A weapon against nursing home fraud and abuse.

Using the federal Civil False Claims Act, plaintiff attorneys can fight fraud and ensure that nursing home residents who receive federal benefits get the care they need.

America is aging. As the baby boom generation moves from middle age to retirement age, tens of millions of Americans will be entitled to Medicare benefits. A significant percentage of these recipients will rely on Medicare as the primary means of obtaining health care.

Currently, about 1.6 million people, including the elderly and people with disabilities, are cared for in the nearly 17,000 nursing homes operating in the United States. As the percentage of our population over age 65 increases, the percentage of elderly people entering nursing homes will likewise increase.

Nursing home care is one of the fastest growing areas of Medicare and Medicaid spending.(1) Unfortunately, a significant portion of this money is going into the pockets of unscrupulous health care providers.

The General Accounting Office estimates that about 10 percent of the federal budget is lost to fraud and abuse in federal health care reimbursement programs.(2) The Department of Health and Human Services' Office of Inspector General has identified nursing homes and home health care as target areas of fraudulent schemes.

The federal Civil False Claims Act,(3) with its qui tam provision, has become one of the primary means the government has for fighting fraud in Medicare, Medicaid, and CHAMPUS or TRI-CARE programs. It has been successfully used to stop fraud and ensure that nursing home patients who receive federal benefits also receive the minimum standard of care required by the Nursing Home Reform Act.(4)

Plaintiff attorneys accustomed to handling negligent care or other tort actions for nursing home residents may not know about the legal tools available to fight the underlying problem of fraud in federal reimbursement programs. By using one of the most effective tools, the False Claims Act, attorneys can fight fraud and, in turn, ensure that nursing home residents who receive federal benefits also get the care they need.(5)

Sometimes referred to as the "Lincoln Law," the False Claims Act was passed at the urging of President Abraham Lincoln in 1863 to combat the fraud being perpetrated on the Union by profiteers selling shoddy, defective, or nonexistent goods. The act included monetary incentives for private individuals to combat the fraud.

This bounty concept was derived from English common law, which provided compensation for a person "who brings the action for the king, as well as for himself." The term "qui tam" is an abbreviation of the Latin translation of that phrase--qui tam pro domino rege quam pro sic ipso in hoc parte sequitur.(6)

The False Claims Act qui tam provisions were amended by Congress in 1943. The provision allowing the party bringing the lawsuit on behalf of the government to receive 50 percent of any recovery was eliminated. The amendments gave courts discretion to award as little as nothing, and no more than 25 percent of recoveries.

The amendments also included a jurisdictional bar to a qui tam action "whenever it shall be made to appear that such suit was based upon evidence or information in the possession" of the U.S. government. Consequently, government employees who possessed information forming the basis of qui tam allegations or fraud could not bring suit.

During the first few decades after World War II, America witnessed the rise of the military-industrial complex and the creation and expansion of federal entitlement programs. By the 1980s, fraud and abuse in these programs was believed to be widespread, and in 1986 Congress amended the False Claims Act and strengthened its qui tam provision.

As a consequence of the amendments, a defendant can be liable for three times the actual damages sustained by the government and be subject to a civil fine of between $5,000 and $10,000 for each false claim submitted. A successful qui tam plaintiff--the "relator" in the act's parlance--is entitled to receive between 15 percent and 30 percent of the funds recovered by the government.

The 1986 amendments eliminated the provision that automatically barred qui tam actions when the government already possessed the information given to it by a potential relator. They also eased the burden of proof by eliminating the need to prove specific intent to defraud the government. Instead, defendants may be found liable if a preponderance of the evidence shows they acted in "deliberate ignorance" or "reckless disregard" of the truth.

Practice and procedure

Liability under the act is established by proving that a person or entity improperly obtained money from the federal government or was improperly relieved of paying money to the government.

Most cases involve one or more of the following violations: (1) knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment;(7) (2) knowingly using or causing to be used a false record or statement to get a claim paid by the federal government;(8) (3) conspiring with others to get a false or fraudulent claim paid by the federal government;(9) and (4) knowingly using or causing to be used "a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property" to the federal government (a "reverse false claim").(10)

Since the act was amended, the number of qui tam actions filed and the amount of money recovered by the government have greatly increased. According to the Department of Justice (DOJ), $2 billion was recovered between 1986 and the end of fiscal year (FY) 1998.(11) Most of the recoveries have been in cases in which the DOJ intervened.

Only $60 million has been recovered by relators in cases in which the justice department did not intervene. Of the more than 2,400 qui tam cases filed since October 1986, the DOJ has intervened in 359 and declined to intervene in 1,252. The rest are still under investigation. On average, the federal government has paid to relators, as their statutory share, 17 percent of recoveries.

The percentage of cases involving health care fraud has increased dramatically since 1986. In that year, a little more than 10 percent of new cases that were filed involved the Department of Health and Human Services. By FY 1998, the number grew to 60 percent.

A relator brings suit on behalf of the U.S. government. The case must be filed under seal, and the relator must disclose to the government all evidence regarding the alleged fraudulent conduct. This information is also provided under seal.

After the complaint is served on the government, it has 60 days in which to intervene.(12) In practice, the government usually asks for multiple extensions of time to intervene. It is common for a year or more to pass before the government makes a decision.

If the government intervenes, the complaint is unsealed, and the Department of Justice takes over the case. The relator may continue to materially participate in the litigation and is entitled to between 15 percent and 25 percent of any recovery. An example of material participation would be the relator's submission of written discovery materials or participation at depositions, hearings, and trial.

If the government declines to intervene, the complaint is unsealed and the relator may continue to prosecute the action on the government's behalf. If successful, the relator is entitled to keep between 25 percent and 30 percent of the money recovered. Whether the government intervenes or not, the defendant must pay a successful relator's reasonable expenses and attorney fees.(13)

Based on the statistics, a case is more likely to succeed if the government agrees to intervene. Therefore, plaintiff lawyers should screen potential cases with this fact in mind.

Relators differ significantly from traditional tort plaintiffs in that they do not seek recovery for an injury or loss they have suffered. Instead, they bring an action on behalf of another party, the United States, for its loss.

The relator's role is to provide detailed knowledge of fraudulent conduct not previously known to the government. As such, potential relators must be scrutinized to determine the extent of the knowledge they possess, how they will come across as witnesses, and what their motivations are for bringing a qui tam action. Claims by former government employees with poor work records, personal grudges against the defendant, and limited personal knowledge of the fraud will probably not get the government's attention.

In nursing home cases, potential relators include anyone with firsthand knowledge of fraudulent conduct or of the delivery of substandard care to residents. Good candidates include former managers, medical directors, nursing directors, treating physicians, or other health care providers who have direct knowledge of the facility's operations, including billing procedures and patient care.

Unfortunately, nursing home residents --who are at high risk of abuse--are often unable to serve as relators. Most residents are not in positions that would allow them to observe systemic fraud or abuse in a facility. Also, they often have physical or mental disabilities that can hamper their ability to serve as effective witnesses. Therefore, a solid negligence case based on the abuse of a resident is not necessarily a viable qui tam action.

Punishment and prevention

Over the last five years, the federal government has increased efforts to crack down on fraud and abuse in nursing homes where a significant percentage of Medicare and Medicaid expenditures are made. These efforts have included issuing special fraud alerts, conducting multistate investigations, launching special initiatives, and filing False Claims Act lawsuits.

Fraud alerts. In 1995, the Health Care Finance Administration began an initiative to weed out fraud and abuse in nursing homes and skilled nursing facilities. In August of that year, the Department of Health and Human Services' Office of the Inspector General published a special alert concerning fraud and abuse in the provision of medical supplies to nursing facilities.(14)

Some of the illegal practices uncovered by the Office of the Inspector General included submitting Medicare claims for medical supplies and equipment that were not medically necessary or were not provided, billing twice for the same item, and paying or receiving kickbacks in exchange for Medicare and Medicaid referrals.

In June 1996, the Office of the Inspector General issued a special alert regarding fraud and abuse in the provision of services within nursing facilities.(15) Fraudulent practices identified in that alert included making claims for services not rendered or not provided as claimed and falsifying claims to circumvent coverage limitations on medical specialties.

Both alerts provide examples of the fraudulent conduct listed, as well as guidance on how to identify similar fraudulent practices within nursing homes. They are useful resources for practitioners who are investigating potential false claims act cases.

Multistate investigations. In May 1995, the Clinton administration launched a program called Operation Restore Trust (ORT), which was designed to stop health care fraud and abuse in the Medicare and Medicaid programs. ORT began as a two-year pilot project in California, Florida, Illinois, New York, and Texas--the five states where more than one-third of all Medicare and Medicaid recipients live.

The program focused primarily on home health agencies, nursing homes, and durable medical equipment suppliers. ORT proved to be very successful in its first two years, returning $23 to the federal treasury in overpayments for every $1 spent on the program.

In May 1997, the program was expanded to include 12 additional states. Eventually, the techniques developed by ORT investigators will be used in all 50 states and will be applied to all areas of Medicare and Medicaid spending.

Special initiatives. In March 1999, the Health Care Finance Administration said it intended to step up efforts to crack down on nursing homes that repeatedly violate health and safety requirements.(16) As part of that effort, the agency strengthened federal oversight of state enforcement of nursing home regulations and provided consumers with improved access to information about nursing homes through the Internet.

Increased enforcement is expected to come about primarily through the use of civil monetary penalties, which under new regulations would be much easier to impose on noncompliant nursing homes. The initiative has met with strong resistance from the nursing home industry, which in May 1999 filed a lawsuit to block implementation of the new monetary penalty enforcement rules.(17)

False Claims Act cases. The government has brought several cases under the act alleging improper billing for supplies and unnecessary or substandard care. These are useful guides for lawyers considering filing under the act.

An example of an improper billing case is a qui tam action recently filed in Ohio. It alleges that Deaconess Hospital and affiliated entities and physicians defrauded Medicare and Medicaid by engaging in "gang visits on nursing home residents," billing for services not performed, and providing inadequate patient care.(18)

According to the complaint, the defendants falsified medical records and charged for procedures not personally performed by the billing physicians but by nurses who routinely signed the physicians' names to records. The allegations also state that nurses adjusted doses of medication, including controlled substances, without first getting physicians' orders to do so.

An example of a case involving unnecessary care is one alleging that a Chicago nursing home's employees submitted false Medicare claims for psychological testing of unresponsive and comatose residents.(19) According to this complaint, the defendants knew the tests were not medically necessary.

The government also alleges that the testing took substantially less time to perform than the time billed to Medicare; that the defendants employed nonlicensed testers; and that these testers were told to conduct a second test, six months after the first, even though the residents' conditions had not changed.

Nursing Home Reform Act

Lawyers representing elderly clients who have been neglected or abused in nursing homes can use the False Claims Act to alert the government to substandard care in the facility. These cases use the act in conjunction with the Nursing Home Reform Act,(20) enacted as part of the Omnibus Budget Reconciliation Act of 1987.(21)

The Nursing Home Act requires nursing facilities to comply with federal requirements when providing services to patients.(22) It specifically requires that "[a] nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident."(23) Facilities must also "provide services and activities to attain or maintain the highest practicable physical, mental, and psychological well-being of each resident," which is to be done in accordance with individualized written care plans.(24)

The act specifies conditions under which restraints may be used on nursing home patients and establishes qualitative nutritional standards.(25) Regulations that have been promulgated under the act address the prevention and treatment of bedsores, the treatment of urinary incontinence, and the provision of naso-gastric tubes and hydration.(26)

The act also prohibits discrimination against Medicaid beneficiaries. It says "a nursing facility must establish and maintain identical policies and practices regarding transfer, discharge, and covered services under [Medicare and/or Medicaid] for all individuals regardless of source of payment."(27)

Moreover, Medicaid-eligible residents must be provided with necessary therapy regardless of whether the state's Medicaid program provides extra reimbursement for those services.(28) The law specifies that a person deciding whether to provide therapy in a nursing home cannot consider the source of reimbursement in making that decision.(29)

False Claims Act cases have been filed against nursing homes seeking to establish regulatory violations of the Nursing Home Act as the basis of violations of the False Claims Act. Liability is based on a certification signed by a nursing home administrator that says the home complied with all government regulations, including the Nursing Home Act.

By submitting the certification of compliance to the Health Care Finance Administration, the nursing facility represents that it has complied with the requirements of the Nursing Home Reform Act, and failure to do so makes any Medicaid claim for the cost of substandard care a false claim. When investigating a potential "substandard care" qui tam case, the attorney should look for evidence of widespread patient neglect, including physical abuse, inadequate staffing, lack of proper nutrition, excessive patient falls, excessive use of restraints, malnourishment, dehydration, and pressure sores.

An opinion holding that substandard care can be the basis for a False Claims Act case is United States ex rel. Aranda v. Community Psychiatric Centers, Inc.(30) In that case, the government alleged that a psychiatric hospital violated the False Claims Act by filing claims for reimbursement while "knowingly failing to provide the government-insured patients with a reasonably safe environment.(31)

The government alleged that patients suffered physical injuries and sexual abuse because the defendant did not provide adequate staff, monitoring equipment, and appropriate housing assignments. Specifically, the complaint alleged that the facility failed to take adequate precautions to protect patients with suicidal or "elopement" tendencies and to protect patients from other physically aggressive patients.

In Aranda, liability was imposed based on the defendant's failure to meet professionally recognized standards in health care as required by 42 C.F.R. [sections] 455.2., a regulation promulgated pursuant to 42 U.S.C. [subsections] 1902 (a)(4), 1903 (i)(2), and 1909 of the Social Security Act. It prohibits fraud in the Medicaid program. The court rejected the defendant's claim that it could not knowingly violate such a vague standard.(32)

A series of four False Claims Act cases based on claims that nursing homes provided inadequate care have been brought and settled by the assistant U.S. attorney for the Eastern District of Pennsylvania. Allegations included failure to provide adequate nutrition, nursing care, monitoring of water temperature (scalding), and staffing.(33) As in the Aranda case, the government's theory of liability in the Pennsylvania cases was based on the nursing homes' certification that the provision of services or items for which payment was claimed comported with all federal and state laws and regulations.(34)

For example, one of the Pennsylvania cases, United States v. GMS Management-Tucker, was based on the allegation that the owner and operator of a nursing home had failed to provide required care to its residents.(35) Specifically, the government alleged that the nursing facility failed to provide adequate nutrition and wound care to residents.

The residents had developed decubitus ulcers and were malnourished to the point that their bodies could not heal from the ulcers. The government contended the claims for reimbursement that the facility submitted to Medicare were false because the services provided did not conform with the Nursing Home Act.

The four Pennsylvania cases resulted in monetary settlements of between $100,000 and $600,000, as well as a consent decree requiring the homes to comply with the Nursing Home Act. Although these were not qui tam cases brought by private relators, they establish the viability of using the False Claims Act to prevent inadequate nursing home care.

Several other False Claims Act cases involving allegations of inadequate nursing home care have been filed outside of Pennsylvania. In September 1998, the Department of Justice announced that it intervened and simultaneously settled a qui tam suit alleging that a Maryland nursing home falsely certified compliance with federal laws requiring homes to meet certain standards of care to participate in state and federally funded health care programs.(36) The Department of Health and Human Services, through the Health Care Finance Administration, closed down the facility in December 1998 and moved residents to other facilities.

The agency also barred the home from further participation in the Medicare program because of continuing concerns regarding the quality of care. The federal district court ruled that the agency had the authority to close the nursing home even though the home had signed a consent agreement with the Department of Justice providing that it would comply with all government regulations, including the Nursing Home Act.

The 24-page agreement specified that the nursing home would, among other things, appoint a temporary manager and an independent monitor, and would hire a certified nurse practitioner to ensure the well-being of residents. The court ruled that the agency was not bound by the terms of an agreement entered into by the Department of Justice.(37)

Another nursing home qui tam complaint that was unsealed in July 1998 alleges that 10 California homes violated the False Claims Act by neglecting residents, falsifying patient records, and submitting bills to Medicare and Medicaid with the knowledge that the homes had failed to satisfy federally mandated conditions of participation.(38)

The complaint alleges the homes violated the Nursing Home Act by failing to provide individualized personal hygiene care plans for residents, adequate water, proper wound care, appropriate medications, or a safe environment. The DOJ declined to intervene in the action, which is pending.

In May 1999, the Department of Justice announced a settlement with Georgia-based Kansas Health Care Investors and Maryland-based Rehab Works, Inc. to resolve the allegations that the defendants falsely certified compliance with federal regulations regarding nursing home standards of care in order to receive Medicare reimbursement.(39) The homes allegedly provided inadequate nutrition and unsanitary living conditions to residents and billed Medicare for physical, occupational, and speech pathology therapy services that were not medically necessary.

As these cases illustrate, the False Claims Act provides an effective means of preventing fraud and ensuring that nursing home patients are given the level of care required by federal law. Every dollar lost to fraud or abuse is a dollar that is not available to provide needed care to nursing home residents.

The benefits to individuals who bring these cases and win are threefold. In addition to the monetary compensation provided by law, relators and their lawyers can also reap the reward of knowing that they have helped to combat wrongful conduct while improving the lives of some of our most vulnerable citizens.

Fraud and abuse

Unfortunately, a significant portion of Medicare and Medicaid money is going into the pockets of unscrupulous heath care providers.

Notes

(1.) DEPARTMENT OF HEALTH & HUMAN SERVS., OPERATION RESTORE TRUST OBJECTIVES AND FIRST-YEAR ACCOMPLISHMENTS (May 13, 1996) (visited Oct. 22, 1999), http:// waisgate.hhs.gov/cgi-bin/waisgate.

(2.) The GAO reported that, in 1997, 11 percent ($20.3 billion) and, in 1998, 7.1 percent ($12.6 billion) of the federal health care budget was improperly paid due to fraud and abuse. DEPARTMENT OF JUSTICE, HEALTH CARE FRAUD REPORT: FISCAL YEAR 1998, 3 (visited Oct. 22, 1999), http://www. usdoj.gov/dag/health98.htm#toc [hereafter 1998 FRAUD REPORT].

(3.) 31 U.S.C. [subsections] 3729-3733 (1994).

(4.) 42 U.S.C. [subsections] 1396r, 1395i-3 (1994).

(5.) The False Claims Act is a complex statute. This brief overview is no substitute for a thorough reading of the statutory language and the case law interpreting that language, which may differ in the various federal circuit courts. See Jeffrey A. Lovitky, Qui Tam Litigation: A Practical Primer, TRIAL, Jan. 1999, at 68.

(6.) United States ex rel. Stinson, Lyons, Gerlin & Bustamante, P.A.v. Prudential Ins. Co., 944 F.2d 1149, 1152 n.2, 1153 (3d Cir. 1991).

(7.) 31 U.S.C. [sections] 3729(a)(1) (1994).

(8.) Id. at [sections] 3729(a)(2) (1994).

(9.) Id. at [sections] 3729(a)(3) (1994).

(10.) Id. at [sections] 3729(a)(7) (1994).

(11.) 1998 FRAUD REPORT, supra note 2, at 6.

(12.) 31 U.S.C. [sections] 3730(b)(2) (1994).

(13.) See M. [sections] 3730(d) (1994).

(14.) Publication of OIG Special Fraud Alert: Home Health Fraud, and Fraud and Abuse in the Provision of Medical Supplies to Nursing Facilities, 60 Fed. Reg. 40,847 (1995). The OIG stated, "Nursing facilities and their residents have become common targets for fraudulent schemes involving medical supplies. The OIG has become aware of a number of fraudulent arrangements by which medical suppliers profit from inappropriate business dealings in the name of unwilling nursing facility residents. Sometimes, nursing facility management and staff are also involved in these schemes." Id. at 40,849.

(15.) Publication of OIG Special Fraud Alert: Fraud and Abuse in the Provision of Services in Nursing Facilities, 61 Fed. Reg. 30,623 (1996).

(16.) HEALTH CARE FINANCING ADMIN., COMPREHENSIVE PLAN FOR PROGRAM INTEGRITY (Mar. 1999) (visited Oct. 22, 1999), http://www.hcfa. gov/medicare/fraud/cover.htm.

(17.) American Health Care Ass'n v. Shalala, No. 1:99-CV-01207 (D.D.C. filed May 17, 1999), reported at 8 Health L. Rep. (BNA) 857 (May 27, 1999). This same industry group has criticized use of the False Claims Act to detect and prevent poor patient care in nursing homes. The group has drafted proposed changes to what it says is a broken enforcement system. Enforcement Reform, (visited Oct. 22, 1999), http://www.ahca.org/brief/Enforcement%20Reform. htm.

(18.) United States ex rel. Martin v. Deaconess Ass'ns, Inc., No. C-1-96- 1164 (S.D. Ohio filed Dec. 16, 1996), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., Oct. 1998, at 34. Other "improper billing" cases include United States v. Medco Physicians Unlimited, No. 98C1622 (N.D. Ill. filed Mar. 19, 1998), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., July 1998, at 48; United States v. Horizon/CMS Healthcare Corp. (settled before filing), reported at 7 Health L. Rep. (BNA) 1011 (June 25, 1998).

(19.) U.S.v. Donaldson & Kaplan, No. 98C3881 (N.D. Ill. filed June 24, 1998), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., Oct. 1998, at 34. Other "unnecessary care" cases include United States Royal Geropsychiatric Servs., Inc., 8 F. Supp. 2d 690 (N.D. Ohio 1998); United States v. Transcor, Inc., No. 96C7373 (N.D. Ill. filed Nov. 12, 1996), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., Jan. 1997, at20.

(20.) 42 U.S.C. [sections] 1396r (1994).

(21.) Id. at [sections] 1359i-3 (1994).

(22.) Id. at [subsections] 1396r (b), 1395i-3 (b) (1994).

(23.) Id. at [subsections] 1396r (b)(1)(a), 1395i-3 (b)(1)(a) (1994).

(24.) Id. at [subsections] 1396r (b)(2)(a), 1395i-3 (b)(2)(a) (1994).

(25.) Id. at [subsections] 1396r(c)(1)(A)(ii), 1396r(b)(4)(A)(iv) (1994).

(26.) 42 C.F.R. [sections] 483.25 (1998).

(27.) 42 U.S.C. [subsections] 1395i-3(c)(4), 1396r(c)(4), 1396r(c)(4)(a) (1994); 42 C.F.R. [sections] 483.12(c)(1) (1994).

(28.) 42 C.F.R. [sections] 483.45(a)(1)(2) (1998).

(29.) 42 U.S.C. [subsections] 1395i-3(c)(4), 1396r(c)(4)(a) (1994) [equal access provision]; 42 C.F.R. [sections] 483.12(c) (1) (1998).

(30.) 945 F. Supp. 1485 (W.D. Okla. 1996).

(31.) Id. at 1487.

(32.) Id. at 1488.

(33.) United States v. GMS Management-Tucker, Inc., No. 96-1271 (E.D. Pa. filed Feb. 21, 1996), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., July 1996, at 31; United States v. Chester Care Ctr., No. 98-CV-139 (E.D. Pa. filed Jan. 13, 1998), reported at 7 Health L. Rep. (BNA) 162 (Jan. 29, 1998); United States v. Philadelphia, No. 98-4253 (E.D. Pa.), reported at 7 Health L. Rep. (BNA) 1494 (Sept. 24, 1998); United States v. Integrated Health Servs. at Penn, Inc. (E.D. Pa. settled before filing), reported at 8 Health L. Rep. (BNA) 857 (May 27, 1999).

(34.) See David R. Hoffman, The Federal False Claims Act as a Remedy to Poor Care, FALSE CLAIMS ACT & QUI TAM Q. REV., July 1996, at 31.

(35.) GMS Management-Tucker, Inc., No. 96-1271.

(36.) United States v. Greenbelt Nursing & Rehabilitation (D. Md. filed Sept. 14, 1998), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., Oct. 1998, at 39.

(37.) See Northern Health Facilities, Inc. d/b/a Greenbelt Nursing & Rehabilitation Ctr. v. United States, No. AW-98-4006 (D. Md. Dec. 28, 1998), reported at 8 Health L. Rep. (BNA) 18 (Jan. 7, 1999).

(38.) United States ex rel. McKenzie & Swan v. Crestwood Hosps., Inc., No. CIV-5-97-0107 (E.D. Cal. filed Jan. 22, 1997), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., Oct. 1998, at 45.

(39.) No. 96-1427-WEB (D. Kan. filed Nov. 26, 1996), reported at FALSE CLAIMS ACT & QUI TAM Q. REV., July 1999, at 34. The case settled for more than $800,000.

John M. Parisi practices law in Overland Park, Kansas.