False Claims Act

ABC Billing Settles False Claims For $1.7M; Whistleblower to Get $323K

Submitted by mma on September 13, 2013
September 13, 2013

Farideh Heidarpour, her billing company A.B.C. Billing Inc., and her son Ali Heidarpour (who was also her employee) have agreed to pay $1.7 million to settle allegations that her and her company knowingly submitted or caused the submission of false claims to workers’ compensation programs, U.S. Attorney for the Northern District of California Melinda Haag announced last month.

The United States alleges that Heidarpour, her company, and her son submitted or caused to be submitted to the Department of Labor, Office of Workers’ Compensation Programs, false claims by certain clinics for supplies and services not provided, not supported by medical documentation and/or not medically necessary, resulting in millions of dollars of damages to the United States. The majority of the patients at issue were United States Postal Service (USPS) employees claiming work-related injuries.

The lawsuit was originally filed by a former employee of a clinic in Texas that worked with ABC Billing.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  The whistleblower in this case will receive $323,000 as her share of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Emory Settles Medicare and Medicaid Fraud Claims For $1.5M

Submitted by mma on September 10, 2013
September 10, 2013

Emory University has agreed to pay $1.5 million to settle allegations that the university violated the False Claims Act by billing Medicare and Medicaid for clinical trial services that were not permitted by the Medicare and Medicaid rules, the U.S. Department of Justice announced last month.

Providers generally are not permitted to bill Medicare for medical care and services for which the clinical trial sponsor has agreed to pay.  The United States and the State of Georgia alleged that Emory University billed Medicare and Medicaid for services the clinical trial sponsor agreed to pay (and, in some cases, actually did pay, thereby resulting in Emory’s being paid twice for the same service).

The lawsuit was originally filed by Elizabeth Eliot, a former Emory employee, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Eliot’s share of the settlement has not yet been determined.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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RPM Intl to Settle Contract Fraud Claims for $61M; Whistleblower to Get $10.9M

Submitted by mma on September 6, 2013
September 6, 2013

Ohio-based RPM International Inc. and its subsidiary, Tremco Inc., have agreed to pay $60.9 million to resolve allegations that Tremco knowingly submitted or caused the submission of false claims in connection with contracts with the General Services Administration (GSA), the U.S. Department of Justice announced last week.  Tremco is a manufacturer of construction products and services.

The government alleged that Tremco knowingly violated its contractual obligations to provide GSA with current, accurate and complete information about its commercial sales practices, to report changes in discounts to comparable commercial customers and to pass those discounts on to government customers.  Tremco allegedly failed to provide the government with price discounts given to non-federal government customers and also allegedly marketed expensive materials to government purchasers without disclosing that the same materials were available at a lower cost that were manufactured and sold by the company.  As a result, the government allegedly paid more than it should have for Tremco’s services and products.   In addition, Tremco allegedly improperly marketed generic products as a superior line of the same product and used a defective adhesive formula in its roofing systems.

The lawsuit was originally filed by former Tremco vice president Gregory Rudolph, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Rudolph will receive $10.9 million as his share of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Imagimed Settles Healthcare Fraud Claims for $3M; Whistleblower to Get $565K

Submitted by mma on September 4, 2013
September 4, 2013

New York-based Imagimed LLC and its former owners, William B. Wolf III and Dr. Timothy J. Greenan, and its former radiologist, Dr. Steven Winter, have agreed to pay $3.57 million to resolve allegations that they knowingly submitted or caused the submission of false claims to federal healthcare programs for magnetic resonance imaging (MRI) services, the U.S. Department of Justice announced last week.  Imagimed owns and operates 15 MRI facilities under the name “Open MRI.”

Imagimed, Greenan, Wolf and Winter allegedly submitted claims to Medicare, Medicaid and TRICARE for MRI scans performed with a contrast dye without the direct supervision of a qualified physician.  Since a potential adverse side effect of contrast dye is anaphylactic shock, federal regulations require that a physician supervise the administration of contrast dye.  Imagimed, Greenan, Wolf and Winter also allegedly submitted claims for services referred to Imagimed by physicians with whom Imagimed had improper financial relationships.  In exchange for these referrals, Imagimed entered into sham on-call arrangements, provided pre-authorization services without charge and provided various gifts to certain referring physicians, in violation of the Stark Law and the Anti-Kickback Statute.

The lawsuit was originally filed by Dr. Patrick Lynch, a local radiologist, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Dr. Lynch will receive $565,000 as his share of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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ATI Enterprises Settles Student Financial Aid Fraud Claims for $3.7M

Submitted by mma on September 3, 2013
September 3, 2013

ATI Enterprises, a Texas-based chain of career training schools operating in the southern and western United States, has agreed to pay the U.S. government $3.7 million to resolve allegations that the company knowingly submitted or caused the submission of false claims to federal student aid programs, the U.S. Department of Justice announced last month.  ATI Enterprises allegedly falsely certified compliance with federal student aid programs’ eligibility requirements and submitted claims for ineligible students.

To participate in federal student aid programs, schools must enter into a contract with the Secretary of Education called a Program Participation Agreement, in which they agree to a number of terms.   For example, if an institution advertises its job placement rates as a means of attracting students to enroll, it must make available to prospective students its most recent and accurate employment statistics to substantiate the truthfulness of its advertisements.   The government alleged that, by misrepresenting its job placement statistics in order to maintain state licensure and accreditation, ATI Enterprises fraudulently maintained its eligibility for federal financial aid.

The government further alleged that ATI employees engaged in fraudulent practices to induce students to enroll and maintain their enrollment in the schools.  This falsely increased the schools’ enrollment numbers, and consequently, the amount of federal dollars they received at the expense of taxpayers and students, who incurred long-term debt.

The lawsuits were originally filed by several former employees of ATI Enterprises under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Their share of the settlement has not yet been determined.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Shands Healthcare to Pay $26M to Settle Healthcare Fraud Claims

Submitted by mma on August 30, 2013
August 30, 2013

Shands Healthcare, which operates a network of health care providers in Florida, including a teaching hospital and a medical center, has agreed to pay $26 million to settle allegations that the company knowingly submitted or caused the submission of false claims to Medicare, Medicaid, and other federal health care programs, the U.S. Department of Justice announced last week. 

Allegedly, hospitals operated by Shands Healthcare knowingly submitted inpatient claims to Medicare, Medicaid and TRICARE for certain services and procedures that Shands Healthcare knew were correctly billable only as outpatient services or procedures.

The lawsuit was originally filed by Terry Myers, President of healthcare consulting firm YPRO Corp., under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Myers’ portion of the settlement has yet to be determined.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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U.S. Govt Files Lawsuit Against PharMerica for False Claims Act Violations

Submitted by mma on August 28, 2013
August 28, 2013

The U.S. government has filed suit against PharMerica Corp. for violations of the False Claims Act and the Controlled Substances Act by dispensing controlled drugs without valid prescriptions and knowingly submitting or causing the submission of false claims to be submitted to the Medicare program, the U.S. Department of Justice announced earlier this month.  The lawsuit was filed in the U.S. District Court for the Eastern District of Wisconsin.

PharMerica is a long-term care pharmacy that dispenses drugs to residents of long-term care facilities, including nursing homes and skilled nursing facilities. PharMerica services approximately 300,000 residents of long-term care facilities and fills approximately 40 million prescriptions annually.   Many of the prescriptions filled by PharMerica are for controlled substances listed in Schedule II under the Controlled Substances Act.   Schedule II drugs, such as oxycodone and fentanyl, can cause significant harm if used improperly and have a high potential for abuse.

The government’s complaint alleges that PharMerica routinely dispensed Schedule II controlled drugs in non-emergency situations without first obtaining a written prescription from a treating physician.    PharMerica’s alleged actions violated both the spirit and the letter of the Controlled Substances Act by enabling nursing home staff to order narcotics, and pharmacists to dispense narcotics, before confirming that a physician had made a medical judgment about whether these narcotics were necessary and should be used by the resident.  The complaint alleges that PharMerica knowingly caused the submission of false claims to Medicare for these improperly dispensed Schedule II drugs, in violation of the False Claims Act.

The lawsuit was originally filed by Jennifer Denk, a former PharMerica employee, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  The government may intervene on its own behalf, which it has elected to do in this case.  Denk’s suit was later consolidated with a subsequent complaint filed by Eric Beeders and Lesa Martino.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Judgment Entered Against Dr. Malik and Advanced Nuclear Diagnostics for $17M

Submitted by mma on August 27, 2013
August 27, 2013

The U.S. District Court for the District of Columbia has entered judgment for more than $17 million against Dr. Ishtiaq Malik and his two companies, Ishtiaq Malik M.D., P.C. and Advanced Nuclear Diagnostics, for submitting false nuclear cardiology claims to federal and state health care programs, the U.S. Department of Justice announced last month.

The government’s allegations focused on Dr. Malik’s inappropriate claims for myocardial perfusion studies, commonly referred to as nuclear stress tests, which are used to determine whether a patient has heart disease. The test is usually performed in two separate phases: stress and rest. The two phases, which can be conducted on the same day or separate days, must be billed as one test. The government alleged that, contrary to these requirements, Dr. Malik and his companies double-billed for multi-day nuclear stress tests.

The government alleged that Dr. Malik submitted false claims to Medicare, District of Columbia Medicaid, Maryland Medicaid, TRICARE and the Federal Employees Health Benefits Plan. In addition, the government alleged that Dr. Malik and his companies billed for services not performed as well as services already included in the payment for nuclear stress test codes, such as intravenous injections, drug infusions, 3D rendering and drug administration.

The government filed suit against Dr. Malik and his two companies under the False Claims Act, which allows the government to recover three times its damages, plus penalties, from those who submit false claims for federal funds. The state of Maryland and the District of Columbia subsequently joined the lawsuit under their respective state false claims acts.  Private citizens with knowledge of fraud against the government can also sue on the government’s behalf and claim a share in the recovery.

The Obama administration has made a priority of preventing fraud and recovering losses, resulting in record recoveries for two years in a row.  Fiscal year 2011 saw $3 billion recovered in False Clams Act cases, with $2.4 billion of that being cases of fraud committed against federal health care programs.  Fiscal year 2012 saw $5 billion recovered in False Claims Act cases, with over $3 billion of that stemming from health care fraud cases.  In both years, a vast majority of the cases were initiated by lawsuits filed by private citizens under the qui tam, or whistleblower, provisions of the False Claims Act. A record 647 qui tam cases were filed last fiscal year.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Northwestern to Pay $3M to Settle Grant Fraud Claims; Whistleblower to Get $498K

Submitted by mma on August 23, 2013
August 23, 2013

Northwestern University has agreed to pay the United States government $2.93 million to resolve allegations of cancer research grant fraud committed by a former researcher and physician at the university’s Robert H. Lurie Comprehensive Center for Cancer in Chicago, the U.S. Department of Justice announced last month. 

Northwestern allegedly allowed one of its researchers, Dr. Charles L. Bennett, to submit false claims under research grants from the National Institutes of Health. Dr. Bennett allegedly submitted improper claims for reimbursement for professional and consulting services, subcontracts, food, hotels, travel and other expenses that benefited Dr. Bennett, his friends, and family, including family trips, meals and hotels for himself and friends, and “consulting fees” for unqualified friends and family members, including his brother and cousin. At Dr. Bennett’s request, Northwestern also allegedly improperly subcontracted with various universities for services that were paid for by the NIH grants.

The lawsuit was originally filed by Melissa Theis, a former employee at Northwestern’s Feinberg School of Medicine, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Theis will receive $498,100 as her share of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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Dubuis to Settle Medicare Fraud Claims for $8M; Whistleblower to Get $2.16M

Submitted by mma on August 22, 2013
August 22, 2013

Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) have agreed to pay $8 million to resolve allegations that the companies knowingly submitted or caused the submission of false claims to Medicare, the U.S. Department of Justice announced last month.  Dubuis Health System manages long-term acute care hospitals in multiple states, including Southern Crescent.  Southern Crescent is a long-term acute care hospital located in Riverdale, GA and is part of the CHRISTUS Health System. 

Long term acute care hospitals are certified to focus on patients with more complex medical needs who, on average, remain in the hospital more than 25 days, and receive a higher rate of Medicare reimbursement than typical acute care hospitals.  This settlement resolves allegations that between 2003 and 2009, Dubuis Health System and Southern Crescent knowingly kept patients hospitalized beyond the time considered to be medically necessary, to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.

The allegations were originally made in a lawsuit filed by Darlene Tucker, a former administrator at Southern Crescent, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Tucker will receive $2.16 million as her share of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

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