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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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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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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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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.…

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Working With Diabetes – Tips for Success!

Diabetes is a serious medical condition which can cause some serious health problems, and may even lead to death. You can live a healthier life if you learn more about this condition and how you can manage it. This article presents many useful tips to help you manage your diabetes and live a healthy life.

A great tip to use to keep in control of diabetes is to live life in a orderly fashion. Keep your insulin close to you and store it in the same spot every night. Make sure you routinely do everything you’re supposed to when testing.

If you have a diabetic condition, you should be tested for sleep apnea as soon as feasible. If you are found to have sleep apnea, receiving immediate treatment can greatly assist you in maintaining a good quality of health.

Many online pharmacies offer steep discounts on popular diabetes medications. These services can deliver the medicine to your house every month, so that you do not forget.

Talk to a physician immediately if you have any vision problems. Diabetes can lead to many eye problems, including diabetic retinopathy and glaucoma. Cataracts can also be an issue. It is critical that you address any vision issues as soon as they appear because diabetic retinopathy can cause blindness.

If you have diabetes, you must be careful about what you eat. Blood glucose levels are affected differently by various foods, so it is necessary to keep close tabs on your food choices. Adapt your insulin injections to what you eat. Watch what you eat to manage your blood sugar levels.

It is never your own fault that you have gestational diabetes. In most cases, this condition does not appear for any specific reasons. Try not to feel stressed out about gestational diabetes. Just cut down on your sugar intake for the remainder of your pregnancy.

If your blood sugar level dips too low, you may need to drink something sugary like orange juice to get it back up. Don’t worry if your blood sugar level spikes when you do this. This means could mean that you are eating and drinking more than you should to fix your low level or that your body is releasing hormones to make up for the low level. Next time, drink or eat half the quantity you normally would, and then check again after thirty minutes.

Diabetics who smoke need to try and quit. Smoking is a poor health decision for those around you and for yourself as it can make your blood sugar dangerous. If you want to quit but are encountering difficulty, consider asking your healthcare practitioner for advice.

Make your favorite comfort foods more diabetes-friendly. One of the hardest things about getting used to having diabetes is that the diet can be very restrictive. Most people believe that they need to get rid of a lot of the foods they love to eat. Others will continue to eat their favorite, unhealthy foods. The smart solution is to examine your favorite dishes and make substitutions. You could replace certain ingredients with more diabetes-friendly alternatives for instance.

It is absolutely critical that all diabetics learn the proper ways to care for their bodies to preserve their health. This article contains some great advice that will be useful for all diabetics and their loved ones.…

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Arthritis And You: How To Treat Your Symptoms

Arthritis is caused by a gradual deterioration of the cartilage that is wrapped around the ends of bones in the body. When the cartilage from the joints is gone, the ends of the bones start to grind together, causing inflammation, swelling, and severe pain. With the treatment options recommended here, arthritis can be very manageable.

Though it may be a challenge, you really do need to exercise as much as you can if you deal with arthritis. Not exercising joints will cause them to get tired, which will make your arthritis worse. An exercise that increases flexibility is beneficial when someone has arthritis because it helps build up your motion ranges.

Be proactive with your arthritis management by educating yourself about the condition. There are plenty of resources you can use to learn about what you should eat, what exercises you should try, and how to deal with pain. By thoroughly researching your arthritis, you can learn some new treatments, and be introduced to some exercises and foods that can help reduce some of your pain.

Sleep as best youc an. People who suffer from arthritis need the energy that a good night’s sleep provides, so be sure you sleep as long and as deeply as you can. If you are having a difficult time sleeping, do all you can to make your room completely dark and silent.

Be sure of what you need to look for when you are dealing with arthritis. Do yourself a favor and get it diagnosed early, as soon as you notice possible symptoms. If symptoms are prevalent and life altering, it’s time to contact a physician for a proper diagnosis and treatment plan.

Use special devices to help you perform certain activities. If you need to lift some heavy objects or know that you have a long day of standing ahead, wear proper shoes, bring a portable chair and take any other measure necessary to protect your sensitive joints from overuse and excessive pain. Further joint damage gives you severe pain, so the best thing that you can do is to avoid the pressures associated to strenuous activity.

Laugh often. Increasing the amount of humor in your life is an excellent way to relieve stress. Laughter is a great treatment option for people who suffer from arthritis, so make sure to do it often.

Always drink lots of water. Always satisfy cravings of thirst, and keep in mind that there is really no better liquid for you than good old-fashioned water. Steer clear of any liquids that just make you more dehydrated, such as caffeine.

Castor oil has been show to alleviate the pain and stiffness of arthritis. The oil will increase the flexibility of your joints and the massage will make the pain disappear. Massaging your joints helps the blood flow and relaxes your joints.

There are a lot of different medications and alternative treatments available to help you deal with the joint inflammation and pain you may be feeling due to arthritis. Remember the tips you read in this article as you seek ways to cope with arthritis and its effects. Relief may be just around the corner.…

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Tips And Tricks For Eliminating Your Acne Woes

For many people, having acne can cause embarrassment, low self-esteem and even depression. If pimples and acne have gotten you down, try some of these proven tips to get rid of your acne, once and for all. Not only will you lose the acne, but you’ll also regain the confidence and self-esteem that you’ve been lacking.

Did you know that acne can be caused by allergies? Allergies are a natural reaction that your immune system uses to fight off something that is trying to work it’s way to inside your body. The problem is, your body can sometimes end up fighting things it just doesn’t need to, because it was incorrectly programmed to do so. An allergy specialist can help by testing to find what allergies you do have. It could be something simple, such as dairy, or it could be more complex such as the paraffin wax in your hairspray. If your allergies are bad enough, an allergist can even give you shots that help to reprogram you body so that it no longer fights the things it doesn’t need to fight.

If you are an acne sufferer, try not to wash your face excessively. Any more than three times daily, and you run the risk of making the problem worse. Wash your face in warm water, using a mild soap. Gently pat your skin dry. This will prevent the acne-causing bacteria from spreading, lessening future breakouts.

Despite being a popular treatment for acne, avoid cleaning your face or spot treating your breakouts with isopropyl alcohol. It is an incredibly harsh cleanser for the already compromised skin. It dries the skin out, which causes it to overproduce oils to keep it moisturized. This then causes the breakouts or it aggravates the already existing breakouts.

A great way to avoid breakouts and acne is by keeping your hair out of your face. If you have long hair or bangs, the dirt and oils from your hair can transfer to your face. The oils and dirt will contribute to clogged pores, eventually leading to a breakout.

Do not combine any acne creams together. Many people combine their acne treatments, believing that the mixture will provide the best results. Because these treatments all contain strong ingredients, you could make your skin worse.

To limit the formation of acne, try to reduce the amount of ketchup and tomato sauce that you consume. These foods have a lot of sugar and carbohydrates and can kick start the formation of acne. Try to stick to natural foods that are raw and organic to eliminate acne through your diet.

When you see that huge zit, most people are tempted to pop it. Instead, do not touch it at all! By popping the zit, you release the white blood cells that had been attacking the bacteria on your face. You will then get a mini scar on your face that will last a long time.

From all of the tips mentioned here, there is bound to be at least one or maybe more that are effective for treating your acne. Don’t let your acne cause embarrassment and get you down. Give these ideas a try and you will be on your way to clear skin and confidence.…