Health Care Qui Tam cases
What does Qui Tam mean?
Qui tam is short for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which roughly translates to “he who brings an action for the king as well as for himself.”
The Department of Justice just announced that U.S. Attorney General Merrick B. Garland created COVID-19 Fraud Enforcement Task Force to enhance enforcement efforts against COVID-19 related fraud.
Cases have included:
- Offers to purchase COVID-19 vaccination cards
If charged with embezzlement, you could face a federal court, or a state court could hear your case, depending on the circumstances. In either case, embezzlement is a serious matter, as well as a complicated one.
Embezzlement begins with property in your lawful possession, though not belonging to you. If you were to then use it in a way that goes against your agreement with the property owner, there could then be an embezzlement case against you.
The requirements to prosecute an embezzlement charge are different from those of a comparable crime like larceny. Here are some important distinctions that set embezzlement apart.
Eight Georgia residents were recently sentenced in federal court for various convictions following a lengthy investigation by the U.S. Department of Justice. According to reports, numerous tax fraud and money laundering conspiracy activities were conducted from 2009 to 2012. A DOJ spokesperson stated that millions of dollars were claimed on fraudulent tax returns.
According to reports, the individuals sentenced claimed $35 million in refunds on over 100 tax returns. The refunds were for the fuel taxes for a number of corporate vehicles. However, during the investigation, it was discovered that the vehicles were never used by the companies listed on the returns. Agents from IRS Criminal Investigation worked with other law enforcement agencies to uncover the activity.
Seven men and one woman from Georgia were sentenced for multiple counts, including theft of government funds, false claims conspiracy and filing false claims. Other charges included conspiracy to steal government funds, using phony identification and attempting to cash checks generated by the scheme. The sentences range from six months to seven years in prison with many followed by several years of supervised released. Several of the individuals have been ordered to pay restitution, ranging from approximately $750,000 to over $5.5 million.
Many Georgia residents and others around the nation seek the treatment of chiropractors for relief of back pain and other spinal issues. Much of this chiropractic treatment is covered by the patients’ medical insurance. Recently, two Georgia chiropractors were charged in federal court with conspiracy and insurance fraud after allegedly submitting false claims to providers.
A 38-year-old man and a 50-year-old woman have practiced at a chiropractic clinic in Marietta for the past three years, according to reports. They purportedly filed claims to private health insurance companies for procedures that were never conducted. The allegations have come following investigations by the FBI and the IRS Criminal Investigation unit. Also involved in the case were the Georgia Office of Commissioner of Insurance and the Atlanta Police Department.
The two chiropractors are accused of using personal information from their clients. They supposedly submitted this information in claims to insurance companies for services that were never performed. According to the reports, there were occasions where the patients that were supposedly being treated were out of the country at the time of the service.
Many Georgia residents and others around the county have a good working relationship with their insurance agents. The agents frequently understand the needs of their clients and offer products and services specifically tailored to their situation. Recently, however, two individuals were accused of committing insurance fraud, following an investigation by state authorities.
The state insurance commissioner reported that a 34-year-old woman and her 48-year-old husband were arrested in their home. Purportedly, information from the man’s previous client base was used by the couple. The information was used without the former clients’ knowledge. With the information, the couple allegedly stole over $11,000 in commission fees. Officials believe that the total amount taken could rise over $100,000.
The woman faces charges of insurance fraud, exploitation of an elder, forgery and identify fraud. The man was charged with insurance fraud and exploitation of an elder. According to officials, the company remains in the Troup County jail.
Georgia residents and others around the nation go to healthcare providers for medical needs. In many cases, the process is standard: services are provided to a patient, paperwork is filed by the facility, then providers receive payment from insurance companies for the services. However, insurance fraud can occur when claims are filed for ineligible services or for those not actually provided. Three medical personnel from Georgia were among a large number of people recently accused of health care fraud.
According to the country’s Department of Health and Human Services, 412 people were charged with fraud in a federal investigation. Officials state that approximately $1.3 billion in fraudulent billing was allegedly discovered. In Georgia, almost $1.5 million in fraudulent claims were filed.
The indictment states that the owner and operator of the Georgia Center for Health, Wellness and Recover, a licensed psychologist in DeKalb County, submitted the claims to Medicaid. Reportedly, another worker at the clinic was also accused of similar charges. The facility provides mental health and substance rehab services. Another person from South Georgia was apparently involved in the case. However, no details were available about them.
The Georgia Bureau of Investigation in conjunction with the Gordon County Sheriff’s Office recently arrested three people on charges of fraud and bribery. These alleged white collar crimes were apparently discovered after the county’s tax commissioner found discrepancies in his office’s records. An investigation among several agencies lasted several days after the sheriff’s office was notified.
The Gordon County Sheriff reported that on May 26, a 26-year-old Atlanta man was arrested and taken to jail. The man allegedly attempted to get vehicle registration documentation from the county Tax Office that police suspected to be fraudulent. Apparently, a 35-year-old man from Marietta was arrested later that same day for similar charges. The men face charges of bribery of a public official, computer document fraud and false statements registering motor vehicles.
According to reports, on June 1, a 40-year-old woman was booked on computer forgery and bribery charges after turning herself in to the Sheriff’s Office. The woman was released on her own recognizance after appearing in court. The investigation continues as other individuals and jurisdictions are examined. Officials claim that an additional arrest is forthcoming, but no county employees are suspected of any misconduct.
Georgia residents regularly deal with insurance agents to obtain coverage for homes, vehicles and other valuable assets. Transactions are routinely conducted with an expectation that an agent is properly submitting premiums payments made by a client to an agency. A McIntosh County agent was recently arrested for insurance fraud for allegedly keeping money intended for insurance companies.
A report from the Insurance Commission’s Fraud Unit claims that a 35-year-old man was personally using funds his clients had remitted to pay for their car insurance. Since the money was apparently never applied to the clients’ insurance premiums, none of them were properly insured. Had an accident occurred, the clients could have experienced potential financial hardships.
The agent was arrested at his insurance office, where he also resides. The man also received an administrative order from the Commissioner that immediately revoked his agent’s license. Fraud investigators from the Insurance Department will be addressing concerns from the agent’s existing clients. The man can request a hearing regarding his license within 10 days following receipt of the order. Both administrative and criminal investigations regarding the case continue, according to the Insurance Commissioner.