New Jersey False Claims Act Lawsuit Seeks Damages for Alleged Healthcare Fraud

Employees who suspect that their employers are engaging in unlawful acts might hesitate to report what they know for fear of losing their jobs. Federal and New Jersey employment laws address those concerns by prohibiting employers from retaliating against employees, commonly known as whistleblowers, who voice their concerns about allegedly unlawful practices. The federal False Claims Act (FCA) gives whistleblowers an added incentive to go public in cases involving alleged fraud against the federal government. An employee can file a qui tam lawsuit under the FCA on behalf of the United States. The employee is entitled to a percentage of the settlement or award in the case. A lawsuit currently pending in a New Jersey federal court involves a hospital administrator who alleges that his now-former employer defrauded a COVID-19 relief program.

The FCA establishes a civil penalty of $5,000 to $10,000 for various types of false claims and other fraudulent activities targeting the federal government. The government may file suit under the FCA. An individual, known as the “relator,” may file suit on the government’s behalf. Relators are often employees with knowledge of alleged wrongdoing by their employers. The government can intervene and take over the case from the relator. If the government declines to intervene, the relator may continue pursuing the lawsuit on their own.

The relator is entitled to a percentage of any recovery in the lawsuit, whether it comes from a settlement or an award after a trial. If the federal government intervenes and takes over the case, the relator may receive fifteen to twenty-five percent. They are entitled to twenty-five to thirty percent if they pursue the case themselves.

Employers may not retaliate against employees who file qui tam lawsuits under the FCA. This includes firing, demotion, threats, and harassment. An employer who violates this provision may be liable for back pay and other monetary damages. A relator who loses their job may be entitled to reinstatement.

The relator in the lawsuit mentioned above worked as an administrator for a hospital system. The defendants include various entities that operate within this system, as well as several individuals who worked as executives. The alleged fraud involves the Provider Relief Fund (PRF), a program created by Congress to help healthcare providers during the COVID-19 pandemic. Congress allocated $186.5 billion for the PRF program.

The lawsuit alleges that the defendants received PRF money for patients who did not have COVID-19 and repeatedly refused to return the overpayments to the government. This allegedly involved about 1,200 patients and over $50 million. If each patient constitutes a separate violation, that could mean $6 million to $12 million in penalties. The relator further alleged retaliation by the defendants to the point that he quit his job.

The relator filed his lawsuit in November 2021, asserting causes of action for conversion of government money and wrongful retention of overpayments. The FCA gives the government sixty days to decide whether to intervene but allows sealed requests for extensions. The government declined to intervene in June 2023, and the defendants were served soon afterward. The relator is seeking thirty percent of the settlement or award.

If you believe your employer has engaged in unlawful activities, either by violating your rights as an employee or defrauding the government, you need an experienced advocate on your side. The employment lawyers at the Resnick Law Group represent New Jersey and New York workers in a wide range of claims. Please contact us today online, at 973-781-1204, or at 646-867-7997 to schedule a confidential consultation to discuss your rights and options.

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