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Description: San Francisco, California civil litigation lawyers represented Defendant charged with violating the False Claims Act, 31 U.S.C. 3729, which provides:
(a) Liability for Certain Acts.—
(1) In general.—Subject to paragraph (2), any person who—
(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;
(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);
(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;
(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;
(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or
(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,
is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Public Law 104–410 1), plus 3 times the amount of damages which the Government sustains because of the act of that person.
(2) Reduced damages.—If the court finds that—
(A) the person committing the violation of this subsection furnished officials of the United States responsible for investigating false claims violations with all information known to such person about the violation within 30 days after the date on which the defendant first obtained the information;
(B) such person fully cooperated with any Government investigation of such violation; and
(C) at the time such person furnished the United States with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under this title with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,
the court may assess not less than 2 times the amount of damages which the Government sustains because of the act of that person.
(3) Costs of civil actions.—A person violating this subsection shall also be liable to the United States Government for the costs of a civil action brought to recover any such penalty or damages.
(b) Definitions.—For purposes of this section—
(1) the terms “knowing” and “knowingly”—
(A) mean that a person, with respect to information—
(i) has actual knowledge of the information;
(ii) acts in deliberate ignorance of the truth or falsity of the information; or
(iii) acts in reckless disregard of the truth or falsity of the information; and
(B) require no proof of specific intent to defraud;
(2) the term “claim”—
(A) means any request or demand, whether under a contract or otherwise, for money or property and whether or not the United States has title to the money or property, that—
(i) is presented to an officer, employee, or agent of the United States; or
(ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government's behalf or to advance a Government program or interest, and if the United States Government—
(I) provides or has provided any portion of the money or property requested or demanded; or
(II) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and
(B) does not include requests or demands for money or property that the Government has paid to an individual as compensation for Federal employment or as an income subsidy with no restrictions on that individual's use of the money or property;
(3) the term “obligation” means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment; and
(4) the term “material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
(c) Exemption From Disclosure.—Any information furnished pursuant to subsection (a)(2) shall be exempt from disclosure under section 552 of title 5.
(d) Exclusion.—This section does not apply to claims, records, or statements made under the Internal Revenue Code of 1986.
Sutter Health, a Sacramento-based health care services provider, and its affiliate Sutter Bay Hospitals, the successor to Sutter East Bay Hospitals dba Alta Bates Summit Medical Center (collectively Sutter Health), agreed to pay more than $13 million to settle allegations that it violated the False Claims Act by billing the United States for toxicology screening tests performed by outside labs, announced United States Attorney Stephanie M. Hinds; Federal Bureau of Investigation San Francisco Special Agent in Charge Robert K. Tripp; Office of Personnel Management Office of Inspector General (OPM OIG) Special Agent in Charge Amy K. Parker; Department of Health and Human Services Office of Inspector General (HHS-OIG) Special Agent in Charge Steven J. Ryan; Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS) Western Field Office Special Agent in Charge Bryan D. Denny; and the Defense Health Agency (DHA).
“Sutter Health agreed to pay $13 million to settle allegations that it billed government health programs for lab tests performed by others,” said U.S. Attorney Stephanie M. Hinds. “Government health care programs must be protected, and this office will investigate and pursue health care providers that fail to provide the services paid for by public health care programs.”
“Investigating health care fraud and abuse is a priority for the FBI,” said FBI San Francisco Special Agent in Charge Robert K. Tripp. “These cases are often worked in conjunction with our federal law enforcement partners, and this settlement is a great example of the multi-agency investigative team’s hard work to protect the integrity of the Federal Employees Health Benefits Program.”
“The OPM OIG is committed to protecting the Federal Employees Health Benefits Program from fraudulent claims,” said OPM OIG Special Agent in Charge Amy K. Parker. “I applaud the dedicated team for their effort in securing today’s settlement.”
“When medical providers charge federal health care programs for services that other providers actually performed, the integrity of these programs is undermined,” said HHS-OIG Special Agent in Charge Steven J. Ryan. “Working with our law enforcement partners, we will continue to uproot and investigate such schemes.”
“Today’s announced outcome concludes a collaborative effort to hold Sutter Health accountable for its improper billing practices that harmed our health care system, including the Department of Defense’s TRICARE program,” said DCIS Western Field Office Special Agent in Charge Bryan D. Denny. “DCIS will continue to work closely with our law enforcement partners to protect the integrity of the health care system.”
“We commend the Department of Justice, the U.S. Attorney’s office, and the other state and federal agencies for their commitment to justice,” stated the Defense Health Agency. “Their efforts protect taxpayer dollars to ensure our service members, veterans and their families continue to receive the highest level of medical care.”
The United States contends in the civil settlement agreement signed by Sutter Health that under the terms of a contract which the Sutter Health hospital Alta Bates Summit Medical Center entered into with Navigant Network Alliance, LLC, Navigant referred urine toxicology specimens obtained from physicians and laboratories across the country to Sutter. Sutter submitted bills, or caused bills to be submitted, for reimbursement of the qualitative and quantitative testing it performed on the specimens. The United States asserts that Sutter did not perform the quantitative testing on thousands of specimens referred under the agreement and that these quantitative tests were instead performed by third-party labs. The United States alleges that Sutter nevertheless sought reimbursement for the tests. In the settlement agreement, the United States contends that between August 1, 2016, and June 30, 2017, Sutter billed for urine toxicology tests it did not perform and was paid for the testing by the Federal Employees Health Benefits Program, Medicare, Medicaid, and Tricare.
Sutter agrees in the settlement agreement to pay $13,091,452 to settle the false claims allegations. Of that amount, Sutter has already paid more than $6.5 million to the United States. Sutter agrees to pay the remaining amount of approximately $6.5 million to the United States within 30 days. The settlement agreement resolves the civil law claims that the United States might have brought based upon these allegations.
This matter is being handled by Assistant United States Attorney David DeVito, with assistance from Garland He, Jonathan Birch, Lillian Do, and Alan Lopez. The matter is the result of a coordinated investigation between the U.S. Attorney’s Office for the Northern District of California and the FBI, OPM OIG, HHS-OIG, DCIS, and the DHA.
The investigation and resolution of this matter illustrate the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The civil settlement agreement is neither an admission of liability by Sutter Health nor a concession by the United States that its claims are not well founded.
Outcome: Defendant agree to pay $13 million.
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