Michigan Healthcare Fraud/Medicare Fraud Enforcement

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In Michigan, major healthcare fraud is civilly and criminally prosecuted by the Western and Eastern District United States Attorney’s Offices and the State’s own Medicaid Fraud Control Unit.

The federal government often accomplishes this task with the assistance of the Michigan Medicaid 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 Michigan Medicaid False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Michigan to recover treble damages and civil penalties. MI ST Ch. 400.603 et seq.

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Michigan 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 Michigan Medicaid False Claims Act, MI ST Ch. 400.603, provide as follows:

Sec. 3. (1) A person shall not knowingly make or cause to be made a false statement or false representation of a material fact in an application for Medicaid benefits;

(2)A person shall not knowingly make or cause to be made a false statement or false representation of a material fact for use in determining rights to a Medicaid benefit…

 

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

Detroit Medical Center agreed to pay the United States $30 million to settle allegations that it violated the False Claims Act, the Anti-Kickback statute and the Stark statute, by engaging in improper financial relationships with referring physicians. The medical center self-reported its violations to the government after discovering them while preparing for its sale to Vanguard Health Systems Inc.

 

GE Healthcare Inc. agreed to pay the United States $30 million to settle allegations that a company GE Healthcare acquired in 2004, Amersham Health Inc., violated the False Claims Act. Amersham Health Inc. was accused of providing false or misleading information to Medicare regarding Myoview, a radiopharmaceutical used in certain cardiac diagnostic imaging procedures, thereby causing Medicare to reimburse for the drug at inflated rates. In addition, the company was alleged to have improperly diluted Myoview in order to maximize the number of doses available per vial, which led to an increased number of patient-ready doses, thereby inflating Medicare reimbursements. This settlement resolves a False Claims Act qui tam suit filed by James Wagel, a pharmaceutical representative for Bristol-Myers Squibb. Wagel, will receive a $5.1 million share of the federal government’s recovery.