Source: http://www.wvlegislature.gov/legisdocs/chamber/2014/rs/floor_amends/HB4001%20HFA%20SHOTT,%20ET.%20AL.%202-24%20_1.htm
Timestamp: 2018-01-18 22:02:00
Document Index: 71650892

Matched Legal Cases: ['§9', '§14', '§14', '§14', '§14', '§14', '§14', '§14', '§14', '§14', '§14', '§14', '§14']

HB4001 HFA SHOTT, LANE, ESPINOSA AND MCCUSKEY 2-24
Dels. Shott, Lane, Espinosa, and McCuskey move to amend the Committee Substitute by striking everything following the enacting clause and inserting in lieu thereof the following:
“ That §9-7-6 of the Code of West Virginia, 1931, as amended, be amended and reenacted; and that said code be amended by adding thereto a new article, designated §14-4-1, §14-4-2, §14-4-3, §14-4-4, §14-4-5, §14-4-6, §14-4-7, §14-4-8, §14-4-9, §14-4-10, §14-4-11, and §14-4-12, all to read as follows:
(a) Any person, firm, corporation or other entity which willfully, by means of a false statement or representation, or by concealment of any material fact, or by other fraudulent scheme, devise or artifice on behalf of himself, herself, itself, or others, obtains or attempts to obtain benefits or payments or allowances under the medical programs of the Department of Health and Human Resources to which he or she or it is not entitled, or, in a greater amount than that to which he or she or it is entitled, or any provisions of section two, article four, chapter fourteen of
this code, shall, in addition to any other penalties provided by
law, be liable to the Department of Health and Human Resources in an amount equal to three times the amount of such benefits, payments or allowances to which he or she or it is not entitled, for civil penalties of (1) payment of interest on the amount of the excess benefits or payments at the maximum legal rate in effect on the date the payment was made to said person, firm, corporation, partnership or other legal entity for the period from the date upon which payment was made to the date upon which repayment is made to the State, (2) payment of an amount not to exceed three times the amount of such excess benefits or payments, (3) payment in the sum of not less than and not more than the civil penalty allowed under section two, article four, chapter fourteen of this code, as it may be adjusted for inflation pursuant to the Federal Civil Penalties Inflation Adjustment Act of 1990, Pub.L.101-410 for each excessive claim for assistance, benefits or payments, and (4) and shall be liable for the payment of reasonable attorney fees and all other fees and costs of litigation.
(C) Exceeds in value the sum of $25,000 at the time the claim is presented; provided, that this limit does not apply to claims brought for fraud and abuse in the medicaid program.
(D) “Claim” does not include a request or demand for money or property that the state has paid to an individual as compensation for state employment or as an income subsidy with no restrictions on that individual’s use of the money or property.
(3) “Knowingly” or “knowing” means that a person has actual knowledge of the information. Innocent mistake shall be a defense to an action under this act; provided, that for claims brought for fraud and abuse in the medicaid program, and that for all such claims “knowingly” or “knowing” means that a person, with respect to information
(C) Acts in reckless disregard of the truth or falsity of the information; and
(b) A copy of the complaint and written disclosure of substantially all material evidence and information the person possesses shall be served on the Attorney General. The complaint shall also be filed in camera, shall remain under seal for at least sixty days and may not be served on the defendant until the court so orders. The state may elect to intervene and proceed with the action within sixty days after it receives both the complaint and the material evidence and the information. Any information or documents furnished by the relator to the Attorney General in connection with the initiation of a qui tam action or investigation under this subdivision is not a public record and is exempt from disclosure under chapter twenty-nine-b of this code.
(d) Before the expiration of the sixty-day period or any extensions obtained under subsection (c), the Attorney General shall review the action and shall issue findings that:
(1) The cause has a reasonable basis in fact and that the Attorney General’s office shall proceed with the action, in which case the Attorney General shall intervene and conduct the action on behalf of the state;
(2) The cause has a reasonable basis in fact but the Attorney General’s office declines to proceed with the action, in which case the Attorney General shall notify the court that it declines to take over the action, in which case the person bringing the action shall have the right to conduct the action; or
(3) In any claims other than those for claims brought for fraud and abuse in the medicaid program, if the cause does not have a reasonable basis in fact, it may not proceed; provided, that any finding by the Attorney General that the cause is not meritorious is subject to an en banc review by the West Virginia Supreme Court of Appeals, which may approve or reverse such finding. If the person bringing the civil action elects to seek such review of the finding, he must file his request upon forms provided by the Court for that purpose within sixty days after receipt of the finding and deliver a copy of the form to the Attorney General. Within sixty days after receipt of a copy of the form, the Attorney General shall deliver to the Supreme Court of Appeals copies of the complaint and all evidence and information provided by the person bringing the civil action together with copies of all evidence developed by the Attorney General during his investigation. If, upon review, the West Virginia Supreme Court of Appeals finds that the cause has a reasonable basis in fact, then the cause may proceed under subdivision two of this subsection.
(f) In any action brought under the provisions of this section, the Attorney General, or any other person bringing the action, shall be required to prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.
(a) If the Attorney General proceeds with the action, it has the primary responsibility for prosecuting the action, and may not be bound by an act of the person bringing the action. That person may continue as a party to the action, subject to the limitations set forth in subsection (b).
(b) (1) The Attorney General may seek to dismiss the action for good cause notwithstanding the objections of the qui tam plaintiff if the qui tam plaintiff has been notified by the Attorney General of the filing of the motion and the court has provided the qui tam plaintiff with an opportunity to oppose the motion and present evidence at a hearing.
(A) Upon a hearing on the Attorney General’s motion to dismiss the action, the Court shall consider, and is authorized to grant, a proposal by the qui tam plaintiff to proceed with the action without the Attorney General’s participation.
(2) The Attorney General may settle the action with the defendant notwithstanding the objections of the qui tam plaintiff if the court determines, after a hearing providing the qui tam plaintiff an opportunity to present evidence, that the proposed settlement is fair, adequate and reasonable under all of the circumstances.
(3) Upon a showing by the Attorney General that unrestricted participation during the course of the litigation by the person initiating the action would interfere with or unduly delay the Attorney General’s prosecution of the case or would be repetitious, irrelevant or for purposes of harassment, the court may impose limitations on the person’s participation, such as:
(c) If the Attorney General elects not to proceed with the action, the person who initiated the action may conduct the action. If the Attorney General so requests, it shall be served with copies of all pleadings filed in the action and shall be supplied with copies of all deposition transcripts (at the state’s expense). When a person proceeds with the action the court, without limiting the status and rights of the person initiating the action, may nevertheless permit the Attorney General to intervene at a later date upon a showing of good cause.
(d) Whether or not the Attorney General proceeds with the action, upon a showing by the state that certain actions of discovery by the person initiating the action would interfere with the state’s investigation or prosecution of a criminal or civil matter arising out of the same facts, the court may stay discovery for a period of not more than sixty days. Such a showing shall be conducted in camera. The court may extend the sixty-day period upon a further showing in camera that the state has pursued the criminal or civil investigation or proceedings with reasonable diligence and any proposed discovery in the civil action will interfere with the ongoing criminal or civil investigation or proceedings.
(a) (1) In any claims brought for fraud and abuse in the medicaid program, if the Attorney General proceeds with an action brought by a person under section four of this article, that person shall receive at least fifteen percent but not more than twenty-five percent of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one that the court finds to be based primarily on disclosures of specific information, other than information provided by the person bringing the action, relating to allegations or transactions in a criminal, civil, or administrative hearing, in a legislative, administrative, or state auditor’s report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than ten percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs prior to the attorney general’s intervention. All expenses, fees and costs shall be awarded against the defendant.
(2) In any claims other than those for claims brought for fraud and abuse in the medicaid program, if the Attorney General proceeds with an action brought by a person under section four of this article, that person shall receive not more than twenty percent of the proceeds of the action or settlement of the claim, or $250,000 whichever is lesser, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one that the court finds to be based primarily on disclosures of specific information, other than information provided by the person bringing the action, relating to allegations or transactions in a criminal, civil, or administrative hearing, in a legislative, administrative, or state auditor’s report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than ten percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs prior to the attorney general’s intervention. All expenses, fees and costs shall be awarded against the defendant.
(b)(1) If the Attorney General does not proceed with an action under this section, in any claims brought for fraud and abuse in the medicaid program, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than twenty-five percent and not more than thirty percent of the proceeds of the action or settlement and shall be paid out of the proceeds. The person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred. All expenses, fees and costs shall be awarded against the defendant.
(2) If the Attorney General does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount may not exceed more than thirty percent of the proceeds of the action or settlement and shall be paid out of the proceeds; nor, in any circumstance, shall the award exceed $1,000,000 absent a specific finding by the judge that such award is necessary and proper based upon specific factual circumstances unique to the action. The person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, which, at the court’s discretion may include reasonable attorneys’ fees and costs up to an amount not to exceed fifty percent of the plaintiff’s recovery. All expenses, fees and costs are the contractual obligation of the person bringing the action and are not the responsibility of the state; provided, the court shall award to the defendant its reasonable attorney's fees and expenses against the person bringing the civil action if the defendant prevails in the civil action and the court finds that the claim of the person bringing the civil action was clearly frivolous, clearly vexatious, or brought primarily for purposes of harassment.
(c) Whether or not the Attorney General proceeds with the action, if the court finds that the action was brought by a person who planned and initiated the violation of section two upon which the action was brought, then the court may, to the extent the court considers appropriate, reduce the share of the proceeds of the action which the person would otherwise receive under subsection (a) or (b) of this section, taking into account the role of that person in advancing the case to litigation and any relevant circumstances pertaining to the violation. If the person bringing the action is convicted of criminal conduct arising from his or her role in the violation of section two of this article, that person shall be dismissed from the civil action and may not receive any share of the proceeds of the action. The dismissal does not prejudice the right of the state to continue the action.
(d) Following any distributions under subsections (a) through (c), the agency injured by the submission of a false claim shall be awarded an amount not to exceed its compensatory damages. All remaining proceeds, including civil penalties awarded under this article, shall be deposited in accordance with section twelve of this article.
(a) Except in any claim brought for fraud and abuse in the medicaid program, a court does not have jurisdiction over an action brought under section four of this article based on information discovered by a present or former employee of the state during the course of his employment unless that employee, first, in good faith, exhausted existing internal procedures for reporting and seeking recovery of the falsely claimed sums through official channels and unless the state failed to act on the information provided within a reasonable period of time.
(b) A court does not have jurisdiction over an action brought under section four of this article against any department, authority, board, bureau, commission, or agency of the state, any political subdivision of the state, a member of the Legislature, a member of the judiciary, or an exempt official if the action is based on evidence or information known to the state when the action was brought. For purposes of this section, "exempt official" means the Governor, Attorney General and the directors or members of any department, authority, board, bureau, commission or agency of the state or any political subdivision of the state.
(c) A court does not have jurisdiction over an action brought under section four of this article by an inmate incarcerated within a state or local correctional facility as defined in this Code.
(d) A person may not bring an action under section four of this article which is based upon allegations or transactions which are the subject of a civil suit or an administrative civil money penalty proceeding in which the state is already a party.
(e) (1) The court shall dismiss an action or claim under this article, unless opposed by the state, if substantially the same allegations or transactions as alleged in the action or claim were publicly disclosed:
(2) For purposes of this section, “original source” means an individual who either:
(A) Prior to a public disclosure, has voluntarily disclosed to the state the information on which allegations or transactions in a claim are based, or
(B) Who has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions, and who has voluntarily provided the information to the state before filing an action under this article.
(c) Any state employee who has suffered as a result of lawful acts done by the employee, contractor, agent or associated others in furtherance of an action brought or to be brought under sections three or four of this article, or other efforts to stop one or more violations of this article may pursue a grievance under the West Virginia Public Employees Grievance Procedure, or through a local grievance process, if applicable; provided: any relief awarded to an employee under this section shall be reduced by any amount awarded to the employee through a state or local grievance process.
(d) Nothing in this article shall disparage impair or limit any other right or legal action of an employee, contractor or agent.
(b) If the state elects to intervene and proceed with an action brought under section four of this article, the state may file its own complaint or amend the complaint of a person who has brought an action under section four of this article to clarify or add detail to the claims in which the state is intervening and to add any additional claims with respect to which the state contends it is entitled to relief. For statute of limitations purposes, any such state pleading shall relate back to the filing date of the complaint of the person who originally brought the action, to the extent that the claim of the state arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth, in the prior complaint of that person.
(c) Estoppel. Notwithstanding any other provision of law, a guilty verdict rendered in a criminal proceeding charging false statements or fraud, whether upon a verdict after trial or upon a plea of guilty or nolo contendre, shall estop the defendant from denying the essential elements of the offense in any action which involves the same transaction as in the criminal proceeding and which is brought under section three or four of this article.
(d) An action under section three or four of this article may be brought in a circuit court of any county in which the defendant or any one of multiple defendants can be found, resides, or transacts business, or in any county in which any act prohibited by section two of this article occurred. The Attorney General or the person who brought the action shall prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.
(e) A subpoena requiring the attendance of a witness at a trial or hearing conducted under this article may be served at any place in the state.
Following the satisfaction of the provisions of subsection (d) of section six of this article, for the fiscal year beginning July 1, 2014, all proceeds the state shall receive from successful actions brought under the provisions of this article shall be deposited as follows: (1) ten percent into the account of the Office of the Attorney General for operation of the Consumer Protection Division of that Office; (2) ten percent into the account of the Office of the Attorney General for operations in that office to carry out the mandates of this article; (3) ten percent into the Education Improvement Fund for appropriation by the Legislature to the PROMISE Scholarship Fund created in section seven, article seven, chapter eighteen-c of this code; (4) ten percent into the account of the School Building Authority School Construction Fund created pursuant to section six, article nine-d, chapter eighteen of this code; (5) ten percent into the Feed to Achieve initiative nonprofit foundation of the State Board of Education created pursuant to section four, article five-d, chapter eighteen of this code, to be spent in accordance with the provisions of said article; (6) ten percent into the State Road Fund in the State Treasury and expended by the Commissioner of Highways for design, maintenance and construction of roads in the state highway system; (7) ten percent into a fund to enable the Bureau of Senior Service to carry out programs pursuant to section nine, article five-p, chapter sixteen of this code; (8) ten percent into a fund to be established to enable the Department of Health and Human Resources to build substance abuse centers; (9) ten percent into a fund to be established for a fund to provide mental health services to veterans under the direction of the Department of Veteran’s Affairs; and (10) ten percent into the Teachers' Retirement System created pursuant to section one, article seven-a, chapter eighteen of this code.”