The False Claims Act of 1863 (FCA) is an American federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government. The law includes a qui tam provision that allows people who are not affiliated with the government, called "relators" under the law, to file actions on behalf of the government. This is informally called "whistleblowing", especially when the relator is employed by the organization accused in the suit. Persons filing actions under the Act stand to receive a portion of any recovered damages.
Insurance fraud is any act committed to defraud an insurance process. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation, the most common schemes include premium diversion, fee churning, asset diversion, and workers compensation fraud. Perpetrators in the schemes can be insurance company employees or claimants. False insurance claims are insurance claims filed with the fraudulent intention towards an insurance provider.
In common law, a writ of qui tam is a writ through which private individuals who assist a prosecution can receive for themselves all or part of the damages or financial penalties recovered by the government as a result of the prosecution. Its name is an abbreviation of the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning "[he] who sues in this matter for the king as well as for himself."
Richard Marin Scrushy is an American businessman and convicted felon. He is the founder of HealthSouth Corporation, a global healthcare company based in Birmingham, Alabama. In 2004, following an investigation by the Federal Bureau of Investigation (FBI), Scrushy was criminally charged by the U.S. Securities and Exchange Commission (SEC). Scrushy was charged with 36 of the original 85 counts but was acquitted of all charges on June 28, 2005, after a jury trial in Birmingham.
Community Health Systems (CHS) is a Fortune 500 company based in Franklin, Tennessee. It was the largest provider of general hospital healthcare services in the United States in terms of number of acute care facilities. In 2014, CHS had around 200 hospitals, but the number had declined to around 85 in 2021.
The United States Food and Drug Administration (FDA) Office of Criminal Investigations (OCI) provides the FDA with a specific office to conduct and coordinate its criminal investigations.
Robert Allen Stanford is a convicted financial fraudster, former financier, and sponsor of professional sports. He was convicted of fraud in 2012, having operated an eight billion dollar Ponzi scheme, and is now serving a 110-year federal prison sentence.
In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.
The ethics involved within pharmaceutical sales is built from the organizational ethics, which is a matter of system compliance, accountability and culture. Organizational ethics are used when developing the marketing and sales strategy to both the public and the healthcare profession of the strategy. Organizational ethics are best demonstrated through acts of fairness, compassion, integrity, honor, and responsibility.
Thomas Joseph Petters is a former American businessman and chairman and CEO of Petters Group Worldwide, a company which stole over $2 billion in a Ponzi scheme. He was convicted of massive business fraud in 2009 and is now imprisoned at the United States Penitentiary, Leavenworth. Amid mounting criminal investigations, Petters resigned as his company's CEO on September 29, 2008. He was convicted of numerous federal crimes for operating Petters Group Worldwide as a $3.65 billion Ponzi scheme and received a 50-year federal sentence.
James Hoyer, P.A. is a Tampa, Florida-based law firm that focuses on whistleblower cases as well as consumer class action lawsuits. In 2015, the firm was named Whistleblower Lawyers of the Year by the Taxpayers Against Fraud Education Fund.
A case of Medicaid fraud was carried out in 2010 by an Armenian-American organized crime group called the Mirzoyan–Terdjanian organization. The scam involved a crime syndicate which created 118 fake clinics in 25 states and used stolen medical license numbers of real doctors and matched them to legitimate Medicare patients whose names and billing information were also stolen. The group submitted more than $163 million in claims and received $35 million of that before they were caught. Prosecutors charged 73 individuals in several states with allegations of racketeering conspiracy, bank fraud, money laundering and identity theft.
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).
Daniel Mark Porush is an American businessman, former stock broker and convicted criminal who helped run a pump and dump stock fraud scheme in the 1990s at the Stratton Oakmont brokerage in collaboration with Jordan Belfort. In 1999, he was convicted of securities fraud and money laundering, for which he served 39 months in prison. After prison, Porush became involved with a Florida-based medical supply company, Med-Care, which was the subject of federal investigations. In the biographical 2013 film The Wolf of Wall Street, which focuses on the story of Belfort and Stratton Oakmont, Jonah Hill portrays Donnie Azoff, a character loosely based on Porush. Porush has called the portrayal inaccurate and threatened to sue the filmmakers to prevent him from being depicted.
IPC Healthcare, previously known as IPC The Hospitalist Company, was a publicly traded corporation which operates a national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 1,900 facilities in 28 states across the U.S. The company name is derived from an earlier company called In-Patient Consultants Management, Inc. and the NASDAQ ticker name was changed to IPCM in 2008. The company changed its name to IPC Healthcare in January 2015. The company was acquired by TeamHealth in 2015 for $1.6 billion.
VITAS® Healthcare is a provider of end-of-life care in the United States. Operating 50 hospice programs in 14 states and the District of Columbia, VITAS employs 10,000 professionals and serves an average daily census of more than 19,000 patients, according to the company's website.
Farid T. Fata is a Lebanese-born former hematologist/oncologist and the mastermind of one of the largest health care frauds in U.S. history. Fata was the owner of Michigan Hematology-Oncology (MHO), one of the largest cancer practices in Michigan. He was arrested in 2013 on charges of prescribing chemotherapy to patients who were healthy or whose condition did not warrant chemotherapy, then submitting $34 million in fraudulent charges to Medicare and private health insurance companies over a period of at least six years.
Erin Nealy Cox is an American attorney who served as the United States Attorney for the United States District Court for the Northern District of Texas from 2017 to 2021. She was nominated to the position by President Donald Trump and confirmed by the U.S. Senate in 2017. After the 2020 election, she resigned effective January 9, 2021, and joined Kirkland & Ellis as a partner on June 23, 2021.
