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From: Linda on 11 Jun 2008 01:52

http://www.taf.org/whyfca.htm

What is the False Claims Act
& Why is it Important?

The False Claims Act is the single most important tool U.S. taxpayers
have to recover the billions of dollars stolen through fraud by U.S.
government contractors every year.

Under the False Claims Act, 31 U.S.C. §§ 3729-3733, those who
knowingly submit, or cause another person or entity to submit, false
claims for payment of government funds are liable for three times the
governments damages plus civil penalties of $5,500 to $11,000 per
false claim.

The False Claims Act explicitly excludes tax fraud. Section 3729(e)
states that the Act does not apply to claims, records, or statements
made under the Internal Revenue Code. If you wish to report tax
fraud, please call the IRS Fraud Hotline at 800-829-0433.

Qui Tam Whistleblower Provisions

The False Claims Act contains qui tam, or whistleblower, provisions.
Qui tam is a unique mechanism in the law that allows citizens with
evidence of fraud against government contracts and programs to sue, on
behalf of the government, in order to recover the stolen funds. In
compensation for the risk and effort of filing a qui tam case, the
citizen whistleblower or "relator" may be awarded a portion of the
funds recovered, typically between 15 and 25 percent. A qui tam suit
initially remains under seal for at least 60 days during which the
Department of Justice can investigate and decide whether to join the
action

A Public-Private Partnership

Congress recognized that the Government alone, with its limited
resources, was overmatched in the fight against rampant fraud. In
response to widespread reports that the U.S. Treasury was being
repeatedly bilked, in 1986 Congress rejuvenated a Civil War-era law
the False Claims Act. The 1986 amendments strengthened the False
Claims Acts qui tam provisions, creating incentives for private
citizens with evidence of fraud to commit their time and resources to
supplement the Governments efforts. By doing so, Congress put into
play a powerful public-private partnership for uncovering fraud
against the federal fisc and obtaining the maximum recovery for
American taxpayers.

Changing the Culture of Fraud

The False Claims Act is about more than money. It is also about
discouraging fraud and changing the culture of corporate America. As
Sen. Charles Grassley (R-IA) and Rep. Howard Berman (D-CA) have noted:

"Studies estimate the fraud deterred thus far by the qui tam
provisions runs into the hundreds of billions of dollars. Instead of
encouraging or rewarding a culture of deceit, corporations now spend
substantial sums on sophisticated and meaningful compliance programs.
That change in the corporate culture -- and in the values-based
decisions that ordinary Americans make daily in the workplace -- may
be the law's most durable legacy."

Who the Law Applies To

In general, the False Claims Act covers fraud involving any federally
funded contract or program, with the exception of tax fraud.

While many qui tam actions in the late 1980s and early 1990s involved
Department of Defense contracts, in recent years most qui tam actions
have been used to fight Medicare fraud and fraud against other
federally funded health care programs. A broad array of scenarios can
constitute FCA violations. Some examples include the following:

A contractor falsifies test results or other information regarding the
quality or cost of products it sells to the Government;

A health care provider bills Medicare for services that were not
performed or were unnecessary, or;

A grant recipient charges the Government for costs not related to the
grant.
Types of Fraud Prosecuted Under the FCA

It is impossible to list all of the frauds that have been prosecuted
under the False Claims Act, but the following list gives some idea of
the scope of the false claims on the Government that have been
uncovered to date:

Billing for goods and services that were never delivered or rendered.
Billing for marketing, lobbying or other non-contract related
corporate activities.
Submitting false service records or samples in order to show better-
than-actual performance.
Presenting broken or untested equipment as operational and tested.
Performing inappropriate or unnecessary medical procedures in order to
increase Medicare reimbursement.
Billing for work or tests not performed.
Billing for premium equipment but actually providing inferior
equipment.
Automatically running a lab test whenever the results of some other
test fall within a certain range, even though the second test was not
specifically requested.
Defective testing - Certifying that something has passed a test, when
in fact it has not.
"Lick and stick" prescription rebate fraud and "marketing the spread"
prescription fraud, both of which involve lying to the government
about the true wholesale price of prescription drugs.
Unbundling - Using multiple billing codes instead of one billing code
for a drug panel test in order to increase remuneration.
Bundling -- Billing more for a panel of tests when a single test was
asked for.
Double billing - Charging more than once for the same goods or
service.
Upcoding - Inflating bills by using diagnosis billing codes that
suggest a more expensive illness or treatment.
Billing for brand -- Billing for brand-named drugs when generic drugs
are actually provided.
Phantom employees and doctored time slips: Charging for employees that
were not actually on the job, or billing for made-up hours in order to
maximize reimbursements.
Upcoding employee work: Billing at doctor rates for work that was
actually conducted by a nurse or resident intern.
Yield burning -- skimming off the profits from the sale of municipal
bonds.
Falsifying natural resource production records -- Pumping, mining or
harvesting more natural resources from public lands that is actually
reported to the government.
Being over-paid by the government for sale of a good or service, and
then not reporting that overpayment.
Misrepresenting the value of imported goods or their country of origin
for tariff purposes.
False certification that a contract falls within certain guidelines
(i.e. the contractor is a minority or veteran).
Billing in order to increase revenue instead of billing to reflect
actual work performed.
Failing to report known product defects in order to be able to
continue to sell or bill the government for the product.
Billing for research that was never conducted; falsifying research
data that was paid for by the U.S. government.
Winning a contract through kickbacks or bribes.
Prescribing a medicine or recommending a type of treatment or
diagnosis regimen in order to win kickbacks from hospitals, labs or
pharmaceutical companies.
Billing for unlicensed or unapproved drugs.
Forging physician signatures when such signatures are required for
reimbursement from Medicare or Medicaid.
Limits on the False Claims Act

Though the False Claims Act is a powerful tool to combat fraud, it is
a tool that is sharply constrained by both the law and economics of
litigation.

Tax issues are not covered by the False Claims Act.
For a civil case to be filed, the fraud has to reach a certain size,
otherwise it is generally not worth it for the relator to risk his or
her career to file suit, nor is it worth it for a law firm to take on
the case and risk the loss of the enormous time and expense that a
False Claims Act represents.
A defendant in a False Claims Act has to have relatively deep pockets.
Many of the smaller companies that may be defrauding the government
are liable to declare bankruptcy if faced with the triple damages that
can be levied under the False Claims Act.
A law firm that take on a False Claims Act case must believe it has a
very strong case in order to proceed. Not only can a firm be out time
and money, but if the government does not take the case and the
whistleblower proceeds, he or she can be forced to pay the defendants
attorney's fees if the court finds that the claim was frivolous or
brought primarily for purposes of harassment.
State False Claims Acts
In addition to the Federal False Claims Act, a number of states also
have False Claims Acts that work to discourage frauds perpetrated
against state governments. States with False Claims Acts include:
California, Delaware, the District of Columbia, Florida, Hawaii,
Illinois, Louisiana, Massachusetts, Nevada, New Mexico, Tennessee,
Texas, and Virginia.

From: Linda on 11 Jun 2008 01:58

From: Linda on 11 Jun 2008 02:01

On Jun 10, 10:52 pm, Linda <Indomitab...(a)netzero.com> wrote:
> http://www.taf.org/whyfca.htm
>
> What is the False Claims Act
> & Why is it Important?
>
> The False Claims Act is the single most important tool U.S. taxpayers
> have to recover the billions of dollars stolen through fraud by U.S.
> government contractors every year.
>

>
> Who the Law Applies To
>
> In general, the False Claims Act covers fraud involving any federally
> funded contract or program, with the exception of tax fraud.
>
>
> It is impossible to list all of the frauds that have been prosecuted
> under the False Claims Act, but the following list gives some idea of
> the scope of the false claims on the Government that have been
> uncovered to date:
>
> Billing for goods and services that were never delivered or rendered.
> Billing for marketing, lobbying or other non-contract related
> corporate activities.
> Submitting false service records or samples in order to show better-
> than-actual performance.
> Presenting broken or untested equipment as operational and tested.
> Performing inappropriate or unnecessary medical procedures in order to
> increase Medicare reimbursement.
> Billing for work or tests not performed.
> Billing for premium equipment but actually providing inferior
> equipment.
> Automatically running a lab test whenever the results of some other
> test fall within a certain range, even though the second test was not
> specifically requested.
> Defective testing - Certifying that something has passed a test, when
> in fact it has not.
> "Lick and stick" prescription rebate fraud and "marketing the spread"
> prescription fraud, both of which involve lying to the government
> about the true wholesale price of prescription drugs.
> Unbundling - Using multiple billing codes instead of one billing code
> for a drug panel test in order to increase remuneration.
> Bundling -- Billing more for a panel of tests when a single test was
> asked for.
> Double billing - Charging more than once for the same goods or
> service.
> Upcoding - Inflating bills by using diagnosis billing codes that
> suggest a more expensive illness or treatment.
> Billing for brand -- Billing for brand-named drugs when generic drugs
> are actually provided.
> Phantom employees and doctored time slips: Charging for employees that
> were not actually on the job, or billing for made-up hours in order to
> maximize reimbursements.
> Upcoding employee work: Billing at doctor rates for work that was
> actually conducted by a nurse or resident intern.
> Yield burning -- skimming off the profits from the sale of municipal
> bonds.
> Falsifying natural resource production records -- Pumping, mining or
> harvesting more natural resources from public lands that is actually
> reported to the government.
> Being over-paid by the government for sale of a good or service, and
> then not reporting that overpayment.
> Misrepresenting the value of imported goods or their country of origin
> for tariff purposes.
> False certification that a contract falls within certain guidelines
> (i.e. the contractor is a minority or veteran).
> Billing in order to increase revenue instead of billing to reflect
> actual work performed.
> Failing to report known product defects in order to be able to
> continue to sell or bill the government for the product.
> Billing for research that was never conducted; falsifying research
> data that was paid for by the U.S. government.
> Winning a contract through kickbacks or bribes.
> Prescribing a medicine or recommending a type of treatment or
> diagnosis regimen in order to win kickbacks from hospitals, labs or
> pharmaceutical companies.
> Billing for unlicensed or unapproved drugs.
> Forging physician signatures when such signatures are required for
> reimbursement from Medicare or Medicaid.
> Limits on the False Claims Act
>
> Though the False Claims Act is a powerful tool to combat fraud, it is
> a tool that is sharply constrained by both the law and economics of
> litigation.
>
> Tax issues are not covered by the False Claims Act.
> For a civil case to be filed, the fraud has to reach a certain size,
> otherwise it is generally not worth it for the relator to risk his or
> her career to file suit, nor is it worth it for a law firm to take on
> the case and risk the loss of the enormous time and expense that a
> False Claims Act represents.
> A defendant in a False Claims Act has to have relatively deep pockets.
> Many of the smaller companies that may be defrauding the government
> are liable to declare bankruptcy if faced with the triple damages that
> can be levied under the False Claims Act.
> A law firm that take on a False Claims Act case must believe it has a
> very strong case in order to proceed. Not only can a firm be out time
> and money, but if the government does not take the case and the
> whistleblower proceeds, he or she can be forced to pay the defendants
> attorney's fees if the court finds that the claim was frivolous or
> brought primarily for purposes of harassment.
> State False Claims Acts
> In addition to the Federal False Claims Act, a number of states also
> have False Claims Acts that work to discourage frauds perpetrated
> against state governments. States with False Claims Acts include:
> California, Delaware, the District of Columbia, Florida, Hawaii,
> Illinois, Louisiana, Massachusetts, Nevada, New Mexico, Tennessee,
> Texas, and Virginia.

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NNTP-Posting-Date: Mon, 15 Mar 2004 10:43:37 -0600
From: "Jo Cohen" <joco...(a)comcast.net>
Newsgroups: alt.support.tourette
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Subject: Re: Bipolar here, there, and everywhere!
Date: Mon, 15 Mar 2004 11:39:13 -0500
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"Pablo" <n...(a)yes.com> wrote in message
news:5Bb5c.21869$%06.15400(a)newsread2.news.pas.earthlink.net...
> "Jo Cohen" <joco...(a)comcast.net> wrote in message
> news:6LqdnWIxMoI6VcndRVn-sQ(a)comcast.com...
> >
> > "bluemoon" <bluem...(a)milkyway.com> wrote in message
> > news:5D35c.271756$Po1.11560(a)twister.tampabay.rr.com...
> > >
> > > "NONITPIK" <cyberb...(a)aol.comNONITPIK> wrote in message
> > > news:20040314064041.20365.00001390(a)mb-m04.aol.com...
> > > > >The tail wags the dog.
> > > > >
> > > > >Everytime a drug is discovered to have properties helpful in
> > relieving
> > > > >symptoms of a particular psych dx--- that dx becomes the IN
dx
> > among
> > > > >clinicians.
> > > >
> > > > You know, I was thinking the same thing a few days ago.
There's a
> > drug
> > > that
> > > > does this or that to relieve thus or such, symptoms of a
> > particular
> > > diagnosis,
> > > > so bam! Suddenly there are more diagnoses of that diagnosis
and
> > more
> > > > prescriptions for that drug.
> > > >
> > > > The psychiatrists still get their fees for the "pack em in,
rush
> > 'em out"
> > > > med-check appointments,
> >
> > the therapists pat themselves on the back for
> > > > medicating yet another person and making THEIR lives easier
(the
> > > therapist's,
> > > > that is).
> >
> >
> > Oh bullshit. Give me a break.
> >
> > > What a cycle.
> > > >
> > >
> > > I don't know if I buy this at all. Quite frankly, I've never
had
> > problems
> > > with the doctors, its been the insurance or lack thereof that
> > determines
> > > what care you get. Its cheaper for the insurance industry to
have
> > folks
> > > treated with meds rather than therapy. Every one is trying to
work
> > within a
> > > broken system, no one is winning.
>
> Hello! And see my rant about cakes (yes, cakes) below.
>
> > Exactly. Thanks for pointing that out. managed care is a mess, and
my
> > professional experience shows that
> > all types of clinician's are frustrated as hell with the
system...or
> > "mismanaged care" as it's called.
>
> How dare you presume that it is managed at all! It is nearly in
total
> chaos! ;-)
>
> The sad thing is that quality care providers tend to burn out and
leave the
> profession if they don't care of themselves. A constant challenge.
>
> And it's NOT the clients! My clients are the BEST part of my work.
I work
> with teens, and they are the greatest. Okay, so I only have to see
them for
> a few hours a week (hehe), but I have the honor and privilege of
sharing a
> part of their world that some of them rarely share with others. And
despite
> all the new challenges out there, I have an abiding sense that we
are
> helping to create a strong, consciencious generation, to whom I
shall gladly
> give over the reins. They will have challenges of which I can only
dream.
> (It suddenly feels good to be old!)
>
> It's the bean counters, who insist on paper copies of everything
they can
> think of. Duplicative work.
>
> "Call him to remind him he has a session so we can bill for the
call" when I
> am attempting to have someone learn about choices and
consequences....when I
> am trying to model and instill a sense of personal responsibility
into the
> client. Then I send them back out into the world that helped to
make them
> who they were. It's just nuts. Fortunately, I have a sense of
humor,
> gallows though it can be at times. I concentrate on planting seeds.
>
> Sometimes it feels like I am grinding my head against a huge grist
wheel and
> I am running out of hair. (Fortunately, I will never grow bald.)
DHS says
> it has to be "this way" and the insurance company says it has to be
"that"
> way. So "this" form is not acceptable to DHS, and it's changed to
comply.
> Then the insurance company sees it and insists that it be changed
again.
> The form changes again. This goes back and forth.
>
> I personally don't like it because (a) it takes away from my
clinical focus,
> and (b) I like keeping accurate records, and I hate it when forms
change. I
> convert them to the computer and make my "paper" practice as
efficient as
> possible. (A daunting challenge when the paper forms keep
changing!)
>
> Let's hope they don't invent 4 pitch fonts. I swear I'll become a
sod
> farmer. If not that, then I might take my family, and we'll do a
Dian
> Fossey thing or something.
>
> I see these very complex people, each with her/his own precious
story. And
> the insurance companies think I'm baking a cake. It's ridiculous.
>
> As much as possible, I let the agencies (including our own billing
> department) fight it out, and I do it how I do it. I have told my
agency
> that if anyone from any agency has a problem with the way I handle
my
> paperwork (including tx plans, etc.), I would like to speak to that
person
> personally. So far, no takers.
>
> Think I am being too forward? ;-)
>
> Seriously, I am there to be a clinician, not a case manager or an
> administrator. Given the nature of my work, I need to focus on my
clients
> and their families. I don't need added distractions.
>
> I realize that some form or oversight may be needed to curb abuses,
but
> using jack-booted paper thugs and "more new rules" are not the way.
>
> I apologize if this is the wrong forum to express any of these
views, but
> thanks for letting me rant a bit.
>

Well, Pablo, you stated quite accurately how it often works. I really
relate to what you are saying, and how a clinician has
to "be creative" sometimes in order to ensure the client's needs are
met, despite what the HMO's might want or require.
My favorite battle was the 8 session rule, with clients with long-term
chronic illnesses. I once fought a prior authorization board and went
to the top of the chain, where I calmly told the Director that my
treatment plans, complete with thorough short-, long-term, objective
and MET goals (we do those for a reason, right? :)) that we worked on
in sessions were the ONLY thing keeping this lovely woman from costing
his company over $150,000 a year if she ended up in a nursing home
facility. I literally did the math for him (a bit patronizing, but he
got the point) and from them on the PA's went through magically. You
just gotta do what you gotta do. And sometimes that even means
diagnosing in ways you don't want or need to in order to get the
sessions for the client (or other services, etc). The burn-out rate
is often more due to the administrative nonsense than the intensity of
the work, for most. Especially since the docs are doing 15-minute med
checks, the supportive counselling needs to be there, and be
effective. anyway...we are basically saying the same thing, right?

Jo

From: Borked Pseudo Mailed on 11 Jun 2008 05:56

Linda Gore wrote:
> What is the False Claims Act & Why is it Important?
> Who does the Law apply to?
> > "Pablo" <n...(a)yes.com> ...
> > > "Jo Cohen" <joco...(a)comcast.net> wrote...
> > > bluemoon" <bluem...(a)milkyway.com> wrote...
> > > "NONITPIK" <cyberb...(a)aol.comNONITPIK> wrote...
> My clients are the BEST part of my work...
> (It suddenly feels good to be old!)
> It's the bean counters...
> I am running out of hair. (Fortunately, I will never grow bald.)
> I am there to be a clinician, not a case manager or an
> administrator.

Linda Gore... practicing law without a license (again).

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