Georgia Healthcare Fraud/Medicare Fraud Enforcement

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In Georgia, major healthcare fraud is civilly and criminally prosecuted by 3 separate United States Attorney’s Offices– the Southern, Northern, and Middle Districts of Georgia.

The federal government sometimes accomplishes this task with the assistance of the GeorgiaMedicaid Fraud Control Unit (MFCU). The MFCU takes the responsibility of stopping fraud very seriously and is often assisted in its efforts by the bravery and actions of whistleblowers.

Modeled after the federal False Claims Act, the Georgia False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Georgia to recover treble damages and civil penalties. Georgia False Medicaid Claims Act, O.C.G.A. § 49-4-168 (2008) et seq.

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Georgia qui tam statute as part of an action under the federal False Claims Act. We do so under the Court’s pendent jurisdiction.

The liability provisions of the Georgia False Claims Act, O.C.G.A. § 49-4-168.1(a) provides liability for any person who:

 

(1)        knowingly presents, or causes to be presented to the Georgia Medicaid program a false or fraudulent claim for payment or approval;

(2)        knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Georgia Medicaid program;

(3)        conspires to defraud the Georgia Medicaid program by getting a false or fraudulent claim allowed or paid.

 

Cases completed in Georgia that were originally brought in a Georgia federal court include:

APS Healthcare Midwest agreed to pay the United States and the State of Georgia a total $13 million to settle a False Claims Act qui tam action that alleged that APS submitted false claims to Medicaid, through the Georgia Department of Community Health, for specialty services related to disease management and case management that were not provided.

 

John D. Archbold Memorial Hospital Inc. agreed to pay the United States $13.9 million to settle allegations that it submitted false claims to Georgia’s Medicaid program. From November 2002 to July 2008, the hospital was alleged to have made false representations to the Georgia Department of Community Health. The hospital received millions of dollars in Medicaid Upper Payment Limit (UPL) program funds and Disproportionate Share Hospital (DSH) funds, to which it was not entitled.

 

St. Joseph’s Hospital of Atlanta and St. Joseph’s Health System agreed to pay $26 million to the U.S. to settle allegations that it violated the False Claims Act by improperly billing Medicare for inpatient admissions and various other services. The allegations arose from a qui tam complaint filed by Tami Ramsey, a nurse and former employee at St. Joseph’s. In her complaint, Ms. Ramsey alleged that from 2000 to 2005, St. Joseph’s had improperly billed ‘outpatient visits’ as ‘inpatient admissions’ which are billed at a higher rate. Additionally, St. Joseph’s allegedly billed Medicare for inpatient admissions related to carotid artery tests which are not covered by Medicare.

 

Allergan Inc., an American pharmaceutical manufacturer, agreed to pay the United States a total of $600 million to resolve allegations of marketing Botox off-label. The company will pay $225 million to resolve civil allegations, as well as a $375 million criminal fine. The company also agreed to plead guilty to a misdemeanor charge. This civil settlement resolves three qui tam suits filed in federal court in the Northern District of Georgia. The relators: Dr. Amy Lang, Charles Rushin, Cher Beilfuss, Kathleen O’Conner-Masse, and Edward Hallivis, will split a $37.8 million share of the government’s recovery.