Connecticut Attorney General George Jepsen has filed a claim under Connecticut’s False Claims Act (“FCA”) alleging that 28 individuals, dental practices, and corporations engaged in a scheme to defraud the state’s Medicaid program to the tune of $24 million. The Connecticut law is one of 10 state FCAs in the U.S. which only allows for recovery in cases concerning fraudulent claims for payment under the Medicaid program; the  twenty other states that have approved their own FCAs allow for recovery in a much broader array of cases, providing a much closer parallel to the scope of liability under the federal False Claims Act. Most state-level FCAs are modeled after the federal law. The Connecticut FCA allows the state to seek compensation for taxpayers from those who submit false claims for reimbursements they are not eligible to receive. The complaint seeks restitution, treble damages, and civil penalties, as well as a permanent injunction against the wrongful conduct alleged in the complaint.

According to the complaint, one of the individuals allegedly involved in the scheme has previously been convicted of a felony in another state for submitting false health care claims, as a result of which he was permanently excluded by the U.S. Department of Health and Human Services from participation in Medicare or Medicaid. Despite the exclusion, the individual set up numerous dental practices in Connecticut that were operated by practicing dentists who improperly billed Medicaid for services, allegedly receiving millions of dollars in Medicaid reimbursements. The dental practices’ failure to disclose their association with an individual excluded by Medicaid on enrollment and re-enrollment forms for the Connecticut Medical Assistance Program would constitute fraud pursuant to the Connecticut FCA.

Twenty states have full-fledged FCAs based largely off of the federal law, the qui tam provisions of which enable whistleblowers (also known as relators) to sue contractors and individuals who have allegedly made false claims for payment from the federal government or in order to evade liability. Recent changes to the federal law have augmented the Act’s coverage to include false claims made to third party grantees or other beneficiaries of government money. Relators may file claims on the government’s behalf, and while the government may interevene in the litigation, it does not always do so. Relators may recover between 15% and 30% of any settlement or final judgment. Moreover, the law protects employees who make efforts to stop violations of the FCA or who file a qui tam action under the statute from retaliation by their employers.

 

 

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