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Changes in Qui Tam Whistleblower Cases Under the False Claims Act – A Review For Lawyers & Attorneys

The Patient Protection and Affordable Care Act of 2010 (“PPACA”) and the Healthcare and Education Reconciliation Act of 2010 (“HERA”) (collectively, the PPACA and HERA are referenced as the “Legislation”), passed in the spring of 2010, enacted sweeping changes to health care, including important changes to the federal False Claims Act that will affect prosecution of qui tam cases by the federal government, relators and whistleblowers. Health care fraud lawyers, attorneys and law firms and their clients must be aware of these significant changes in cases involving fraudulent claims against federal government healthcare programs such as Medicare, Medicaid and Tricare. Health care fraud defense attorneys will be disheartened, and federal government prosecutors, whistleblower lawyers and qui tam plaintiffs will be pleased, because these changes have lowered the bar for prosecutors and qui tam whistleblowers with respect to False Claims Act cases.
The False Claims Act, 31 U.S.C. §§ 3729-3733 (the “FCA”), is an important tool used by the Department of Justice (“DOJ”), U.S. Attorney’s (“USAOs”) and private whistleblowers to bring civil prosecutions against those individuals and entities who perpetrate frauds upon the United States through false and fraudulent claims for payment. The FCA provides for treble damages and civil monetary penalties to be awarded to the federal government, and the qui tam whistleblower plaintiff, often called a “relator,” may recover up to 30% of the award, plus statutory attorney’s fees.
The recent FCA amendments make it easier for whistleblowers to bring qui tam suits on behalf of the federal government by lowering the “public disclosure” standard. Prior to the amendments, a qui tam plaintiff who was not an original source was jurisdictionally barred from bringing an FCA suit if the fraudulent conduct of the defendant had been previously disclosed in the public domain through the media, federal, state or local reports, audits and investigations, or criminal, civil and administrative hearings and proceedings. For instance, in Graham County Soil & Water Conservation Dist. v. United States ex rel. Wilson, 130 S.Ct. 1396 (2010), the United States Supreme Court recently upheld the dismissal of an FCA claim for lack of jurisdiction based on prior public disclosure of fraud in California county’s audit reports. See United States ex rel. Gonzalez v. Planned Parenthood of Los Angeles, et al., Case No. 09-55010 (9th Cir. July 1, 2010).
Under the amendments of the Legislation, publications deemed as public disclosures under the FCA are now more limited. They only include a federal criminal, civil and administrative hearing in which the government or its agent is a party, a congressional, Government Accounting Office (GAO) or other federal report, hearing, audit or investigation, or a disclosure in news media. See 31 U.S.C. § 3730(e)(4)(A). This means that state and local audits, reports, investigations and hearings, as well as litigation between private parties, can now be used as the sole source of information for an FCA suit for defrauding the federal government, and the Legislation has abrogated this part of the Graham County Soil & Water Conservation Dist. decision.
The Legislation’s amendments also changed the jurisdictional nature of the public disclosure provisions. Before the new law was enacted, a violation of the public disclosure requirements of the FCA was a jurisdictional defect which could be raised by a party at any time or sua sponte by the court. Now, a qui tam whistleblower complaint which violates the public disclosure provision can be dismissed pursuant to a Rule 12(b)(6) motion, unless such dismissal is “opposed by the Government.” Id.
The Legislation also amended the “original source” provisions of the FCA. Prior to the amendments, a whistleblowing relator who was an original source could bring an FCA suit regardless of whether there was a previous public disclosure. This meant that the whistleblower had to have “direct and independent knowledge” of the information on which the fraud allegations were based and had voluntarily provided the information to the Government before filing an FCA action which was based on the information. Under the Legislation, the “direct and independent knowledge” requirement has been eliminated, and an original source is an individual who voluntarily discloses the frauds to the government prior to a public disclosure or “has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions.” 31 U.S.C. § 3730(e)(4)(B). Therefore, as long as the qui tam whistleblower has information about the government frauds which are independent of publicly disclosed information, even if the qui tam whistleblower did not have “direct” information usually derived from personally witnessing the fraudulent conduct, an FCA suit may be pursued.
By broadening the original source provisions and limiting the public disclosure provisions of the FCA, Congress has encouraged an increase in the filing of qui tam whistleblower lawsuits. While the change in the jurisdictional aspect of the public disclosure provisions ostensibly helps qui …

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Good Health

Effective Dental Health Care For Pregnant Women

Contrary to what others advice and believe, dental health care must not be neglected even during pregnancy. This is because the condition of the mother’s gums and teeth can affect the baby’s health inside her womb. Several medical surveys show that preterm delivery and babies with low birth weight are both caused by dental and periodontal infections.
Now, how do you start with this? Firstly, inform your dentist whether you are trying to get pregnant or already in the early stages of pregnancy. By doing so, he can help you prepare for oral health problems that may come your way during the conceiving stage up to the delivery stage. Secondly, take efforts to know which of the dental procedures are not advisable for you to undergo.
Challenges on pregnant women’s dental health care usually start from the presence of plaque. The latter is a film of bacteria which can wound the gums and seep deep into the gums and into the bloodstreams. Take note whatever infection present in the bloodstream can reach the fetus any time. The good news about this is that it can be prevented through a thorough periodontal exam that which may be done months or years before your planned pregnancy.
In the case that you are already pregnant, do not forget to religiously practice oral hygiene at home. This can prevent potential problems in your gums and teeth. Seeing the dentist while pregnant is another measure to observe. Moving forward, you can also undergo professional cleanings which can equip your gums and teeth from the harms of dental illnesses brought about by the hormonal changes during pregnancy. Enamel erosion and gingivitis are two common examples of these illnesses.
Some specialists suggest that cavity fillings and installation of crowns may be done to reduce possibilities of further infection from gingivitis or enamel erosion. In fact, root canal may also be administered so long as local anesthesia is used. Dental x-rays are the procedures to be avoided since its harmful rays are believed to harm the fetus. If ever emergencies require them, abdominal shields may be used. As for the medicines associated with these treatments, they should only be taken under prescription by the dentist. Do not risk the health of your unborn child by buying over-the-counter pain relievers. Cosmetic treatments like teeth whitening and implant installation must be postponed until your baby is born. The same goes for treatments with which application of electricity will be used.
Again, dental health care must be observed with persistence even before you plan to bear a child in your womb. Apart from regular brushing and flossing of your teeth, you should not miss regular dental check-ups at least twice a year. Opt to all kinds of healthy foods as well. Avoid sugars and feast on foods that can make your gums and teeth stronger. Keep a copy of ovulation calendars when planning your pregnancy so that you can keep your wellness in tune and track dental concerns after giving birth.…

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Fitness

Dog Health Tips You Should Know

You want the healthiest dog possible, so when you choose the puppy that you will take home, find the healthiest looking one possible. The one that is playful, bright-eyed and outgoing. This will be one of the first ways to ensure that when your puppy grows up, it will be a healthy dog. Of course, you have to help along the way.
Vaccinations
Make sure you take the puppy for their vaccinations. This is extremely important because dogs can get diseases that will kill them just like people. The parvovirus is one and it is very contagious. Distemper and rabies are a couple more. Your dog should have the vaccinations for these diseases and keep up to date on boosters they may need.
Food and Water
Always make sure your dog has a good supply of fresh drinking water. Dogs will often make a mess of their water. If they are outside they will throw dirt in it by digging, they will turn it over and generally make a mess. So, you will have to check on this often.
The food you feed your dog will be another way of keeping him healthy. This needs to be a good quality with the right vitamins and minerals for your dog. Your veterinarian can tell you what your dog needs better than anyone else. They will know if they have special needs when they examine them. Read the labels on dog food and avoid the ingredients that are not conducive to good health.
Your dog’s dental health may be a concern as well. There are some veterinary dentists that recommend brushing your dog’s teeth daily. They can develop plaque and tartar on their teeth just as people can and this needs to be addressed. There are some products on the market that are made to help remove this from your dog’s teeth and you should ask your vet about this.
Good grooming is one way to keep your pet healthy. Some breeds have more complicated needs when it comes to keeping their ears cleaned and free of hair. They can often develop an ear infection if this is not done properly. Likewise for the toenails; they need to be trimmed as well. They can grow too long and cause walking problems for your puppy or dog.
Just as all of the things mentioned above are ways of keeping your puppy or dog healthy, exercise is another. Your dog will need to get plenty of exercise on a daily basis in order to keep them from becoming overweight. When they gain too much weight they can suffer from many health problems just as people do. Research shows approximately 40% of the dogs in the U.S. today are overweight.
A healthy dog can live for many years and this is what you have in mind when you purchase that cute little puppy. You want him to be a part of your family for a long time. The best way to ensure that he is around as your friend and companion for as long as possible is to provide the essential needs so that he can be as healthy as possible.…

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Fitness

Alternative Medicine – Frequently Asked Questions About Holistic Treatments

Alternative medicine has become more popular in recent years as people have begun to seek healthcare solutions outside the norm of traditional treatment. It has become almost trendy for persons to begin taking yoga classes or using only herbal medicine to treat what ails them, but holistic medicine does have benefits that go beyond any trend. There are many questions surrounding these practices, and here are some of the most common.

What is alternative medicine?

It’s any healing practice that doesn’t fall within the conventional medicine realms. Practices utilized are based commonly in beliefs from traditional, folk, spiritual or other sources. Many of the most popular come from Eastern sources, with countries like China and India being the most common.

What kinds of treatments fall under the holistic umbrella?

Health care practices and treatments most associated with alternative medicine include naturopathy, chiropractic medicine, herbalism, meditation, yoga and acupuncture.

What are the benefits?

There are a number of benefits associated with these types of practices, including:

You become an active participant in techniques involved in the cure.

You’ll better understand your physical body functions and the way they relate to your health.

You will change your way of thinking, first exercising the mind and then the body.

Your mind and body will be relaxed, and health will develop from within.

Are these types of treatments right for me?

It depends on what you would like to heal, as well as whether you’re comfortable with the treatments.

Does health insurance cover alternative medicine treatments?

This varies by insurance company. Ask your doctor if the treatments are covered.

What is holistic medicine?

Holistic medicine is another name for alternative medicine, with the latter being the term most used by the general public and some healthcare practitioners.

What is naturopathy?

Naturopathy is based on a belief in vitalism, which trusts that a special energy, vital energy or force, guides bodily processes. Those who believe in it follow a strict approach to find remedies outside of traditional surgeries and drugs.

What is herbalism?

Herbalism uses plant and plant extracts. It’s a traditional medicinal or folk medicine practice.

What is acupuncture?

Acupuncture is a practice that treats patients by insertion and manipulation of needles in the body.

What is homeopathy?

Homeopathy is a practice that treats patients using highly diluted preparations, which are believed to cause the healthy to show symptoms similar to those exhibited by the patient.…

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Good Health

Hospitalized Again? Keeping Your Older Parent From Returning to the Hospital

According to studies by Medicare 18-20% of patients find themselves back in the hospital within 30 days of being released. Lack of follow up by patients is the main reason for a return trip. Discharge instructions almost always recommend that patients see their primary care physician within one to two weeks of being released from the hospital.
This is important because medical care today is very different from medical care years ago when your primary care physician actually came to the hospital to see you. Today, physicians called hospitalists care for you while in the hospital. Your primary care physician cares for you when you are in the community. Many times your primary care physician has no idea you were even hospitalized, thus the importance of making an appointment to discuss further treatment for the condition that placed you in the hospital in the first place. Otherwise it’s likely you’ll win a return trip to the hospital.
Make sure any prescriptions that you leave the hospital with are filled and that you take the medication as prescribed. These prescriptions were written for a reason, yet many of go unfilled. Were you prescribed physical or other therapy? Participate. Again more recommendations that go unheeded by patients. Did you think you ended up in the hospital because you were caring for yourself properly? Is it your intention to go back home and do the same thing? You’re playing monopoly with your life, lose a turn and go back to the hospital.
Many older adults fail to see the progression and seriousness of their diagnosis. This occurs for several reasons. Physicians talk in medical speak. Older adults seeing the physicians as god-like are hesitant to ask questions; they do not ask questions about anything they do not understand. Physicians also diagnose versus offer information that affects the day to day life of their patients. For example many physicians do not tell patients to lose weight, improve their diets or stop smoking when this direction would benefit many individuals.
Due to insurance issues, hospitals are also rushed to push patients out the door, usually in three days or less. This rush many times does not allow for conditions to be fully diagnosed thus the problem resulting in the hospitalization is not resolved. What happens then? The patient is released, does not take medications, does not make a follow up appointment with the primary care physician and ends up back in the hospital.
This is expensive not only to the patient but the healthcare community. In 2009 a trip to the hospital costs the average Medicare patient a co-pay of $1,068. The ambulance trip to the hospital another $600-800. If individuals, not insurance, had to pay these costs I have to believe that we would take better care of ourselves.
Other issues with older adults that complicate this situation is memory loss. Many individuals do not take care of themselves because they simply can’t remember if medications were taken, meals were eaten, and bathing was completed. About fifty percent of individuals over the age of 85 have dementia, many times undiagnosed unless a family member notices because the individual cannot report a condition to their physician of which they are not aware. To further complicate the situation; most general physicians do not have experience with the subtlety of memory loss.
It is important if you are an older adult to have someone who can advocate for your health care needs. If you are a child, offer to attend medical appointments or coordinate information for your parents. Make sure they follow up with post hospitalization recommendations. You’ll save unnecessary trips to hospital emergency rooms and help your parent have a better quality of life. A little help goes a long way.…

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Fitness

Prescription Fraud – Prevent Your Pharmacy From A Major Health Care Crime

Prescription fraud, which can be elaborated by the exact term as “pharmaceutical diversion,” is defined as the criminal acquisition of prescription drugs for personal use or profit. This definition of prescription fraud does not include the other related terms like theft, burglary, backdoor pharmacies, and illegal importation or distribution of prescription drugs.

Prescription fraud is the most dominant kind of a health care fraud, since the new century had started, the problem has grown significantly and the major reason which is daunting the health care and safety measures is the inflation in the medication cost. A common man, who had already hit by an extreme bought of a recession, is compelled to buy a 2nd grade to third grade medicine to reduce the cost of his health care. And this is the cause of the major prescription failure and fraud.

The second reason which has a great deal is that the number of people are abused by the “Backdoor pharmacies”, which are businesses not licensed/authorized to distribute pharmaceutical drugs. On the other hand people commit prescription fraud in different ways, like forging prescriptions, multiple prescriptions by multiple doctor interventions (doctor shopping), and altering the prescriptions to increase quantity.

Prescription fraud is a very complex health care crime. Limited awareness and lack of oversight among doctors, pharmacists and the patients may also contribute to the problem. Identifying the different faulty factors in prescribing, dispensing and administration of medication may help in reduction of this dangerous health care crime.

Prescription Fraud: Tips to Escape a Major Health Care Crime and Disaster at the Pharmacy

Knowing the prescriber, his signature, DEA (Drug Enforcement Administration) number and knowing the patient is primary task.

Checking the prescription date is essential and is it presented within a reasonable time?

Contacting the doctor/ prescriber by a telephone for verification or clarification if you have any questions.

If you believe that there is doubt in prescription details, request proper identification. Doing so increases offenders’ risk of getting caught.

Build up a strategy to track the prescriptions written by the doctor and administer it accordingly with the name of the patient to whom the prescription was given; the drug that was prescribed; the number of tablets prescribed; and the dosage amounts.

Prescriptions can only be made and written by licensed and accredited doctor/ physician, including the accreditation seal and the signature on a temper-proof prescription pad.

Refuse to call-in prescriptions unless they are backed up with written prescriptions that must be provided by the patient at the time of pickup.

Use a prescription drug monitoring program to monitor who access drugs. It is a part of the job to look for the obvious signs that include the appropriate dozing and refills.

Electronic prescription method is the best way to counter the false, forged and altered prescriptions as the doctor transmits the prescription directly to the pharmacist.

Training to detect fraudulent prescriptions is essential for the pharmacists and the doctors may also discuss their prescription writing criteria with the local pharmacists regularly.

A strong relationship with local pharmacists is important as they are often the first to detect a diversion or fraud attempt.

Conclusion to Consider:

Prescription fraud is a particularly interesting information security management issue because it occurs in an information intensive domain, that of drug use and management. Increased security measures help prevent prescription fraud and reduce counterfeit losses. By reducing the inflation in the medication cost can also suppress the prescription fraud situation in a massive way as the patient can easily reach his Doctor’s prescribed medication without opting a self-medication danger.…

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Advice For Getting The Best Possible Chiropractic Care

Back pain causes many people to struggle and suffer throughout each day. It shouldn’t be this way for you, and if you need help with this you’ve come to a good place. Many wonderful chiropractic care techniques are included below.

Alternative providers are becoming more common, and primary care physicians are turning to them for advice and help on difficult cases. You need to make sure your insurance covers other services that you may need in your treatment. They are great additions to more traditional medical care.

Concentrate on sleeping on your back. Put a pillow beneath your head and shoulders. Stick a rolled up towel under your neck and knees to help keep the three primary curves in your body stabilized. You also need to make sure you sleep on a comfortable mattress.

Are you aware of the fact that chiropractic care can help make your body’s immunity much better? When you have a spine that’s in the wrong position, it can make your nervous system act wrong and that’s bad for your immune system. When you get your spine aligned right, you get more blood going to the nervous system. This increases the body’s ability to ward off infection.

You need to get out of your bed the proper way. Before getting up, stretch before slowly raising. Then, you should swing the legs to the floor while supporting yourself with your arms. Getting out of bed this way can reduce spinal injuries.

Ask the chiropractic office to see of they offer discounts for multiple visits. Often, chiropractic treatment means multiple visits. They can even be a couple times per week for several months. Over time, this price can begin to add up. Perhaps you can get a discount if you have a program of extended treatment.

If you are looking for a chiropractor, it would be a good idea to ask your primary care doctor for a suggestion on a good provider. A referral may not be required, but it helps you find the most qualified, trusted professionals in your local area.

If you do choose to go with chiropractic care, then review references carefully before choosing a specific individual. Most chiropractors truly care about their patients; there are always a few bad eggs, however, in any bunch. Use online reviews and trusted references from physicians if you can.

How you sleep can be contributing to your back problems. Consider using a cervical pillow or rolled towel under your neck as you sleep. This technique allows you to maintain posture while you sleep.

Do you have high blood pressure? Studies show that manipulating the first neck vertebrae is as good as using two hypertension medications together. This manipulation frees the heart’s nerve supply, making for better regulation of pressure.

As you’ve read, suffering with back pain doesn’t have to ruin your whole life. There are some things you can do to get rid of the pain. Use the advice in this piece, and you will begin feeling great in no time.…