The Civil Healthcare Fraud case happened in Birmingham. The case was as a result of a complaint launched by a whistleblower. The defendants in the case were; King Jnr., King and Associates Inc., Marie King, SouthernCare Inc. and William Bill. Those involved in the investigation of the case were the FBI, The US Attorney (Joyce White Vance) and the Department for Health and Human Services in the United States.
According to the article, “Civil Healthcare Fraud Allegations Settled for $ 1.4 Million”, the manager of King and Associates, Inc. was Marie King. She was a registered nurse and had the duty of directing and operating the King and Associates Inc. The King and Associates Inc. was a healthcare company that provided consulting services. King and Associates Inc. was located in Alabama and other states of the south. The Southern Care Inc. was managed by Bill King. Bill King was a fully-fledged accountant. Bill King was in-charge of managing, directing and operating the Southern Care Inc. Just like the King and Associates Inc., the Southern Care was involved with skilled nursing facilities. Their work, however, was to prepare Medicare reports for the skilled nursing facilities. In most cases, they use to do business with the King and Associates Inc.
The Whistleblower claimed that from 2002 to May 2007, all the defendants made a false claim for Utilization Review (“UR”) services that were being presented in reports of cost to the Medicare Program. The whistleblower told the investigators that the King and associates Inc. and the Southern Care Inc. manipulated their clients so that they could present overstated amounts of the work that were performed by physicians in their claim. The law on Medicare guidelines requires that payments to be made only to physicians for their services on the utilization review (“UR”) committees. These payments for the services are what are accepted as the cost claims for any skilled nursing facility as explained by the article by the US. Attorney’s Office.
According to the article, “Civil Healthcare Fraud Allegations settled for $ 1.4 Million”, the whistleblower filed a qui tam complaint to the United States. The Whistleblower filed the case under the False Claims Act. The False Claim Act allows private entities to file a suit against organizations or persons who defraud the US. The Act also states that the whistleblower should receive part of any recovery that is made. After doing investigations, the United States intervened in the case filed by the whistleblower (on April 30th, 2008). The United States later, on June 2nd 2008, filed a case against Marie Kings, Bill Kings and associates. The case was settled through settlement agreement, and the United States was directed to pay nineteen-percent of the amount that would be recovered. The settlementagreement also directed that the defendants would pay $36,273.50 to the counsel of the whistleblower. Both Bill King and Marie King pleaded guilty and were sentenced for their actions of federal criminal violations. They were forfeited $ 600,000. The total amount that was to be shared partly to the whistleblower was $ 1,448,174.
I agree with the disposition of the case. I agree with the False Claim Act that ensures that those people who risk their lives and jobs in the processes of exposing fraud, are paid a portion of what is recovered. The move will serve as an encouragement and an assurance. The Act will encourage people to expose fraud so as to benefit in return. The Act assures one that part of the legal cost of the case will be covered. This means that people will not be worried about the cost of hiring a legal representative. In my view, the case was settled in the most appropriate way.
US. Attorney’s Office. Civil Health Care Fraud Allegations Settled for $1.4 Million. The Federal Bureau of Investigation (FBI), 7th August 2009) Web: Retrieved from; http://www.fbi.gov/Birmingham/press-releases/2009/bh08709.htm.