TYPICAL CLAIMS UNDER THE VIRGINIA FRAUD AGAINST TAXPAYERS ACT
During 2006-2008, the Commonwealth of Virginia will expend over Seventy Eight Billion Dollars ($78,000,000,000.00), through all of its agencies and offices.
Virtually any situation within which “the Commonwealth” (which includes the Commonwealth, or a County, City, Town or Village) is paying someone money, or collecting money, can give rise to a claim under the Commonwealth’s Fraud Against Taxpayers Act.
Some of the most typical types of claims are as follows:
- General Claims
- Claims Against Providers of Medical Services, Supplies or Equipment
- Sales of Ordinary Goods to any Agency of The Commonwealth
- Claims Against Government Contractors
- Claims Against City, County and other Local Governments
- Claims Against Colleges and Universities
Activities which constitute a violation under the Virginia Fraud Against Taxpayers Act include, but are not limited to:
(a) knowingly presenting, or causing to be presented, to the Commonwealth a false or fraudulent claim for payment;
(b) knowingly using, or causing to be used, a false record or statement to get a claim paid by the Commonwealth;
(c) conspiring with others to get a false or fraudulent claim paid by the Commonwealth;
(d) knowingly using, or causing to be used, a false record or statement to conceal, avoid or decrease an obligation to pay money or transmit money to the Commonwealth.
Claims Against Providers of Medical Services, Supplies or Equipment
A substantial portion of the monies recovered under False Claims Acts, involve cases against Doctors, Hospitals, Clinics and companies or entities which were engaged in the practice of providing medical services, medical supplies and/or medical equipment.
All too often such entities and individuals receive monies from Medicare, Medicaid, or any medical insurance which is funded in whole or in part, by the Commonwealth. This gives rise to a wide variety of qui tam violations, the most typical of which are as follows:
Billing for Brand - Billing for brand name drugs when generic drugs are actually provided.
Bundling - Billing more for a panel of tests when a single test was asked for.
Concealment - Failing to disclose, or taking affirmative acts to conceal billing errors which resulted in overpayment for services or goods provided.
Double Billing - Charging more than once for the same goods or service.
Equipment Billing Fraud - Billing for the use of new equipment, or premium equipment, when either used or inferior equipment is provided.
Inflated Management Fees - Artificially inflating management fees in situations where the government pays management fees in connection with any provision of medical services, or in the conduct of government-sponsored medical research.
Kickback Fraud - Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
“Lick & 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.
Phantom Billing - Billing for tests, goods and services that were never delivered or rendered.
Phantom Labor - Charging for employees that were not actually on the job, or billing for made-up hours to maximize reimbursements.
Retention of Overpayments - Being overpaid by the Government for a service or good, and then not reporting the overpayment to the Government.
Shelling - Setting up a shell company, or manipulating the mode or receiving payments for the purpose of inflating the rate of reimbursement to be received.
Shorting - Charging for full quantities of prescriptions, when actually dispensing partial or short prescriptions.
Signature Fraud - Forging physician’s signatures when such signatures are required for reimbursement from Medicare or Medicaid.
Unapproved Billing - Filing claims for reimbursement of expenses and for services while knowing that such reimbursements and services were not covered by Medicaid or Medicare. Billing for unlicensed or unapproved drugs or devices.
Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
Unwarranted Billings - Billing for services which were not reasonable or necessary, in frequency, duration, or at all. Billing for medically unnecessary tests. 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.
Upcoding Diagnoses - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
Upcoding Employee Work - Billing at doctor rates for work that was actually performed by a nurse or resident intern.
Upcoding Services/Goods - Billing for a more highly reimbursed service or product than the one provided.
Sales of Ordinary Goods to any Agency of The Commonwealth
Virtually any individual or company which sells ordinary goods or merchandise to any branch or office of the Commonwealth, may violate the Act.
Some typical claims which have been filed against commonly known retailers are as follows:
Phantom Charges - Charging the Commonwealth for goods which were not actually provided, in whole, or in part.
Defective Goods - Selling defective goods to the Commonwealth. Selling the Commonwealth used equipment as new equipment. Presenting broken or untested equipment as operational and tested.
False Certifications - Providing false certification that a product meets specifications required by Commonwealth. Providing false certification that products being supplied are being subjected to testing procedures in accord with Commonwealth requirements, when such testing had not been performed.
Retention of Overpayments - Being overpaid by the Commonwealth for a service and then not reporting the overpayment to the Commonwealth.
Claims Against Government Contractors
Government Contractors often engage if fraudulent conduct which can serve as a basis of claims under the Act.
Typical claims against Government Contractors include, but are not limited to, the following:
Phantom Billing - Charging the Commonwealth for labor or services not provided, in whole or in part.
Overcharging - Overcharging the Commonwealth for labor or services provided.
Upcoding - Charging the Commonwealth at labor rates higher than permitted, or billing for a skilled or licensed tradesman, when an unskilled or unlicensed laborer was used.
Mischarging - Mischarging time, by billing the government for time or labor which was actually expended on other matters. Billing for marketing, lobbying or other non-contract related activities.
Procurement Fraud - Providing false certification that minority or female contractors are providing services, or are the true principals of the company or companies providing services, or providing other false information to secure contracts from the Commonwealth.
False Testing - Submitting false service records or samples to show better than actual performance.
Retention of Overpayments - Being overpaid by the Commonwealth for a service and then not reporting the overpayment to the Commonwealth.
Claims Against City, County and other Local Governments
Because they are recipients of large amounts of government money, local governments and officials can be defendants in False Claims actions.
The most typical claims against local governments are as follows:
A. Funding Procurement Fraud
When an official or local government provides false information or data to the Commonwealth in applying for any grant or to obtain any funding, or to secure an increase in any such funding.
When an official or local government fails to disclose material information or data to the Commonwealth in applying for any grant or to obtain any funding, or to secure an increase in any such funding.
B. Misappropriation
When an official or local government uses funds received from the Commonwealth for any purposes other than the specific purpose for which such funds had been given to them by the Commonwealth.
C. Noncompliance with Grant or Funding Guidelines
When an official or local government fails to comply with the restrictions which govern the permitted use, method and manner of expending monies they have received from the Commonwealth.
D. Evasion
When an official or local government provides false information or data to the Commonwealth to reduce or eliminate any required program contribution or the payment of any sums which might otherwise be due and owing to the Commonwealth.
When an official or local government fails to disclose material information or data to the Commonwealth to reduce or eliminate any required program contribution or the payment of any sums which might otherwise be due and owingto the Commonwealth.
E. Retention of Overpayments
When an official or local government receives an overpayment of Commonwealth funds, or realizes a surplus from such funds received, due to an expense being less than previously anticipated, and the official or local government fails to report the overpayment or excess to the Commonwealth.
Claims Against Colleges and Universities
Data Falsification - Falsifying research data that was paid for by the Commonwealth.
Fraudulent Billing - The employ of fraudulent billing practices at University clinics and programs to obtain unearned Medicaid funding.
Grant Noncompliance - When a College or University fails to comply with the restrictions which govern the permitted use, method and manner of expending monies they have received from the Commonwealth.
Misappropriation - When a College or University uses funds received from the Commonwealth for any purposes other than the specific purpose for which such funds had been given to them by the Commonwealth.
Phantom Research - Charging the Commonwealth for research that was never conducted.
To read about actual cases, go to the NEWS section of this web site.
Or, to obtain more information, contact:
Andrew J. Campanelli
Campanelli & Associates, P.C.
129 Front Street
Mineola, NY 11501
(516) 746-1600
