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    Arent Fox is Finding Truths in the False Claims Act

    October 15, 2014

    In 2005, a so-called “whistleblower,” who stood to gain millions of dollars from his accusations, claimed that one of the oldest most respected health care systems in the Northeast region of the United States had violated the False Claims Act by improperly inflating its Medicare claims.

    The accusations and subsequent government investigation threatened to close the doors of the health care system’s network of facilities – including a medical center, a children’s hospital, a nursing home, home health services, and nearly 30 ambulatory care and other clinical sites – and suddenly deprive thousands the thousands of patients served annually of much needed health care services.

    To defend itself against the allegations of fraud, the health system turned to Arent Fox, one of the most respected Medicare and Medicaid False Claims defense firms in the nation, a firm with a well-earned reputation for tackling the thorniest allegations of health care fraud around, aggressively but quietly defending its clients while simultaneously working to protect the client’s reputation and preserve its confidentiality.

    Arent Fox went to work to examine the charges and claims involved to show the US Justice Department and the whistleblower’s counsel that the client had strong defenses it could assert to rebut allegations of Medicare reimbursement fraud. The Arent Fox team worked closely with the client in the painstaking collection and analysis of the hospital’s policies, procedures, claims and other documents for the period when the improper billing of Medicare was alleged to have taken place. Using the information collected in conjunction with the complex formula Medicare uses to calculate outlier payments, Arent Fox attorneys presented their findings and defenses to government investigators, Justice Department lawyers and the whistleblower’s counsel.

    In light of the findings and defenses Arent Fox was able to establish, the whistleblower’s law firm recognized that its chances of winning had been significantly reduced. Consequently, the whistleblower and his attorneys entered into negotiations with Arent Fox to settle the lawsuit with Justice Department oversight.

    In October 2008, Arent Fox’s Linda Baumann and a team of attorneys from the firm’s health care and litigation groups finalized an extraordinarily favorable settlement agreement for their client. Indeed, the agreement negotiated by Arent Fox was one of the lowest amounts reportedly paid to the whistleblower in his various suits against other hospital systems.

    To read the full story of how Arent Fox enabled our client to settle the case at a remarkably low cost with its well-earned reputation for decency and integrity intact, please click here.