must be reported and returned by the later of sixty days after they were identified or the date any applicable cost report is due. Any overpayment retained after this deadline is defined as an “obligation” within the meaning of the FCA.
This section of the Act, entitled “Reporting and Returning of Overpayments,” requires a person who has received an overpayment to report and return the overpayment to HHS, the State, an intermediary, a carrier, or a contractor, as appropriate, and to notify the HHS, State, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.
Examples of “overpayments” are:
Examples of overpayments also include:
Whistleblower lawsuits based on hospital system retention of overpayments can be complex. Contact our whistleblower lawyers for more information.
Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.
CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.
Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.
Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.
Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.
