FHW Announces $299,000 Settlement in Whistleblower Retaliation Case
The law firm of Frank Haron Weiner, PLC has announced a settlement in the amount of $299,000 with the City of Dallas, Texas (“City”), to resolve allegations that the City retaliated against former employee Douglas Moore when it terminated his employment after learning Moore had filed a qui tam suit against the City under the federal False Claims Act and Texas Medicaid Fraud Prevention Act.
Moore, a former police officer for the City of Hurst, Texas, was employed by the City of Dallas as a fraud, waste and abuse investigator in the City Auditor’s Office. During the course of his employment, Moore became concerned that the City was defrauding the Medicare and Texas Medicaid programs by improperly billing for certain ambulance transport services. Moore advised other members of the City Auditor’s Office of the City’s potential risk of overpayment based on its billing Medicare and Medicaid for all ambulance transports at a higher level. Dallas City Auditor Craig Kinton testified that, although he was aware of Moore’s concerns and the City’s potential liability for an overpayment, he never reported the issue to the Dallas City Attorney’s Office, Texas Attorney General, Medicaid Fraud Control Unit, Medicare contractor, or the City’s ambulance billing vendor, Southwest General Services of Dallas, LLC, to discuss the issue.
In August of 2009, dissatisfied with the City’s response to his concerns, Moore filed suit in the U.S. District Court for the Northern District of Texas under the qui tam provisions of the federal False Claims Act and the Texas Medicaid Fraud Prevention Act. The federal False Claims Act (and similar state legislation, such as the Texas Act) allows private individuals with knowledge of fraud against the government to file lawsuits on the government’s behalf. If the case is successful, the private plaintiffs, known as “relators,” are entitled to a percentage of the monies recovered by the government.
Specifically, Moore’s complaint alleged that the company hired by the City to perform ambulance-service billing, Southwest General Services of Dallas, LLC, coded 100 percent of the City’s 911-dispatch ambulance transports at the Advanced Life Support (“ALS”) level, regardless of whether the patient’s medical condition justified the claim or if an ALS-level service was actually furnished. As a result, many runs should have been coded and billed as basic life support (“BLS”), which is reimbursed at a lower rate by both Medicare and Medicaid. Accordingly, Moore alleged that the City received higher Medicare and Medicaid reimbursements than it was entitled to and was at all times aware of Southwest General Services of Dallas, LLC’s activities.
On November 10, 2009, Moore received a “Fully Successful” performance review from the City, appraised by City Auditor Craig Kinton and Assistant City Auditor Gary Lewis. Kinton handwrote on the review that Moore’s “knowledge, skills and abilities are valuable assets to this office.” Despite this favorable performance review, Moore was terminated from his position with the City on December 2, 2009, two business days after the City was made aware of his lawsuit, because, according to Dallas City Auditor Craig Kinton, Moore’s services were no longer needed. Although Moore’s services were no longer needed, the City posted a job listing for Moore’s previous position days later.
Following his termination, Moore amended his complaint to add allegations of retaliation under the federal False Claims Act, the Texas Medicaid Fraud Prevention Act and the Texas Whistleblower Act. After a year without a job, Moore secured employment and continues to work in the field as a fraud investigator.
On June 7, 2011, the City of Dallas entered into a $2,470,000 settlement, plus statutory attorney fees, with the United States, Texas and Moore to resolve allegations of improper Medicare and Medicaid billings. Under the terms of the Settlement Agreement, Moore was entitled to receive up to 30 percent of the recovery as his relator’s share. In settling the suit, the City of Dallas neither admitted liability nor did the state or federal governments conclude that the claims were not well founded. Excluded from the settlement were any employment-related claims Moore had against the City for its retaliation for Moore’s investigation and reporting of the allegations.
Moore filed a second complaint in the U.S. District Court for the Northern District of Texas under the federal False Claims Act and Texas Medicaid Fraud Prevention Act against Southwest General Services of Dallas, LLC and the Cities of Cedar Hill, Celina, Corpus Christi, DeSoto, Frisco, Hurst, Mesquite, North Richland Hills, Plano, Richardson, Rowlett and University Park, Texas, including similar allegations of improper Medicare and Medicaid billing. The case, captioned United States of America, et al. ex rel. Moore v. City of Cedar Hill, et al., Civil Action No. 3:10-cv-0233-O (N.D. Tex.), resulted in settlements totaling $1,863,848, plus statutory attorney fees of $50,000.
In announcing the settlements, U.S. Attorney James T. Jacks of the Northern District of Texas praised the efforts of the Office of Inspector General of the U.S. Department of Health and Human Services and FBI. “Any time false claims are submitted for payment, the nation’s health insurance programs suffer,” said Special Agent in Charge Mike Fields of the OIG’s Dallas Regional Office.
The cases were handled by Assistant U.S. Attorney Sean McKenna, Assistant Texas Attorney General Sinty Chandy, and OIG Senior Counsel Ellen Slavin.
On October 26, 2011, the City of Dallas entered into a settlement with Moore in the amount of $299,000 to resolve allegations that it had retaliated against him for his investigation and reporting of the federal False Claims Act and Texas Medicaid Fraud Prevention Act allegations.
David L. Haron and Maro E. Bush of Frank Haron Weiner represented Moore in this litigation, in cooperation with Charles S. Siegel and Loren Jacobson of Waters & Kraus in Dallas, Texas.
Last year the federal government recovered over $2.3 billion from qui tam cases filed by private relators, according to statistics released by the U.S. Department of Justice. Over $1.9 billion was related to Medicare, Medicaid and other federally-funded health care programs.
Moore, a former police officer for the City of Hurst, Texas, was employed by the City of Dallas as a fraud, waste and abuse investigator in the City Auditor’s Office. During the course of his employment, Moore became concerned that the City was defrauding the Medicare and Texas Medicaid programs by improperly billing for certain ambulance transport services. Moore advised other members of the City Auditor’s Office of the City’s potential risk of overpayment based on its billing Medicare and Medicaid for all ambulance transports at a higher level. Dallas City Auditor Craig Kinton testified that, although he was aware of Moore’s concerns and the City’s potential liability for an overpayment, he never reported the issue to the Dallas City Attorney’s Office, Texas Attorney General, Medicaid Fraud Control Unit, Medicare contractor, or the City’s ambulance billing vendor, Southwest General Services of Dallas, LLC, to discuss the issue.
In August of 2009, dissatisfied with the City’s response to his concerns, Moore filed suit in the U.S. District Court for the Northern District of Texas under the qui tam provisions of the federal False Claims Act and the Texas Medicaid Fraud Prevention Act. The federal False Claims Act (and similar state legislation, such as the Texas Act) allows private individuals with knowledge of fraud against the government to file lawsuits on the government’s behalf. If the case is successful, the private plaintiffs, known as “relators,” are entitled to a percentage of the monies recovered by the government.
Specifically, Moore’s complaint alleged that the company hired by the City to perform ambulance-service billing, Southwest General Services of Dallas, LLC, coded 100 percent of the City’s 911-dispatch ambulance transports at the Advanced Life Support (“ALS”) level, regardless of whether the patient’s medical condition justified the claim or if an ALS-level service was actually furnished. As a result, many runs should have been coded and billed as basic life support (“BLS”), which is reimbursed at a lower rate by both Medicare and Medicaid. Accordingly, Moore alleged that the City received higher Medicare and Medicaid reimbursements than it was entitled to and was at all times aware of Southwest General Services of Dallas, LLC’s activities.
On November 10, 2009, Moore received a “Fully Successful” performance review from the City, appraised by City Auditor Craig Kinton and Assistant City Auditor Gary Lewis. Kinton handwrote on the review that Moore’s “knowledge, skills and abilities are valuable assets to this office.” Despite this favorable performance review, Moore was terminated from his position with the City on December 2, 2009, two business days after the City was made aware of his lawsuit, because, according to Dallas City Auditor Craig Kinton, Moore’s services were no longer needed. Although Moore’s services were no longer needed, the City posted a job listing for Moore’s previous position days later.
Following his termination, Moore amended his complaint to add allegations of retaliation under the federal False Claims Act, the Texas Medicaid Fraud Prevention Act and the Texas Whistleblower Act. After a year without a job, Moore secured employment and continues to work in the field as a fraud investigator.
On June 7, 2011, the City of Dallas entered into a $2,470,000 settlement, plus statutory attorney fees, with the United States, Texas and Moore to resolve allegations of improper Medicare and Medicaid billings. Under the terms of the Settlement Agreement, Moore was entitled to receive up to 30 percent of the recovery as his relator’s share. In settling the suit, the City of Dallas neither admitted liability nor did the state or federal governments conclude that the claims were not well founded. Excluded from the settlement were any employment-related claims Moore had against the City for its retaliation for Moore’s investigation and reporting of the allegations.
Moore filed a second complaint in the U.S. District Court for the Northern District of Texas under the federal False Claims Act and Texas Medicaid Fraud Prevention Act against Southwest General Services of Dallas, LLC and the Cities of Cedar Hill, Celina, Corpus Christi, DeSoto, Frisco, Hurst, Mesquite, North Richland Hills, Plano, Richardson, Rowlett and University Park, Texas, including similar allegations of improper Medicare and Medicaid billing. The case, captioned United States of America, et al. ex rel. Moore v. City of Cedar Hill, et al., Civil Action No. 3:10-cv-0233-O (N.D. Tex.), resulted in settlements totaling $1,863,848, plus statutory attorney fees of $50,000.
In announcing the settlements, U.S. Attorney James T. Jacks of the Northern District of Texas praised the efforts of the Office of Inspector General of the U.S. Department of Health and Human Services and FBI. “Any time false claims are submitted for payment, the nation’s health insurance programs suffer,” said Special Agent in Charge Mike Fields of the OIG’s Dallas Regional Office.
The cases were handled by Assistant U.S. Attorney Sean McKenna, Assistant Texas Attorney General Sinty Chandy, and OIG Senior Counsel Ellen Slavin.
On October 26, 2011, the City of Dallas entered into a settlement with Moore in the amount of $299,000 to resolve allegations that it had retaliated against him for his investigation and reporting of the federal False Claims Act and Texas Medicaid Fraud Prevention Act allegations.
David L. Haron and Maro E. Bush of Frank Haron Weiner represented Moore in this litigation, in cooperation with Charles S. Siegel and Loren Jacobson of Waters & Kraus in Dallas, Texas.
Last year the federal government recovered over $2.3 billion from qui tam cases filed by private relators, according to statistics released by the U.S. Department of Justice. Over $1.9 billion was related to Medicare, Medicaid and other federally-funded health care programs.