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How To Write A Qui Tam Complaint: A Tutorial Series

Article #7 The Medicaid Program Law Section

Posted on Sunday, December 23, 2012, 04:40:00 PM Eastern Time USA by JOSEPH J. PAPPACODA, ESQ..




Several States have either full or limited False Claims Act statutes authorizing a Relator to file a State Qui Tam Case. To the extent that your federal case alleges Medicare Fraud you can also include any Medicaid Fraud allegations within the body of your federal Qui Tam Complaint, as Medicaid is partially funded by the United States. Ergo, the United States is a victim of Medicaid fraud, notwithstanding that the Medicaid Program is administered by the States.

In the event you elect to file a State False Claims Act Case you would need to determine if your particular State has a False Claims Act on the books to begin with. Assuming it does, next you would need to decide if you wanted to go through all of the pre-filing prerequisites, pre-filing disclosures, other pre-filing requirements, and filing requirements, or not. You would be doubling your work load to complete both a Federal False Claims Act filing and a State False Claims Act filing with the same set of facts. You may also learn that any State filing may take a backseat to your federal filing. In certain instances with the right set of facts however, you might gain a certain level of leverage in federal settlement negotiations by having both filings pending concurrently. The decision is really yours. There is no right or wrong answer.

In any event, if you are working on completion of a federal Medicare fraud False Claims Act Complaint you may include the Medicaid fraud allegations within the body of the federal Complaint. Make sure to include your State Medicaid fraud averments within the body of the federal Complaint.

If you chose to include your Medicaid fraud False Claims Act case within the Federal Qui Tam Complaint your The Medicaid Program Law Section may look something like this (Section numbers and paragraph numbers should be tailored to fit you Complaint):

"X. THE MEDICAID PROGRAM

67. Medicaid is a federally assisted grant program for the states, which enables them to provide medical assistance and related services to needy individuals. The United States Department Of Health and Human Services, through the Centers for Medicare & Medicaid Services, administers the Medicaid program at the federal level. Although each state decides who is eligible and what services will be offered to Medicaid recipients, the states obtain federal funding for the program from accounts which draw on funds of the United States Treasury. Those persons or entities that wish to become participating providers in Medicaid, and who wish to become participating providers in Medicaid, and who wish to received reimbursement for covered medical services, must agree to abide by the provisions of Title XIX of the 1965 Amendments to the Federal Social Security Act, entitled “Grants to the States for Medical Assistance Programs”, as set forth at 42 USC §§ 1396 to 1396v. See United States v. Omni H.C, Inc., 2008 WL 906425, p. 3 (M.D. Fla. Mar. 31, 2008).

68. Several United States District Courts have held that claims submitted to Medicaid are claims submitted to the federal government for purposes of 31 USC § 3729. See United States v. Omni H.C., Inc., 2008 WL 906425, p. 4 (M.D. Fla. Mar. 31, 2008); See also United States v. Cathedral Rock Corp., 2007 WL 4270784, p. 3 (E.D. MO Nov. 30, 2007); See also United States ex. rel Tyson v. Amerigroup Ill., Inc., 2005 WL 2667207 (N.D. Ill. Oct. 17, 2005)."

These averments can be and should be modified or supplemented for your particular case. The idea here is to show the Court and US Attorney why Medicaid fraud averments can be appended to the federal filing under 31 U.S.C. § 3729.

For further information on the False Claims Act, or your specific Quitam case, please contact Attorney Joe Pappacoda directly at 954-560-2616, or use the link found at USFraudCases.com.

Copyright 2012 Law Offices Of Joseph J. Pappacoda, Fort Lauderdale, Florida 33301.



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