Risk Adjustment Fraud, Coding Creep, etc.

Risk Adjustment fraud is a major problem estimated to cost Medicare billions of dollars per year. Here is how it works. Medicare pays Medicare Advantage plans a “capitated” rate per insured. That is, they pay a flat rate per covered person per month. However, to compensate plans for the fact that some insureds are at […]

Really Disturbing FCA Case From Los Angeles

Last week the DOJ intervened in a case alleging that federally funded housing developments in Los Angeles were falsely certifying compliance with federal accessibility laws in connection with claims submitted to HUD for millions of dollars in housing grants. According to the DOJ: [T]hese laws require that five percent of all units in certain federally-assisted […]

I HEART NY

I love the New York State False Claims Act. One of the reasons is that the statute explicitly allows Qui Tam claims for tax violations. Combine this with an excellent and aggressive AG’s office and it’s a big win for the state and the whistleblower. I predict that NY state coffers will benefit tremendously in the years to come from this law. I hope it becomes a model for the rest of the country.

A perfect example of the statute’s strength became public this week, right in time for tax day.

The Excuse of “Powerless”

How easy is life when we give ourselves no power? Regardless of how bad a situation is, if you have no power there is nothing to do. No decisions to make. You can’t affect the outcome in any way so why bother doing anything? Keep your head down and make no waves.

The problem with this is it is based on an illusion. The illusion that the “powerful” always win and that the little guy has no recourse. The law gives us the power to take on the richest corporations.

Congrats!

Congratulations to Jan Orlando and her legal team. Ms. Orlando blew the whistle on an HSBC subsidiary for alleging defrauding the Small Business Administration’s SBA Express Loan program. Prosecutors said that HSBC USA sought reimbursement from the SBA on at least 42 defaulted loans that had been identified as fraudulent or potentially fraudulent, including cases of false commercial identity, check fraud, and other swindles.

The government recovered over $2 million, of that, over $360,000 has been allocated to Ms. Orlando for her efforts.

Something We Can All Agree On

In today’s hyper partisan environment there is little Republican and Democrats seem to agree on. One exception to this is that whistleblower protections are good for America. There is currently bipartisan proposed legislation to bolster the notoriously problematic IRS whistleblower program.

The fixes proposed are relatively modest, but a step in the right direction. The bill seeks to enable the IRS to keep relators and their counsel more informed on the progress of their cases and to strengthen anti-retaliation protections.

Sarraf Gentile LLP Blog

We are excited to announce Sarraf Gentile LLP is launching a new blog dedicated to being a resource for those interested in learning more about Whistleblower claims and Qui Tam law. This is an area of law we specialize in and are very passionate about. We hope the blog will become a valuable resource for those struggling with whether to blow the whistle and attorneys and other professionals who seek to help them with this momentous decision.

The blog will contain helpful pointers, some basics on the law and other practical issues, summaries and opinions on new developments in the law and public discourse as they arise and whatever else we think would be of value.