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AFFIRMATIVE CIVIL ENFORCEMENT

Affirmative Civil Enforcement (ACE) refers to filing civil lawsuits on behalf of the United States. The purpose of these civil actions is to recover government money lost to fraud or other misconduct or to impose penalties for violations of federal health, safety, or environmental laws. The following are examples of prosecutions under the ACE program:

  • contractors who provide defective goods or worthless services to Federal agencies or who charge the government for goods and services not delivered;

  • health care providers who defraud Federal health programs like Medicare and Medicaid by overbilling for goods and services or billing for goods and services that were not rendered, not medically necessary, or substandard;

  • individuals who defraud Federal agencies such as the Small Business Administration, the Department of Housing and Urban Development, the Department of Education and other Federal agencies by using misrepresentations to obtain grants, loans, and other benefits to which they are not entitled;

  • companies and individuals to recover the government’s costs to clean up polluted land and water caused by their misconduct.

Usually ACE cases are pursued under the Federal False Claims Act which allows the United States to sue those individuals or organizations who made false or fraudulent claims against the government. The Act provides for recovery of triple the amount of damages incurred by the United States, plus a monetary penalty for each violation.

Many of these cases result from whistleblower lawsuits under the False Claims Act. Individuals or entities with inside information about fraudulent conduct may file suit on behalf of the United States. The ACE program then undertakes an investigation of the allegations. The United States may choose to intervene in and take over prosecution of such a suit or may choose to decline and allow the whistleblower to pursue the case on behalf of the United States. Whomever pursues the case, if there is a recovery for the government, the whistleblower may receive a percentage of the money.

Investigations are undertaken with agents from the FBI, the Office of the Inspector General for the U.S. Department of Health and Human Services, and other federal and state agencies. ACE cases can present facts and issues that warrant criminal as well as civil prosecution.

The ACE Program in the Eastern District of Tennessee has gained a national reputation for its outstanding work. We have recovered millions of dollars and significant administrative oversight agreements by pursuing health care and procurement fraud cases and investigations involving health care providers and suppliers such as hospitals, doctors, pharmaceutical companies, and durable medical equipment suppliers, as well as government contractors. Some examples of the significant ACE recoveries in recent years include:

  • Erlanger Will Pay $40 Million to Resolve Chattanooga Federal Health Care Fraud Investigation

  • Settlement Reached with Tenncare Provider for Drug Overbilling

  • TVA Contractor Stone & Webster Pays $6.2 Million To Resolve Contract Fraud Investigation

  • Hill-Rom Company, Inc. Will Pay $41.8 Million To Resolve Federal Health Care Fraud Investigation

  • Apex Medical Group Will Pay $4.36 Million to Resolve Federal & State Health Care Fraud Investigation

  • HCA Inc To Pay $16.5 Million To Resolve Federal & State Health Care Fraud Investigation

  • United States Reaches Settlement With Memorial Health Care System

  • Grace Healthcare And Grace Ancillary Services Agree To Pay United States And State Of Tennessee $2.7 Million To Resolve False Claims Allegations
  • To report fraud and abuse against the Federal government, please contact the ACE Coordinator for the Eastern District of Tennessee.

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