False Claims Investigation

SITUATION

When a whistleblower sounded the alarm on their employer that had allegedly violated the Anti-Kickback Statute and submitted false claims to the government, FSS was hired by the whistleblower’s attorneys to pinpoint evidence and determine the value of any identified claims.

STRATEGY

This qui tam case involved allegations that the company compensated a third-party organization in exchange for referrals for services that were payable by a federal program. FSS worked with the whistleblower’s attorneys to request relevant data, including:

  • Transactional data, from two disparate billing systems, detailing claims submitted to the government
  • Records of purchases from vendors of goods provided to their customers by the third-party organization
  • Emails between the company, their customers, and/or the third-party organization requesting and acknowledging receipt of the goods

FSS used advanced data analytics to:

  • Test the transactional data to determine its validity
  • Aid the attorneys in preparing responses when the data production was not responsive
  • Participate in hearings with the judge to discuss the data needs and responses
  • Reconstruct disparate data – both structured and unstructured – into a single database for analysis to Identify and develop evidence of false claims and the value thereof
  • Testify to our findings
RESULTS

We identified and developed evidence of government reimbursement for thousands of false claims submitted by the company to the government totaling more than $10 million.

Through the reconstruction of the disparate structured and unstructured data into a single database for analysis, FSS was able to identify evidence that customers were incentivized to do business – and that the third-party organization was paid kickbacks by the company. The structured data was used to establish that the claims were submitted to the government. The unstructured data was compared against the structured data – allowing us to draw the connection among the incentivized referral (goods provided to the customer), claim submission to and reimbursement from the government, and commission payment to the third-party organization.