Medicare Advantage Provider to Pay $6.3 Million to Settle False Claims Act Allegations

DOJ

Kaiser Foundation Health Plan of Washington, formerly known as Group Health Cooperative (GHC), agreed to pay $6,375,000 to resolve allegations that it submitted invalid diagnoses to Medicare for Medicare Advantage beneficiaries and received inflated payments from Medicare as a result, the Justice Department announced today.

The settlement resolves allegations originally brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act by Teresa Ross, a former employee of Group Health.  The act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.  Ms. Ross will receive approximately $1,500,000. read more »

NJ Intervenes in a whistleblower lawsuit against Academy Bus, LLC 

NJ AG

Attorney General Gurbir S. Grewal announced today that the State has intervened in a whistleblower lawsuit against Academy Bus, LLC (Academy), which advertises itself as the nation’s largest private transportation company, as well as related entities and individuals. The Attorney General’s complaint alleges the defendants defrauded New Jersey Transit (NJT) out of more than $15 million by vastly underreporting the number of scheduled bus trips that the company missed and charging fees for hours and miles driven for bus trips that never happened.

The New Jersey False Claims Act allows private parties, or relators to file lawsuits on behalf of New Jersey for violations of the False Claims Act, and to share in any recovery. The False Claims Act provides that the Attorney General may intervene in such an action. read more »

OECD Working Group on Bribery Issues Report Commending United States for Maintaining Leading Role in the Fight Against Transnational Corruption

DOJ

The Working Group on Bribery of the Organisation for Economic Co-operation and Development (OECD Working Group) issued its Phase 4 Report of the United States today, announced the U.S. Departments of Justice, Commerce, State, and the Securities and Exchange Commission (SEC). The Phase 4 Report is part of the OECD Working Group’s peer monitoring process and focuses primarily on the United States’ enforcement of its foreign bribery statute, the Foreign Corrupt Practices Act (FCPA), and was issued following a year-long review that included a series of interviews with government, private sector, academic, and civil society experts.  In releasing the report, the 44-country OECD Working Group applauded the United States for its sustained and outstanding commitment to enforcing its foreign bribery laws. read more »