United States

A settlement has been reached in a whistleblower class action lawsuit brought against San Mateo Medical Center (SMMC) who is accused of submitting false claims to the United States in connection with payments from the Medicare and Medicaid programs.

The whistleblower that filed the orignal complaint will receive $1,020,000.

The government alleges that SMMC falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The DSH adjustment is an extra Medicare payment available to hospitals that meet certain requirements, including having 100 or more acute care beds.

In addition, the government alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. Such services are ineligible for federal funding, and San Mateo County was required to separately report them to the California Department of Mental Health so that the state could ensure that no federal funds were used to pay for them. Medicaid (known as Medi-Cal in California) is a program funded jointly by federal and state funds. The settlement covers conduct from 1997 to 2007.

A settlement has been reached to resolve False Claims Act allegations against Fastenal Company who is accused of knowingly failing to meet its contractual obligations.

This settlement was reached following an investigation of alleged false claims in connection with a General Services Administration (GSA) contract. 

The GSA Office of Inspector General learned that Fastenal knowingly failed to meet its contractual obligations to provide the GSA with current, accurate and complete information about its commercial sales practices, including discounts afforded to other customers.

In addition, the United States alleged that Fastenal failed to comply with the price reduction clause of its GSA contract, overcharged government customers, and improperly assessed delivery and sales tax charges on government sales. As a result, the government paid more than it should have for Fastenal products. The settlement also resolves allegations that Fastenal violated the Trade Agreements Act when it knowingly sold products to the United States that were manufactured in countries that do not have trade agreements with the United States, e.g., China.

A settlement has been reached in a whistleblower class action lawsuit brought against CareSource, CareSource Management Group Co and CareSource USA Holding Co. They are accused of causing Medicaid to make payments for assessments and case managements they failed to provide to children and adults.

The whistleblowers will receive a $3.1 million share of the government's recovery.

Originally filed in November 2006, the United States alleged that between January 2001 and December 2006, the CareSource entities knowingly failed to provide required screening, assessment and case management for adults, and children with special health care needs. As a result, it was alleged that CareSource received millions of dollars in Medicaid funds to which it was not entitled. The CareSource entities subsequently submitted false data to the state of Ohio so that it appeared they were providing these required services to improperly retain incentives received from Ohio Medicaid and to avoid penalties.

A settlement has been reached in a whistleblower class action lawsuit brought against Alaska DigiTel LLC, a former Alaska limited liability company now owned by General Communication Inc. (GCI), who is accused of submitting false claims to the Federal Communications Commission’s (FCC) Low Income Support Program.

The whistleblower will receive $260,274 from the settlement.

Originally filed in 2008, the United States alleged that Alaska DigiTel violated the False Claims Act by submitting claims to the Low Income Support Program for improperly substantiated, duplicative, or otherwise ineligible subscribers for the period from Jan. 1, 2004, though Aug. 31, 2008.

The Low Income Support Program of the Universal Service Fund, which includes the Lifeline, LinkUp and Toll Limitation Services, was created by Congress in the Telecommunications Act of 1996 and is administered by the Universal Service Administrative Company for the FCC. Under the Low Income Support Program, eligible individuals may apply for free ordiscounted phone or wireless services. Reimbursement is paid directly to Eligible Telecommunications Carriers, such as Alaska DigiTel.

A settlement has been reached to resolve False Claims Act Allegations against BlueCross BlueShield of Illinois who is accused of  wrongly terminating insurance coverage and denying patient claims, among other claims.

Under the agreement, BlueCross BlueShield of Illinois will pay $14.25 million to the state of Illinois and $9.5 million to the United States. The company will also pay $1.25 million to Illinois for allegations under the state consumer fraud statute.

In detail, the United States contends that BlueCross BlueShield of Illinois wrongly terminated insurance coverage for private duty skilled nursing care for medically fragile, technologically dependent children, in order to shift the costs of such care to the Medicaid program. Medicaid funds a special program designed to provide home care for children at risk of institutionalization.

As a result, children whose specialized care should have been covered by BlueCross BlueShield of Illinois under the terms of existing insurance policies, were shifted to the government-funded Home and Community Based Services Medicaid program, operated by the Illinois Division of Specialized Care for Children under an agreement with the Illinois Department of Healthcare and Family Services. As a result, Medicaid spent millions of dollars providing care that should have been paid for by private insurance.

The settlement resolves claims that BlueCross BlueShield of Illinois denied patient claims based on internal, undisclosed guidelines that were more restrictive than the language provided to beneficiaries in plan policy materials. Additionally, the government alleged that BlueCross BlueShield of Illinois improperly told policy holders that children were not covered for private duty nursing during the claims review process sought after initial denials.

A settlement has been reached in a whistleblower class action lawsuit brought against Verizon Communications Inc who is accused of overcharging the General Services Administration (GSA) on invoices dealing with government-wide voice and data telecommunications services contracts.

The whistleblowers portion of the government's recovery was not disclosed.

Originally filed in January 2007,  the United States alleged that Verizon subsidiary MCI Communications Services Inc. dba Verizon Business Services invoiced GSA for a variety of federal, state and local taxes and surcharges in violation of the contracts or applicable regulations in connection with the FTS2001 and FTS2001 Bridge contracts. The department’s joint investigation with GSA’s Office of the Inspector General (OIG) found that Verizon and MCI submitted false claims under the contracts for the reimbursement of property taxes, common carrier recovery charges and unallowable surcharges, charges that are not directly reimbursable under the FTS2001 contracts.