You can support the Department of Justice’s National Nursing Home Initiative by filing a qui tam action under the federal False Claims Act for substandard nursing home care and fraudulent billing practices.
Since March 2020, DOJ has been focusing on long-term care providers, such as nursing homes, sub-acute rehabilitation centers and skilled nursing facilities (SNFs), who provide grossly substandard care to Medicare beneficiaries and/or bill for services that have not been rendered or were “upcoded,” including, rehabilitation treatment, like physical, occupational and speech therapy.
The government is looking for whistleblower cases involving gross abuse and neglect of Medicare patients and blatantly fraudulent billing practices. This includes inadequate care stemming from severely low staffing levels and the use of unlicensed and uncredentialed healthcare providers and aides. It also includes withholding necessary services and activities, including, psychiatric care. Failing to establish or follow plans of care and treatment. And not properly creating and maintaining medical records.
The government is also very focused on significant patient safety issues, like failing to follow
hygiene and infection control protocols. Dispensing unnecessary medications or failing to
provide necessary ones. Housing residents in unsafe or unacceptable living quarters. Failing to
provide adequate food and nourishment. Not attending to bed-ridden patients resulting in
pressure sores. Infrequently bathing and washing residents. Subjecting patients to verbal or
physical abuse. Physically restraining or sedating patients when not warranted. And
inadequately protecting patients’ safety and their personal belongings.
Overbilling and gaming the system for rehabilitation services is also a potential targeted area of
concern. The government is particularly interested in cases where the provider fails to establish
compliance programs and protocols. Turns a blind eye to patient and staff complaints and
warnings. And implements polices and practices that put profits far above quality of care.
Pervasive, long-standing and widespread misconduct involving substandard nursing home care
can result in a provider’s liability under the False Claims Act and a substantial reward to
whoever alerts the government to such conditions.
In the eyes of the law it is improper to file a claim for Medicare reimbursement for services to
nursing home residents knowing the quality of the care was grossly substandard. This is
because every provider’s Medicare claim for reimbursement carries with it an implication that all
material rules and regulations concerning patients’ wellbeing, safety and care have been
complied with. When they have not, then the claim for reimbursement might constitute a false
representation.
If that is what a court or jury finds, then the provider is potentially liable for three times the
amount of the improper payments it received, plus per claim fines of over $25,000, or even
criminal penalties. And, whoever blows the whistle on nursing home or elder care fraud is
potentially eligible for as much as 30% of any funds the government recovers.
The people in the best position to bring successful False Claims Act cases for nursing home
and elder care fraud are current employees. This is because it is important to have or be able to
amass patient-specific and detailed information and evidence corroborating allegations of
substandard nursing home care or Medicare billing fraud.
If you are aware of misconduct in a nursing home or other facility treating seniors and are
confident you have or can obtain strong proof of it, then you should immediately contact an
experienced qui tam whistleblower lawyer to learn about your rights and options.
False Claims Act Recoveries Top $5.6 Billion in 2021
In 2021, the United States government recovered more than $5.6 billion in False Claims Act
recoveries. A good deal of this money came from so-called “qui tam” law suits filed by private citizens.
Those with winning cases typically received between 15%-25% of the recovered amount, some even got
as much as 30%.
As has been true for a number of years, the lion’s share of the False Claims Act settlements and
judgments arose from healthcare fraud cases, mostly involving Medicare and Medicaid, and to a lesser
extent Tricare and Federal Employees Health Benefits (FEHB) program. We expect that trend to continue
for the foreseeable future, including in the Medicare Part C, Medicare Advantage Program, where “risk
factor gaming” has become more prevalent. Anti-Kickback Statute (AKS) and Stark Law violations for
improper referrals are also likely to loom larger. Of course, there will likely be no shortage of
unnecessary procedures, upcoding and billing for services not rendered cases.
With the trillions of dollars handed out during the COVID pandemic, one should also expect to
see any number of schemes where undeserving companies and organizations, as well as individuals, got
Stimulus money, PPP loans, CARES Act funds and Provider Relief money to which they were not entitled.
While this is not an exhaustive list of types of fraud cases heading our way, we do also want to
mention the government’s Cybersecurity Initiative, which aims to tackle the problem of hacking and
theft of government and government contractor data and the failure of those responsible for thwarting
these attacks. This is just one of the many types of procurement fraud the False Claims Act addresses,
along with more traditional defense industry and grant fraud.
If you think might have information about these and other types of potential qui tam False
Claims Act cases, you should immediately contact an experience whistleblower lawyer
US Customs Duty Whistleblower Lawsuit Settles for $6 million
NYC whistleblower attorney Timothy J. McInnis announced today a $6m settlement against an importer of Chinese apparel and related companies. The settlement resolves a False Claims Act lawsuit against Joseph Bailey and his two New York City companies, Stargate Apparel, Inc. and Rivstar Apparel, Inc. The case began with the filing of a qui tam whistleblower complaint under seal in the United States District Court for the Southern District of New York in 2014. The settlement agreement among the whistleblower, the United States and the defendants was approved by U.S. District Judge J. Paul Oetken on July 28, 2021.
The action, initiated by a former employee, alleged that the defendants submitted invoices to the U.S. Customs and Border Protection (“CBP”) that understated the true value of the clothing that they imported into the United States in order to avoid paying millions of dollars in U.S. customs duties. The United States investigated the whistleblower’s allegations and joined in the lawsuit. All the defendants admitted the allegations against them as part of the civil settlement. Bailey also pleaded guilty to related criminal charges and was sentenced to 6 months in federal prison.
According to attorney McInnis, a former federal prosecutor, the whistleblower who brought this action will receive more than $1.2m (20%) for the information he provided. That unnamed person was “very courageous and extremely helpful to the United States during the ensuing
civil and criminal investigations,” according to McInnis. McInnis also acknowledge the tremendous work and successful results of the Assistant U.S. Attorneys and federal agents on the matter.
The case is captioned, United States of America ex rel. John Doe, Plaintiffs, v. Stargate Apparel, Inc., Rivstar Apparel, Inc. and Joseph Bailey,. Defendants, Index No. 1:14-cv-08991-JPO (S.D.N.Y.)
For additional information, please contact Timothy J. McInnis, Esq. of McInnis Law at (212) 292- 4573 or tmcinnis@mcinnis-law.com.
How to report anti-money laundering violations? Are you aware of anti-money laundering violations and want to report them to the authorities and receive a whistleblower reward? If so, you may be entitled to receive as much as 30% of any penalties recovered by the U.S. Department of Treasury or the U.S. Attorney General as a result of your information.
The Anti-Money Laundering Act of 2020 (AMLA), which was enacted as part of the National Defense Authorization Act for 2021, established a whistleblower reward program for reporting anti-money laundering violations. Under the AMAL people who report “original information” (not merely public information) of money laundering activities may be entitled to receive up to 30% from any covered action in which the Government recoups more than $1 million. The AMAL also permits whistleblowers to remain anonymous if they are represented by legal counsel.
What are the signs of money laundering to look out for and report? Such conduct is usually very complex and involves intricate financial arrangements used to circumvent Bank Secrecy Act (BSA) regulations.
These include: a. setting up shell corporations and off-shore foreign entities b. creating sham contracts and business arrangements establishing “slush” funds and secrete or misidentified accounts c. using improper financial wires and banking transfers
The ultimate goal of these machinations is to disguise the source, use or ownership of financial assets in order to hide illicit proceeds or further some type of illegal activity, such as, paying bribes, evading taxes, supporting terrorism, hiding involvement in criminal activity and defrauding investors.
You also may be entitled under the AMLA to bring a separate claim with the U.S. Department of Labor’s OSHA and federal court for any whistleblower retaliation you suffer for bringing forward your allegations. The AMLA protects money laundering whistleblowers from being fired, demoted, suspended, threatened, blacklisted, harassed or discriminated against in any other manner. It allows for double backpay with interest, reinstatement, compensatory damages (including emotional distress), attorneys’ fees and other forms of relief.
Whether you want to report anti-money laundering violations and/or file a claim for whistleblower retaliation, you should consult with an experienced whistleblower attorney as soon as possible. That is the best way to protect your rights.
"Tim McInnis is an amazing attorney. He is intelligent, thorough, ethical, kind and he works very strategically in order to insure the best outcome for his clients. I would trust him with my life. He is not only an excellent attorney, but he is a compassionate person." Denise A. Romano, January 2004
"Tim McInnis is a superb lawyer for whistleblowers. As both a relator and a lawyer I worked with for more than three and a
On October 14, 2020, medical device maker Merit Medical Systems Inc. (MMSI), of South Jordan, Utah, agreed to pay $18 million to settle allegations the company helped submit false claims to the federal Medicare and TRICARE programs and numerous state Medicaid programs by giving kickbacks to physicians and hospitals to induce the purchase and use of MMSI’s durable medical equipment devices and products. NYC attorney Timothy J. McInnis was a member of the legal team that successfully represented the whistleblower in the case, Charles J. (“CJ”) Wolf, M.D., who was the former Chief Compliance Officer of MMSI.
According to Dr. Wolf’s complaint and the government’s settlement agreement, for over six years MMSI paid kickbacks to physicians, medical practices, and hospitals. The payments were made indirectly under the guise of free advertising assistance, practice development, practice support, and so-called “educational” grants. All of this was intended to induce the healthcare providers to purchase and use MMSI’s products, including EmboSphere devices, which are used for uterine fibroid embolization procedures, and QuadraSphere devices, which are used for other types of embolization procedures. Among other things, MMSI used local advertising campaigns to steer patients to healthcare providers as a reward for past sales and to increase future purchases of MMSI products. Dr. Wolf and the government further alleged that MMSI disregarded numerous internal warnings, including from Dr. Wolf, that MMSI’s sales practices potentially violated the healthcare Anti-Kickback Statute (AKS).
The lawsuit was filed in the federal court in District of New Jersey, where attorney McInnis formerly served as an Assistant U.S. Attorney. The case is captioned United States ex rel. Wolf v. Merit Medical Systems, Inc., No. 2:16-cv-01855-CCC-MF (D.N.J.). Of the $18 million MMSI is paying to settle the case, $15.21 million will be go to the U.S. Treasury, and the remaining $2.79 million will go to the approximately 30 individual states that also joined the lawsuit.
half years and his counsel and perseverance were always spot on. His work was critical to a successful settlement of the case." Stephen B. Diamond, Esq., August, 2016
"Tim McInnis Law represented my case with the up most professionalism. He communicated with me at every turn of the case ensuring I understood the process as well what was to come next. His patience, comprehension of Qui Tam Law and persistence in getting me the highest amount possible out of the case is unmatched. I wouldn't hesitate to recommend his law firm for a minute." Don A. Briscoe, September 2016
"Tim McInnis Law represented my case with the up most professionalism. He communicated with me at every turn of the case ensuring I understood the process as well what was to come next. His patience, comprehension of Qui Tam Law and persistence in getting me the highest amount possible out of the case is unmatched. I wouldn't hesitate to recommend his law firm for a minute." Don A. Briscoe, September 2016
How to report a Criminal Antitrust Anti-Retaliation Act Violation? On December 23, 2020, the Criminal Antitrust Anti-Retaliation Act of 2019 (15 U.S.C. § 1 note) became effective. If you have been discriminated against at work for engaging in protected antitrust whistleblower activities, you may be able to report and sue for a violation of this new employment anti-retaliation law. Below is list of important FAQs summarizing what the Criminal Antitrust Anti-Retaliation Act covers and how you can report a violation of this law. FAQs What whistleblowing activities does the Criminal Antitrust Anti-Retaliation Act protect? The Act prohibits employers from retaliating against employees, contractors or subcontractors who, with reasonable belief and in good faith, report antitrust violations to the federal Government or a supervisor or assist in the investigation and prosecution of antitrust misconduct.
What constitutes a violation of this new anti-retaliation law? Pursuant to the Act, no employer may discharge, demote, suspend, threaten, harass, or in way discriminate against a covered person in terms and conditions of employment for any lawful act done in providing information or assistance to the Government or a supervisor concerning a violation of the antitrust laws.
What is meant by the phrase “anti-trust laws?” It refers to sections 1 and 3 of the Sherman Act (15 U.S.C. §§ 1 and 3). Does the Act cover civil antitrust violations? No, to be protected, a whistleblower must have a reasonable belief that a criminal antitrust violation or a related criminal act has been committed. Is every employee, contractor or subcontractor protected by the Act? Generally yes, as long as the person did not plan or initiate the misconduct or obstruct justice. What steps do you need to take to protect your rights under this law? You must first file a complaint with the Secretary of Labor under the rules of 49 U.S.C. § 42121(b). If you do not get satisfaction in that administrative proceeding you can then file a federal lawsuit in a United States District Court. How does a person benefit by reporting a violation of the Criminal Antitrust Anti-Retaliation Act? If your case is successful you will get all relief necessary to make you whole, including, compensatory damages, such as reinstatement with seniority; back pay, with interest; and compensation for any special damages resulting from such discrimination, including litigation costs, expert witness fees, and reasonable whistleblower lawyer fees. Important Statute of Limitations Warning You do not want to delay reporting a Criminal Antitrust Anti-Retaliation Act violation. Under the Act, you have only 180 days after your employer commits a retaliatory act against you to file your complaint. It is important therefore to contact an experienced whistleblower lawyer immediately.
If you did not meet our firm’s requirements for a PPP case, you can either contact the National Center for Disaster Fraud (NCDF) at (866) 720-5721 or file an online complaint at: https://www.justice.gov/disaster-fraud/webform/ncdf-disaster-complaint-form. Complaints filed will be reviewed at the NCDF and referred to federal, state, local, or international law enforcement or regulatory agencies for investigation. Where you will be able to report the fraud but NOT receive a financial reward. Or you can contact another whistleblower attorney to try to obtain a financial reward by filing a federal qui tam False Claims Act lawsuit.
