whistleblower act

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.

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.

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.

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.

New York-based Park Avenue Medical Associates, P.C., Park Avenue Health Care Management LLC, and Park Avenue Health Care Management, Inc. (collectively “PAMA”) have agreed to pay $1 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.

Medicare prohibits payment for services that are not “reasonable and necessary” for the diagnosis or treatment of an illness or injury, as well as payment for any claim without adequate documentation substantiating the reasonableness and necessity of the services provided.  In particular, Medicare does not cover psychotherapy services rendered to patients with Alzheimer’s disease or dementia unless the patient’s dementia is mild, the patient has the capacity to recall what occurred at the therapy from one session to the next, and that capacity is documented in the patient’s record.  Psychotherapy services are not covered when dementia has produced a severe enough cognitive defect to prevent psychotherapy from being effective. In addition, Medicare provides that psychiatric diagnostic examinations are covered only once for each episode of illness or suspected illness in a patient.

In violation of Medicare policies, as well as its own policies, PAMA provided psychotherapy to patients who, because of their severe dementia, lacked the capacity to benefit from it.  In addition, PAMA billed for psychiatric evaluations that were duplicative, failed to comply with Medicare rules, and reflected a lack of coordination of care both among PAMA’s own psychiatrists, psychologists and nurses, and between PAMA’s employees and staff at the facilities at which PAMA performed services.

PAMA also entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of the Inspector General, in order to ensure future compliance with Medicare laws and regulations.

The lawsuit was originally filed by Zachary Wolfson, a former PAMA 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.  Wolfson’s share 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.