Hardly a Victim-less Crime: The Victims of Health Care Fraud

September 1, 2014 by Gregory J. Brod

Why health care fraud? We’re asked this a lot. Much of our practice involves representing the wrongfully injured causing some to peg us as a victims’ law firm. That is a label that we are proud to say fits much of our practice. The truth is there are MANY victims of health care fraud. All taxpayers are victims of the economic fraud, with the neediest suffering the most as scammers target government health programs. There are also more immediate victims, people are endangered by health care fraud from those who lose out on necessary medical care because their plans have been wrongfully depleted to those who receive inappropriate/unneeded care. Today’s post looks at some of these victims of health care fraud, people who are helped when a whistleblower comes forward and partners with our Northern California health care fraud law firm to help the victims.

Homeless Recruited in Health Care Scam
The perpetrators often take advantage of the neediest members of our society in order to carry out their schemes, preying on the disadvantaged and profiting from endangering the people that public health programs are intended to help. An example, discussed in a 2008 New York Times article, came to light due to a tip from a rescue mission worker. In 2004, Scott Johnson healthcash.jpgcalled state authorities to report suspicious cars and vans packed full (including the trunks!) wit homeless people. He suspected they might be ambulances wrongfully discarding poorer patients.

The reality? The vehicles arrived in Skid Row each morning and solicited homeless people, offering food, cigarettes, and occasionally money (around $30), focusing on individuals who had their Medi-Cal eligibility cards. After loading up, the vans went to one of three hospitals where the “patients” would sometimes receive no medical care, unnecessary care, or even dangerous “care.” One woman reports that she was given a unneeded nitroglycerin patch for a cardiopulmonary condition she didn’t have which caused her blood pressure to drop and made her ill.

By October 2006, Los Angeles police determined the homeless people were being used as “human pawns” in a fraudulent scheme to steal money from federal and state health care programs when the scammers billed Medicaid and Medical for this “medical care.” The 2008 article marked a raid on three for-profit hospitals in connection with this long-running scheme. Charges included conspiracy to commit health care fraud and to take/receive kickbacks for referrals (an issue discussed at length in a prior entry linked below). A 2013 Los Angeles Times article announces the sentencing of one of the recruiters who would be joining health care executives already serving time for the criminal scheme.

“Living ATM Cards”
Health care scams built on the backs of the homeless remain all too common. Recently, a group called Fierce Health Payer which purports to provide information on fraud and waste in the health insurance arena wrote about the problem noting the homeless are both vulnerable and unlikely to report fraud. The article notes: “Many of the homeless who participate in fraud are drug addicts or mentally ill, and criminals have treated them like living ATM cards. Because in some fraud scams, body counts drive dollars.” Referencing frauds that range up to the present day, the author emphasizes a key point – health care fraud is far from a victimless crime.

Helping the Victims, Protecting Future Victims: Whistleblowers’ and Whistleblowers’ Legal Counsel
The Skid Row recruiting scam came to light -- and the perpetrators were stopped – because one person spoke up when something didn’t look quite right. Both outside observers and company insiders, not to mention people swept into the schemes such as the homeless “patients” above, can “blow the whistle” on health care fraud. In doing so, they help the government recoup money and prevent future harm to direct and indirect victims.

Whistleblowers in successful health care fraud lawsuits are often eligible for substantial financial rewards. This money is offered in recognition of their bravery in coming forward and the role they play in the resulting investigation and litigation. It is a bonus, but every whistleblower we speak to reports that their motivations in coming forward were bringing about justice and injury. Likewise, while may be less apparent than in our personal injury work, in the end our work as a San Francisco health care fraud law firm is part of our proud service as a victims’ law firm (note: we also protect whistleblowers, preventing them from becoming the victim of retaliation).

See Related Blog Posts:
Tainted Decisions: Kickbacks Leave Providers Focused on Money, Not Patient Care

Putting Money Over Medicine: Health Care Fraud, Kickbacks and Patient Recruiters

(Image by Flicker user 401(K) 2013)

Concussions and Other Head Injuries in Youth Soccer

August 29, 2014 by Gregory J. Brod

soccer.jpgEarlier this summer, sports lovers in America joined those across the globe in watching (and cheering for) a game loved the world over – soccer. While long-popular in other countries, Americans have been slow to embrace soccer, but the game is slowly infecting adults and children alike. As people begin to play the sport, not just watch from the sidelines, soccer injuries and particularly soccer concussions become a growing concern. Our San Francisco sports injury attorney understands the unique contours of sports injury cases. When the injury can be traced to a negligent or even reckless decision by a governing body, sponsor, coaching group, or other entity, we can help the injured recover money damages and prevent future tragic accidents on the field.

Parents File Suit Seeking Changes in Youth Soccer
A group of parents has filed a lawsuit in San Francisco asking FIFA, the United States Soccer Federation, and other major soccer organizations to make changes to keep children safe. CBS Sports explains that the class action suit is looking for changes in policy and practice rather than money damages. The suit asks the soccer groups to improve the way they diagnose head injuries and to change the guidelines as to when a player may return to play following a concussion. Additionally, the plaintiffs are asking FIFA to change its rules on substitutions, allowing more than the usual three per game limit when a substitution is needed to allow for a medical evaluation.

As CBS notes, the danger of concussions in soccer was brought to international attention with this summer’s World Cup. Discussions of how to handle head injuries were fueled by the case of Germany’s Cristoph Kramer. Kramer continued to play in the final against Argentina despite a blow to the head. After being helped off the field, he admitted that he could not remember any of the first half.

While head injuries affect players of all ages, the pending suit focuses on players under age 17 and the potential impact that concussions may have down the road. Counsel for the plaintiffs emphasizes that needed safety policies have not been enacted despite the fact that the medical community has called for changes for more than a decade. Another spokesperson said that the failure of the organizations to act to protect young soccer players is unacceptable given the “epidemic of concussive injuries” and the advances in medical knowledge and practice.

Soccer Injury Statistics
An article in the journal Pediatrics, published in January 2010, focused on the threat of injuries to youth soccer participants. Across all ages, the authors estimate that 15.5 people participate in soccer in the U.S. and further note that it is one of the fastest growing sports, including among high school athletes. They also note, however, that soccer has a higher injury rate than many other contact sports. In terms of all injuries, 80% impact participants under age 24 and 44% impact those under 15. The concussion rate for soccer is comparable to that for ice hockey and American football. While concussions and other head injuries are listed as accounting for only 3% of all injuries, the authors suggest this may be an issue of underreporting. Most concussions resulted from collisions and not from intentional “heading” of the soccer ball.

Representing Injured Youth Soccer Players and Other Young Athletes
If your child suffered a head injury (or if you did) as a result of playing soccer and you suspect the organization, its rules, or its policies contributed to the accident, call our Northern California sports injury lawyer. Head injuries can mean lifelong expenses, not to mention the pain and suffering they can cause, and our team can help you and your child recover the monetary compensation you deserve. This is also a great example of a field in which a personal injury claim can also lead to positive changes that may prevent future injuries.

P.S. See the CDC’s Heads Up: Concussion in Youth Sports fact sheet for details on how to prevent, identify, and respond to concussions in young athletes.

See Related Blog Posts:
Concussions & Youth Sports

Youth Sports-Related Injuries by the Numbers: a Hefty, Growing Toll

(Image by Jarrett Campbell)

Allegations Against Doctor, if Confirmed, Suggest Brazen Medicare Fraud

August 28, 2014 by Gregory J. Brod

caduceus-1219485-m.jpg
As we have detailed on these pages, the scope and brazenness of Medicare fraud is truly breathtaking. The federal government is having trouble keeping up with all the schemes, and some of them are quite blatant indeed. But San Francisco qui tam lawsuit attorney Gregory J. Brod would cite the allegations against one doctor that surfaced in the news this week as a case, if proven, that would take brazenness in Medicare fraud to a new low.

According to the Detroit Free Press, a search warrant affidavit that was unsealed in federal court detailed allegations against Dr. Farid Fata in which his health maintenance organization practice billed Medicare $225 million, of which $109 million was for chemotherapy or other cancer treatments and $91 million was paid by Medicare to Fata’s medical practice. Trouble is, many of the treatments were administered to patients who did not have cancer, the government’s attorneys charge.

If the allegations are proven to be true, not only would fraud have been committed against Medicare, fleecing the U.S. Treasury and the taxpayers as well as contributing to upward pressure on Medicare premiums, but perhaps even more troubling, the health of innocent people could have been placed in jeopardy through the use of treatment that was not appropriate.

money-series-5-909235-m%20%28200x133%29.jpg
As if the aforementioned allegations are not bad enough, Dr. Fata has also been accused of showing interest in spending some of the ill-gotten gains on a $3 million castle overlooking a seaside resort area in Lebanon. In the search warrant, which was executed in November 2013, the FBI sought the contents of Fata’s email account in order to track the movement of tens of millions of dollars that moved among various Fata-linked entities. Included among the emails is one in which Fata asks his financial adviser to contact Fata’s father and go along with the father to inspect and assess the value of investing in the multimillion-dollar seaside castle. The email was given an “urgent” subject line, and in it Fata asks if the castle can be “funded from the Fata Foundation,” which one of his numerous trusts.

Fata has sought to prevent the email from being submitted as evidence to jurors at a trial that starts October 14 in federal court.

If convicted, Fata faces 10 years in prison. In the meantime, he has been held at a federal prison for the last year after his $9 million bond was revoked.

Continue reading "Allegations Against Doctor, if Confirmed, Suggest Brazen Medicare Fraud" »

Earthquakes, Insurance, and Liability

August 27, 2014 by Gregory J. Brod

Over the weekend, our area was hit by a 6.o earthquake. As Californians, we all know that earthquakes can happen, but it is always a bit surprising when it does and Sunday’s quake was the largest since 1989. In this post, our Northern California earthquake injury law firm looks at two issues relating to earthquakes and the damage they leave behind. First, we look at why earthquake insurance is of limited assistance following tremblers. Second, we turn to the issue of earthquakes and civil liability. Specifically, the second section examines the liability of a property owner for injuries sustained during a quake because the property was not earthquake-safe.

The Limits of Earthquake Insurance
An article in the San Francisco Chronicle explains that only a small portion of those whose homes were damaged in the Napa quake will be covered by earthquake insurance policies. Glenn Pomeroy, the California Earthquake Authority’s chief executive, noted that a mere 5% of homeowners in the quake zone compared to about 10% statewide.

earthquakesign.jpgOne reason for the low figure is that mortgage companies don’t usually require earthquake insurance (as opposed to requiring homeowner’s policies). Another key issue is that earthquake insurance typically has a percentage deductible based on the amount of coverage purchased. If a homeowner has a $500,000 policy and a 10% deductible, the insured would need to cover $50,000 before insurance would kick in. One insurance company employee commented that she has yet to come across a homeowner whose damages met this threshold for the recent quake.

Earthquakes, Building Failures, Civil Injury Liability and Wrongful Death Claims
This May, the Los Angeles Times discussed another crucial issue for our clients -- landlord liability and tenant’s rights. The article focused on caselaw developed following 2003’s 6.5 Central Coast earthquake. Two women, California’s most recent earthquake deaths, were working at a clothing store when falling bricks and plaster fell on them as they tried escape, crushing them to death. Their family owners sued the property owners who, in turn, said the quake was an “act of God” and that they were in compliance with the law. At the time, the deadline for seismically retrofitting brick buildings in the city was several years away.

Ultimately, the jury found the owners negligent for failing to make the building safer and awarded $2 million to the women’s families. An appeals court upheld the ruling in 2010. The court held that merely complying with city law would not insulate an owner from liability where they negligently failed to retrofit the building. One commentator drew a parallel to lightning damages noting that a bolt may be an “act of God” but an owner would still be negligent for failing to provide fire extinguishers or sprinklers. While earthquake injury/fatality cases had settled in the past, this case created caselaw that can be used to help support future claims.

A San Francisco Attorney for Earthquake Injuries
First and foremost, we hope all of our readers and their families are safe and uninjured. If you do suffer an injury in an earthquake, do not assume you are without recourse. Where a property owners’ negligence creates an unduly dangerous situation, an injured person or the family of the deceased may have a claim. Also, if you do have earthquake insurance, do not sign anything without having your own attorney look over the document.

Our San Francisco, Oakland, and Santa Rosa civil injury law offices exist to serve clients throughout Northern California. Call to arrange a free initial consultation to discuss your rights and how we can help you.

See Related Blog Posts:
Lightning Strikes and California Injury Law

Most Californians Don’t Have Earthquake Insurance

(Image by David Weekly)

Theater’s Alleged Bedbug Problem Reminder That Parasites Can Strike Anywhere

August 26, 2014 by Gregory J. Brod

bedbug_3.jpg
Theatergoers typically flock to their favorite venues on weekends, and last weekend would be no exception with summer blockbusters available for viewing. However, last weekend was also the first one on which a theater in Lodi that had allegedly been infested with bedbugs was open for business again. And San Francisco personal injury attorney Gregory J. Brod would cite the high-profile incident at the multiplex facility as an example of how bedbugs can potentially make their nasty presence known in all types of structures.

According to CBS News, the theater in question, the Lodi Stadium 12 Cinemas, re-opened Thursday for matinee showings on 10 of its screens after being treated for an alleged bedbug infestation that led the management to close the theater on Sunday, August 17. Lodi police code enforcement said that the theater owners took care of the infestation by employing three methods of extermination: using high heat in the theater, steaming the seats, and applying chemicals to the furniture.

The Lodi police code enforcement also said that Clark Pest Control was monitoring the theaters, and code enforcement would inspect the theater next week and follow up with monthly inspections of the facility. The repeated inspections and monitoring of the theater point to an issue that is often present whenever there is a bedbug infestation – the parasites are very hard to fully eradicate.

movie-house-771223-m.jpg
Indeed, according to the Centers for Disease Control and Prevention and the U.S. Environmental Protection Agency, bedbugs (Cimex lectularius) are remarkably hardy insects that feed on human blood, typically during the evening hours when humans sleep or, say, go to the movies. Aside from their nocturnal habits and small size, bedbugs are difficult to notice, much less eradicate, because they can enter a dormant condition and can even live for 18 months without a source of food. Bedbugs do not spread disease but they do inflict nasty bites upon their victims, who may suffer, as a result, from the bite marks as well as allergic reactions, other skin problems, painful swelling, itching, insomnia and anxiety. And it is difficult to tell if one has been bitten by bedbugs because the critters inject an anesthetic and an anticoagulant into their victims, who, as a result, are prevented from realizing that they have been bitten.

Bedbugs are also adept at finding new victims, as their slim, flat bodies permit them to fit easily into the smallest of spaces, including the luggage they love to crawl into, a habit that affords them an easy and far-flying means of transportation as people travel. Therefore, travelers are often unwitting carriers of bedbugs who stow away in their luggage, permitting bedbugs to take their infestation on the road, so to speak. And the fact that bedbugs can go for long periods of time without a meal make them very efficient parasitic insects, indeed.

Continue reading "Theater’s Alleged Bedbug Problem Reminder That Parasites Can Strike Anywhere" »

Medicare Advantage and Risk-Adjustment Fraud

August 25, 2014 by Gregory J. Brod

Health care is an ever-evolving field with constant changes both in the area of medical knowledge and in terms of health care as a business. Medicare began back in the 1960s and the concept of Medicare Advantage (“MA”) programs dates back to the mid-1990s and allows Medicare beneficiaries to choose a private company to provide their Medicare services. Both have seen changes, with Medicare Advantage undergoing significant changes in 2003 and significant growth in the past decade. Sadly, along with the growth has come the problem of Medicare Advantage fraud. Efforts to combat this fraud are also evolving and our Northern California Medicare fraud law firm is keeping a close eye on the important legal developments in this area.

Health & Human Services OIG Lists Medicare Advantage Fraud Among Top Challenges
Each year, the Office of the Attorney General (“OIG”) for the Department of Health and Human Services (“HHS”) creates a list of the top management challenges that HHS is facing, a list that can point to some of the department’s key vulnerabilities. Item Six in the list of the Top Management & Performance Challenges for 2013 (released in December 2013, this appears to be the most recent list) is “Preventing Improper Payments and Fraud in Medicare medicine$.jpgAdvantage.” According to the OIG, taxpayers lose billions of dollars because of improper payments to MA plans. In FY 2013, HHS identified a 9.5% error rate for MA plans which corresponds to an estimated $118 billion in improper payments including $9.3 billion in overpayments and $2.6 billion worth of underpayments. This includes both accidental errors and fraudulent transactions.

Often, MA fraud relates to the risk-adjustment system. Each year, MA plans submit information about their beneficiaries to Medicare. The government program will pay the MA plans a monthly amount per beneficiary that is based on these health characteristics. Medicare pays MA plans more for sicker patients, such as those with a diabetes or cancer diagnosis, given the expected higher costs associated with providing health care to such individuals. As the OIG explains: “To calculate risk-adjustment payments, MA organizations submit beneficiaries' clinical diagnoses to [Medicare]. If a diagnosis submitted is not supported by the beneficiary's medical record, the risk-adjustment will be inaccurate and result in payment errors.” It is not the only form of MA fraud (another involves payments from the MA plans to providers), but inaccurate risk-adjustment information is one of the main points at which MA fraud occurs.

Humana Litigation
Currently, a qui tam lawsuit is pending against Humana, Inc. relating to MA payments. Dr. Olivia Graves filed the suit after allegedly noticing an unusually high number patients receiving unsupported diagnoses from a Humana clinic, diagnoses the suit alleges were made to boost reimbursement rates. In July, as detailed in a Law360 article, Humana filed a Motion to Dismiss based on the contention that the complaint does not allege the diagnoses resulting in an actual claim for payment. This is an issue because the False Claims Act requires a link between the fraud and the submission or payment of a wrongful claim.

Staying Informed, Serving the Public, Supporting Whistleblowers
We are following the Humana litigation and other cases in this fast-developing arena. We believe that even if the Humana case is dismissed, cases based on similar frauds can be successful if properly framed. If you are aware of fraud involving an MA plan, including cases involving improper acts by plans themselves or by providers caring for MA patients, call our office to arrange a consultation with Gregory Brod. Attorney Brod is a California lawyer for Medicare Advantage fraud and is proud to partner with private whistleblowers throughout the state. Our firm is committed to protecting whistleblowers from retaliation and helping them recover the financial reward provided under the False Claims Act if the whistleblower’s knowledge helps the government recover wrongfully diverted funds.

See Related Blog Posts:
Focus on Potential Medicare Fraud Shifts to Lab Billing
Medicare Fraud Hits Nursing Homes and Other Senior Care Centers

(Image by Mike Licht)

Back to School Safety II - San Francisco Child Injury Attorney on School Zone Safety

August 22, 2014 by Gregory J. Brod

Earlier this week, we focused on school bus safety. However, the safety of students is too important to confine to one blog entry. We all know that drivers should pay extra attention and slow down when passing through school zones. Still, far too often, drivers choose shaving a few moments off their travel time over protecting our school children and teens. When school zone injuries or fatalities stem from a driver’s failure to value school zone safety, our San Francisco school injury attorney is ready to help.

SFPD Increases Safety Patrols As Students Return to School
This week, SF Weekly reported that the SFPD is stepping up efforts to target drivers who might endanger students as they return to school. Police are watching for speeders, drivers who fail to yield to pedestrians, and those who simply aren’t focused on the path before them. Notably, while 42% of San Francisco elementary students live within walking distance of their school, only a quarter actually walk because of safety worries.

School zone safety has been an on-going effort. Two years ago, San Francisco became the first California city to set 15mph speed limits for school zones citywide. More recently, the SFPD became one of the first city agencies to create a plan aimed at eliminating pedestrian deaths in the next ten years through the Vision Zero program. In the first half of 2014, SFPD wrote 61% more traffic citations than in the same timeframe last year before when the plan was in effect.

School Zones & Speeding schoolzone.jpg
In October 2010, The Early Show investigated school zone safety, prompted by two school zone crashes that each claimed a child’s life. These accidents were, as they quickly found, not isolated events. The Transportation Research Board reported 100 children die and 25,000 are injured each year when walking to and from school.

When Early Show reporters observed a Long Island, NY school zone, they found nearly every driver was speeding despite a clearly marked 20mph speed limit. Many of the observed drivers were travelling two or even three times the posted max, endangering student pedestrians and many others. The higher the speed, the longer it takes to stop. In a test, reporters found hitting the brakes at 20mph created a 23 foot stopping distance, 30mph led to a 41 foot braking distance, and 40mph travel left a 68 foot gap between stepping on the brake and coming to a stop. Adding to the danger, a crash at 30mph is eight times more likely to kill a pedestrian than one at 20mph.

School Zones & Distracted Drivers
In 2009, Safe Kids reported on another threat to school zone safety – distracted drivers in school zones. After observing more than 41,000 drivers in school zone areas, the study found that one in six drivers passing through active school zones was distracted. While cell phones were the top source of distraction, there were others including eating/drinking, reaching/looking behind, grooming, or even reading. Notably, drivers who weren’t wearing their seatbelts were 35% more likely to be distracted than their buckled in peers. Flashing lights appeared to reduce the rate of school-zone distraction and drivers in states with handheld electronics bans that include all ages were 13% less likely to drive distracted in school zones than those in states with no restrictions. Importantly, the study could only evaluate observable distractions (like talking on the phone) and not those invisible to the eye (like talking to a passenger).

Representing School Zone Accident Victims
Our children are our most important asset and educating them is one of the most important investments we can make in the future. Drivers should always be alert for children, especially in areas where they congregate. While we should teach our kids about street safety, children are less able to appreciate risk and anyone who has ever seen children at recess or at school dismissal knows they frequently dart into the road. Drivers must exercise the highest level of care when passing through school zones.

If a negligent or reckless driver caused a school zone accident that injured your child or ended a young life in Northern California, call our child injury law firm in San Francisco or at any of our area offices. We can help you recover damages on your child’s behalf, money that is especially critical when an injury will impact a child for a lifetime.

See Related Blog Posts:
Back to School Safety: School Bus Accidents & School Transportation Safety
School Zone Car Accident in Antioch Raises Major Safety Concerns

(Image by Al Muya)

Back to School Safety: School Bus Accidents & School Transportation Safety

August 20, 2014 by Gregory J. Brod

With commercials for laptop computers and old-fashioned spiral notebooks, not to mention new sneakers and stylish jeans, there’s no question that the time children dread and parents celebrate has arrived – Back to School. As classrooms throughout Northern California open, school buses ready to transport students to and from school. Although they rank as one of the safest means of transportation, a recent headline proves that school bus accidents are a reality. When drivers fail to give these vehicles the special care they deserve or when a school bus driver violates our trust and puts kids at risk, our Northern California school bus injury lawyer is ready to protect the young victims.

Suspected Drunk Driver Arrested After Hitting School Bus
Classes had resumed for just one week when a school bus travelling to Union Mine High School was hit by a suspected drunk driver. KCRA reports that 32 schoolbus.jpgstudents were on board when the crash occurred on Thursday August 14 at 6:30 A.M. on Grizzly Flat Road in Somerset, El Dorado County. An SUV driven by 24 year old Steven Gruber hit a school bus on the two-lane road. Police arrested Gruber on suspicion of driving under the influence. Five students and the bus driver suffered minor injuries and two students were taken to the hospital as a precaution. Another vehicle was also involved in the incident, although it is not known whether its occupants were injured.

Statistics on School-Transportation Accidents
A June 2014 Traffic Safety Facts page from the National Highway Safety Transportation Association (“NHTSA”) focuses specifically on School Transportation Related Crashes. In the studied 2003 to 2012 period, there were 348,253 fatal vehicle accidents, with 1,222 deemed school-transportation related. On average for the time span, 135 people died in a school-transportation crash each year. Most of the deaths involved adults in other vehicles. Overall, from 2003 to 2012, a total of 119 school-age pedestrians and an added 55 school-aged vehicle occupants were killed in school-transportation accidents.

A study by the Center for Injury Research and Policy (“CIRP”) at Columbus Children’s Hospital purports to provides a more comprehensive picture of school bus safety. Instead of focusing on fatal incidents as the NHTSA does, the CIRP study looks at a wider range of injury-causing school bus crashes and suggests school bus injuries are three times more common than previously thought. The study finds that emergency departments treat approximately 17,000 school bus related injuries every year. The report also conclude: “[T]raffic-related crashes are the leading mechanism of nonfatal school bus-related injury for children in the U.S.”

Protecting and Representing Our Students
School buses are safer than many other forms of travel but, despite laws and regulations aimed at protecting the buses and their passengers, school bus accidents remain a reality. Thankfully, the recent Union Mine incident caused only a few minor injuries, mostly leaving behind a lot of rattled nerves. School bus accidents, including accidents involving passengers getting on and off the bus, can be much more tragic.

When a school-transportation crash occurs, an investigation is critical. Possible causes include: A reckless driver; A defective vehicle or part; A dangerous bus policy, or; A careless bus driver. Determining the cause is part of what we do. As a law firm for school bus injuries in Sonoma, Oakland, San Francisco, and throughout Northern California, we also help victims obtain money damages. Call to arrange a no-cost consultation.

See Related Blog Posts:
National School Bus Safety Week

School Zone Car Accident in Antioch Raises Major Safety Concerns

(Image by John Seibert)

Where Health Care Fraud and Government Contracting Fraud Intersects

August 18, 2014 by Gregory J. Brod

Readers of this blog know that our firm is actively working to help combat fraud against our government, including health care fraud and government contracting fraud. Sometimes, these two fields overlap. In this post, we look at a case of pharmaceutical fraud that is akin to cases of government contracting fraud and procurement fraud, with some of the fundamental concerns of health care fraud. As with cases of Medicare fraud and military contracting fraud, our San Francisco government fraud whistleblowers’ law firm works with people who see transgressions in the health care contracting area and opt to fight this dangerous misdeed.

Government Settles Vaccine Distribution Case Involving San Francisco Corporation
vaccine.jpgThis month, McKesson Corporation, a San Francisco-headquartered company that distributes pharmaceuticals, agreed to pay $18 million allegations brought by the Centers for Disease Control and Prevention (“CDC”) against the company. Per a Department of Justice press release, vaccine distribution agreements provided that McKesson would distribute government-purchased vaccines to practitioners. According to the government, the contracts required McKesson keep the vaccines at an appropriate temperature during shipping. The government claims McKesson failed to set temperature monitors to the appropriate range between April 2007 and November 2007. The recently settled suit alleged that McKesson knowingly submitted false claims for payment while failing to meet its contractual obligations.

These allegations were initially raised in a qui tam lawsuit filed by Terrence Fox, a former finance director with a division of the McKesson Corporation. As the DOJ explains, qui tam provisions allow a private whistleblower to bring suit on behalf of the government for False Claims Act violations. Pursuant to these provisions, the whistleblower is entitled to a share of funds recovered by the government as a result of such a lawsuit. Fox’s share has not yet been determined.

The Cost of Fraud in Health Care Contracting: Duplicate Efforts Help, But What About Next Time?
As a Modern Healthcare article notes, McKesson has not admitted to any wrongdoing and says no vaccines were compromised. The DOJ release suggests the CDC does agree on the last part. There are redundant measures used to ensure the safety of the vaccines and the temperature monitors were secondary to packing procedures which don’t appear to have been improper.

We are glad that the vaccines remained safe, but agree with sentiments expressed by several government voices in the press release. Assistant Attorney General Stuart F. Delery notes that a company must comply with the terms agreed upon on in their government contracts, especially when it involves products that protect the public. He says “If a contractor does not adhere to the terms it negotiated, its conduct not only hurts taxpayers but also could jeopardize the integrity of products, like vaccines, that Americans count on to be safe.” Derrick L. Jackson with the Department of Health and Human Services agreed, especially when the underlying contracts protect our children (note: it is not clear in the press release exactly what type of vaccines were involved, but the Modern Healthcare article notes the contract involved a program aimed at vaccinating children). Jackson adds that entities that fail to meet such important obligation violate our trust and holding them accountable should be a top priority.

What if the packaging people also chose to skirt the requirements too? What if the dual failure led to vaccines that were either defective or outright dangerous? What if vaccines became ineffective leading to an outbreak of measles or even polio? What if instead of protecting our children, vaccines sickened them? There are lots of safeguards to prevent this from happening, but it is still the danger created by health care contracting fraud.

A Partnership in Fighting Fraud
Health care fraud is a broader transgression than many assume and sometimes it is much simpler. A scheme like that alleged above might better be described as government contracting fraud involving health care than “traditional” health care fraud. Military contract fraud endangers our national security, health care contract fraud endangers our well-being. In either case, others may have a hunch something is amiss it is often insiders who have the knowledge to truly support a legal claim.

If you know that a company is cheating in its government contractor role and defrauding the government, you can make a huge difference and may also be eligible for a very significant reward. Call our Northern California whistleblower’s firm to arrange an appointment to discuss how you can help and how, in turn, we can help you.

See Related Blog Posts:
Working With and Protecting Whistleblowers, Bringing Down Schemers Who Defraud the Government and Its Citizens
Whistleblowers’ Attorney Discusses Guilty Plea in Case Involving Contractor Providing Substandard Parts to Department of Defense

(Photo by Daniel Paquet)

Variety, Number of Medicare Fraud Schemes Overwhelm Efforts to Collar Them

August 15, 2014 by Gregory J. Brod

100-dollars-15.jpg
The federal government’s quest to stem the tide of fraud against Medicare has been overmatched by a flood of schemes that have been as widespread as they have been varied. For every case of Medicare fraud the government has cracked, it seems, there are many more that are go unpunished. And that is a reason why San Francisco qui tam lawsuit attorney Gregory J. Brod reminds us that brave whistleblowers who step forward with critical information on fraud help buttress the government’s efforts to reduce this crime wave against U.S. taxpayers.

According to The New York Times, the federal government is spending $600 million per year to combat Medicare fraud, a campaign that includes the marshaling of expert teams and use of sophisticated computers. Despite Washington’s efforts, however, the fraudsters remain several steps ahead of the government. To put the problem in a monetary perspective, it has been estimated that fraud and systematic overcharging against Medicare costs about $60 billion a year, which translates into 10 percent of the program’s annual expenditures, but the government was only able to recover about $4.4 billion last year.

Part of the problem stems from the sheer number of claims that must be reviewed for verification purposes: at the Centers for Medicare and Medicaid Services, the agency responsible for overseeing the vetting process, only 3 million claims of an estimated 1.2 billion claims per year are reviewed.

Systemic problems also plague the government’s efforts to curtail abuses against Medicare. Foremost among them is the fact that the government employs an army of outside contractors who are poorly managed, with conflict-of-interest issues, political pressures, and competition and lack of communication among the contractors some of the problems that hamper their efforts.

color-pills-915933-m.jpg
As another example, Medicare opted to shut down a successful hotline in South Florida, which is a hub for Medicare fraud, claiming that the hotline was no longer needed. But the suspension of the hotline has led to calls being routed to a general number, which in turn has significantly slowed down the government’s response time to complaints.

But while the pace of addressing complaints in South Florida has slowed down, the variety and depth of schemes against Medicare in the Sunshine State has picked up steam. Indeed, according to the South Florida Business Journal, a study released by the Department of Health and Human Services’ Office of Inspector General has found Miami to the be the epicenter of a scheme to defraud Medicare for HIV-related drugs and treatments: it seems that while only 2 percent of Medicare beneficiaries who receive drugs for treatment of HIV live in the Miami area, that small percentage accounts for 24 percent of all billing patterns that have been deemed questionable.

Included among the practices that have raised red flags have been the prescriptions of $6.5 million worth of HIV drugs for 888 patients who have no history of the disease on record. Other eyebrow-raising practices have included prescriptions meted out for an unusually large number of HIV drugs or prescriptions for the medications being written from six or more pharmacies or doctors.

Continue reading "Variety, Number of Medicare Fraud Schemes Overwhelm Efforts to Collar Them" »

A Settlement Offer by Another Name: GM Offers Compensation Plan for Defect Victims

August 15, 2014 by Gregory J. Brod

Car makers should be focused on the future, on the next car to come down the assembly rather than the last. However, lately it seems GM is spending more time dealing with problems from yesterday’s cars than making tomorrow’s. Our San Francisco auto accident law firm is always concerned when an auto recall is announced and earlier this week The San Francisco Chronicle reported that GM had added six new recalls to the sixty already announced. The new recalls mean the auto giant’s recalls for 2014 cover more than 29 million vehicles.

GM Ignition Switch Recall and Compensation Program
GM.jpgWhile note every recall involves a problem that has been known to cause accidents, a piece in last week’s Wall Street Journal focused on a problem initially linked to at least 54 crashes and 13 fatalities. The actual toll may be much higher. GM recently began a compensation program and in the first eight days received approximately 120 claims, half of which involve purported fatalities and another dozen or so that involve catastrophic injury. The issue, which led to a recall of around 2.6 million cars, is a possibly faulty ignition switch that could slip out of the “on” setting, abruptly stalling the vehicle and disabling its air bags. Distressingly, reports say that GM knew about the underlying problem for over a DECADE, but only began to recall and repair affected vehicles this February.

A compensation program aimed at the ignition switch defect (note: the defect above, not to be confused with a more recent recall for an ignition-key problem that could cause SUV window-switches to catch fire) is expected to offer payments from $20,000 to several million dollars. Claimants must show: (a) they were hurt or their family member was killed (b) in a crash involving a vehicle on the relevant GM recall list (c) and a police report or similar reputable source shows the air bags failed to deploy. Under the plan, a fatality will automatically qualify for a $1 million pain and suffering payment above and beyond other damages. Ken Feinberg is overseeing the program for GM and expects it will to take until after Labor Day to evaluate the eligibility of the initial claims. Ultimately he hopes to be able to make payments within 90 days of an eligibility ruling for simple claims and within 180 days for more complex matters.

Safety Recalls and Victims’ Rights
A booklet published by the National Highway Traffic Safety Administration (“NHTSA”) discusses the auto recall program and its goals. Recalls are issued when either a safety-related defect exists or a vehicle/equipment piece does not meet federal standards. Typically, manufacturers issue recalls voluntarily and prior to NHTSA involvement. Once the safety issue is identified, the manufacturer can choose from three remedies: Repair the vehicle (at no cost); Replace it with an identical or similar vehicle; or Refund the purchase price (minus depreciation).

Beyond the recall remedies, victims injured because of the defect still have a right to be compensated for their injuries. A program like GM’s, however, will presumably require waiving any civil claim in return for the compensation payments. The program is, essentially, a settlement offer. As with any settlement offer, we strongly urge injured victims and grieving families obtain legal counsel before signing anything. You do not need to agree to a program that allows the car company to make a one-sided offer, a program managed by their lawyers and in their best interests.

If you were hurt or lost a loved one in Northern California as a result of a faulty ignition switch or any other recall-related defect, whether it is a GM recall or a recall by another manufacturer, call our firm. With three convenient offices, our auto recall law firm in Santa Rosa, San Francisco, and Oakland will help make sure you get the compensation you deserve.

See Related Blog Posts:
Recall Highlights the Importance of Child Safety Seats
Unexpected Braking Leads to Second Honda Recall

(Photo by Flickr User jm3)

Sewage Spills in Northern California: The Impact and the Legal Rights of Toxic Exposure Victims

August 13, 2014 by Gregory J. Brod

People talk about a “California Lifestyle.” Having met such diverse people in our practice, we’d be hard-pressed to define just one. Any definition would certainly include a mix of sand and surf, land and water, and an active engagement with our environment. Typically healthy, this lifestyle means environmental problems can quickly become health problems. In this post, our Oakland toxic exposure law firm looks at one example -- the health impact of sewage spills and sewage contamination.

Oakland Water Main Break Follows a History of Sewage Leaks and Spills
sewagesign.jpgOne way sewage can get into our waterways is following a water main break. While sewage isn’t mentioned, The Oakland Tribune recently reported on three water main breaks that occurred around Oakland on Monday. An East Bay Municipal Water District spokesperson linked the breaks with work on an aqueduct and related pressure changes. The largest break flooded Kingston Road near the Piedmont Border. There was also a break at 47th Avenue and a third at Walavista & Arimo Avenues. An official noted that all of the affected pipes were aging.

A 2009 article from an environmental science group said 20 million gallons of raw sewage had been release into California waterways in 2008, a record-breaking number they expected would be exceeded that year. Old worn-out pipes, severe weather, and a lack of funding could, per the article, “add up to a disaster of septic proportions.” Perhaps in recognition of that danger, the EPA and others filed a lawsuit seeking to prevent sewage spills. That suit was recently settled, as reported in The The Contra Costa Times, with an agreement that seeks to improve 1,500 miles of aging pipes that threaten to release sewage into San Francisco Bay following heavy rainfall. Cities and water districts agreed to pay for prior violations and the settlement continues the requirement that homeowners inspect/upgrade certain sewer lines upon selling the home or undertaking substantial renovations.

The Health Risks
There are good reasons for paying attention to sewage spills and similar toxic leaks. American Rivers, a water and waterways conservation group, hosts a general sewage spills webpage and PDF on related health risks. More than 850 billion gallons of untreated/raw sewage are released into our waterways each year. Sewage releases carry disease-causing pathogens into drinking water supplies and swimming areas with approximately 7.1 million mild-to-moderate and 560,000 moderate-to-severe cases of waterborne illness occurring annually in the U.S. The EPA believes 1.8 to 3.5 million people are sickened by recreational contact with sewage-contaminated waters each year. Authorities are also increasingly worried about pharmaceuticals finding their way into waterways via sewer overflows, a hazard that may cause serious hormonal health hazards.

We are comparatively lucky compared to many nations; most waterborne illnesses in the U.S. are intense but relatively brief thanks to medical care. However, there are still many cases in which sewage overflows lead to long-term or even fatal illnesses, with the elderly, infants, and the immunocompromised at greatest risk. In 1993, for example, a parasite contaminated Milwaukee’s drinking water, causing 403,000 illness and 70-100 fatalities (the majority of deaths involved HIV-positive individuals).

Legal Rights of Californians Sickened By Sewage Spills
Even with the recent settlement, sewage spills are unlikely to disappear. While some are truly unfortunate accidents linked to severe weather, numerous sewage spills can be traced to the actions of an entity or individual. The risk of illness is exponentially increased if an entity fails to report a leak or spill to the appropriate health authorities. These actions may be negligent (ex. if a failure to inspect parts of an aging system leads to a leak) or distressingly intentional (ex. if a company opts not to report a sewage release for fear of negative press or economic consequences and people are sickened because they are unaware that water is tainted).

The law protects the wrongfully injured. A toxic tort or other civil claim may allow a victim of sewage-exposure to recover economic damages. If you were sickened or lost a loved one because you were exposed to a sewage spill or other toxic release, call our Northern California toxic tort attorney in Oakland, San Francisco, or Santa Rosa. We can help.

See Related Blog Posts:
Coal Ash – A Dangerous Byproduct of Energy Production
California Toxic Torts Law and the Many Dangers (and Uses) of Chlorine

(Image by Flickr user bclinesmith)