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La “False Claim Act” américaine: quand la lutte anti-fraude devient payante pour le citoyen .

Publié le 03 novembre 2009 par Helenebouchard

dreamstime_1072032Durant la guerre civile américaine le gouvernement nordique achetait des mules, des chevaux et des armes en grande quantité. La porte s’est donc ouverte pour que des fournisseurs peu scrupuleux livrent des mules et chevaux malades, des armes défectueuses et des mauvaises denrées. La fraude était grande et le gouverment de la Justice n’avait pas les ressources pour enquêter et donc, de punir. Lincoln fit voter une loi: la False Claim Act :

“Worse than traitors in arms are the men who pretend loyalty to the flag, feast and fatten on the misfortunes of the nation while patriotic blood is crimsoning the plains of the south and their countrymen are moldering in the dust.”

Cette loi  est toujours en vigueur aujourd’hui ( après plusieurs amendements) et assez populaire.

Une personne , ayant la connaissance et les preuves d’une fraude peut poursuivre au nom du gouvernement  les présumés fraudeurs:

The False Claims Act contains qui tam, or whistleblower, provisions. Qui tam is a unique mechanism in the law that allows citizens with evidence of fraud against government contracts and programs to sue, on behalf of the government, in order to recover the stolen funds. In compensation for the risk and effort of filing a qui tam case, the citizen whistleblower or “relator” may be awarded a portion of the funds recovered, typically between 15 and 25 percent.  A qui tam suit initially remains under seal for at least 60 days during which the Department of Justice can investigate and decide whether to join the action.

En réponse aux fraudes de plus en plus fréquentes et importantes , le gouvernement remet au lanceur d’alerte ( whistleblower) une récompense de 15% à 30% des sommes recouvrées selon les cas(  50% dans le temps de Lincoln) :

The 1986 amendments strengthened the False Claims Act’s qui tam provisions, creating incentives for private citizens with evidence of fraud to commit their time and resources to supplement the Government’s efforts. By doing so, Congress put into play a powerful public-private partnership for uncovering fraud against the federal fisc and obtaining the maximum recovery for American taxpayers.

Le but poursuivi est de changer la culture de la fraude pour une meilleure gouvernance. Les fraudes sous la loupe sont :

  • Billing for goods and services that were never delivered or rendered.
  • Billing for marketing, lobbying or other non-contract related corporate activities.
  • Submitting false service records or samples in order to show better-than-actual performance.
  • Presenting broken or untested equipment as operational and tested.
  • Performing inappropriate or unnecessary medical procedures in order to increase Medicare reimbursement.
  • Billing for work or tests not performed.
  • Billing for premium equipment but actually providing inferior equipment.
  • Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested.
  • Defective testing - Certifying that something has passed a test, when in fact it has not.
  • “Lick and stick” prescription rebate fraud and “marketing the spread” prescription fraud, both of which involve lying to the government about the true wholesale price of prescription drugs.
  • Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
  • Bundling — Billing more for a panel of tests when a single test was asked for.
  • Double billing - Charging more than once for the same goods or service.
  • Upcoding - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
  • Billing for brand — Billing for brand-named drugs when generic drugs are actually provided.
  • Phantom employees and doctored time slips: Charging for employees that were not actually on the job, or billing for made-up hours in order to maximize reimbursements.
  • Upcoding employee work: Billing at doctor rates for work that was actually conducted by a nurse or resident intern.
  • Yield burning — skimming off the profits from the sale of municipal bonds.
  • Falsifying natural resource production records — Pumping, mining or harvesting more natural resources from public lands that is actually reported to the government.
  • Being over-paid by the government for sale of a good or service, and then not reporting that overpayment.
  • Misrepresenting the value of imported goods or their country of origin for tariff purposes.
  • False certification that a contract falls within certain guidelines (i.e. the contractor is a minority or veteran).
  • Billing in order to increase revenue instead of billing to reflect actual work performed.
  • Failing to report known product defects in order to be able to continue to sell or bill the government for the product.
  • Billing for research that was never conducted; falsifying research data that was paid for by the U.S. government.
  • Winning a contract through kickbacks or bribes.
  • Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
  • Billing for unlicensed or unapproved drugs.
  • Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid.

Source: www.taf.org.  ( taxpayers against fraud)

La liste est longue, ce n’est pas le choix qui manque. De 1986 à 2003 , le gouvernement a recouvré 12 milliards de dollars. Pour une liste des 100 meilleurs cas, voir à l’adresse suivante : www.corporatecrimereporter.com/fraudrep.pdf

Sur le même site de la TAF , il y a la liste des 100 cas les plus payants. Voici des exemples:

  • Pfize:, 1 milliard
  • Tennet Healt Care: 900 millions
  • HCA Healtcare: 730 millions
  • Sereno (hormones) : 567 millions
  • TAP (paharmaceutics) : 559 millions
  • et la liste continue…

Je remarque que ce sont les cie pharmaceutiques  qui sont dans les premiers rangs… Il semble que cette  culture de la fraude  et de la corruption est bien présente dans ce milieu aux États-Unis. Est-ce seulement aux États-Unis que ça arrive?


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