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Government Intervenes in IPC False Claims Lawsuit

Submitted by kludowitz on December 10, 2013
December 10, 2013

The government has intervened in a lawsuit against IPC The Hospitalist Co. Inc. (IPC), and its subsidiaries, under the False Claims Act, for submitting false claims to federal health care programs, the Justice Department announced yesterday. 

IPC, one of the largest providers of hospitalist services in the US, employs physicians and other health care providers who work in more than 1,300 facilities in 28 states.  Hospitalists are physicians who work only in hospitals and other long-term care facilities, overseeing and coordinating inpatient care from admission to discharge.

The lawsuit alleges that IPC physicians knowingly sought payment for higher and more expensive levels of medical services than were actually performed – a practice commonly referred to as “upcoding.”  Specifically, the lawsuit alleges that IPC encouraged its physicians to bill at the highest levels regardless of the services provided, trained physicians to use higher level codes and encouraged physicians with lower billing levels to “catch up” to their colleagues.

The lawsuit was originally filed by Dr. Bijan Oughatiyan, a former IPC physician, under the whistleblower provision of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery. Oughatiyan’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 uncover fraud of every kind perpetrated against our 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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Lynch Settles False Medicare Claims For $3M; Whistleblower to Get $5.5K

Submitted by kludowitz on December 9, 2013
December 9, 2013
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Lynch Ambulance has agreed to pay more than $3 million to settle a lawsuit, under the False Claims Act, alleging it received overpayments from the Medicare program and other federal health care programs for transporting patients who were not eligible for ambulance transports, the U.S. Attorney’s Office announced last month.

Allegedly, Lynch Ambulance knowingly billed Medicare and other federal healthcare programs for transporting patients who were not “bed-confined” or whose transports otherwise were not medically necessary. The federal health care programs that paid claims for medically unnecessary transports were Medicare, TRICARE, and the Federal Employees Health Benefits Program.

 Lynch Ambulance has also entered into a Corporate Integrity Agreement with the Department of Health and Human Services.

The lawsuit was originally filed by Jamie Weatherly and Dawn Lucero, two former Lynch Ambulance employees, under the whistleblower provision of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery. Weatherly’s and Lucero’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 uncover fraud of every kind perpetrated against our 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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Jury Finds JM Eagle Liable for Pipe Fraud

Submitted by mma on December 6, 2013
December 6, 2013

A federal jury has found that JM Eagle, the nation’s largest manufacturer of plastic pipe, violated the False Claims Act when it knowingly sold defective pipes to states and municipalities for use in drinking water, firefighting, irrigation and other public systems, the New York Times reported.

JM Eagle, formerly J-M Manufacturing, allegedly cut costs by using shoddy manufacturing practices to create weaker but more profitable polyvinyl chloride (PVC) pipe, and lied about whether or not it met strength and durability standards required by the government.  JM Eagle may have to pay triple damages, plus additional penalties for each false claim submitted to a state or municipal government.  The settlement has not yet been determined.

The lawsuit was originally filed by John Hendrix, a former JM Eagle employee, under the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.

JM Eagle plans to appeal.

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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Caremark Settles False Medicaid Claims For $4.2M; Whistleblower to Get $5.5K

Submitted by kludowitz on December 4, 2013
December 4, 2013
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Caremark LLC (Caremark) has agreed to pay the government more than $4.2 million to settle allegations, under the False Claims Act, that they knowingly failed to reimburse Medicaid for prescription drug costs, the Justice Department announced earlier this week. Caremark is operated by CVS Caremark Corp., one of the largest pharmacy benefit management (PBM) company and retail pharmacies in the country.

Caremark served as the PBM for private health plans that insured a number of individuals receiving prescription drug benefits under both a Caremark-administered plan and Medicaid.  When an individual is covered by both Medicaid and a private health plan, the individual is called a “dual eligible.”  Under the law, the private insurer, rather than the government, must assume the costs of health care for dual eligibles.  If Medicaid erroneously pays for the prescription claim of a dual eligible, Medicaid is entitled to seek reimbursement from the private insurer or its PBM, in this case Caremark. 

According to the government, Caremark allegedly used a computer claims processing platform to cancel claims for reimbursement submitted by Medicaid for dual eligibles.  The government alleged that Caremark’s actions caused Medicaid to incur prescription drug costs for dual eligibles that should have been paid for by the Caremark-administered private health plans rather than Medicaid.

The lawsuit was originally filed by Janaki Ramadoss, a former Caremark quality assurance representative, under the whistleblower provision of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Ramadoss will receive $505,680 as his portion 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 uncover fraud of every kind perpetrated against our 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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CA Slaughterhouses Settle False Claims for up to $2.4M; Whistleblower to Get $600K

Submitted by kludowitz on December 3, 2013
December 3, 2013
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Several California companies and individuals that formerly supplied beef to the National School Lunch Program have agreed to settle allegations, under the False Claims Act, of inhumane handling of cattle, circumventing appropriate inspection of non-ambulatory disabled (“downer”) cattle and false representations regarding their eligibility to process beef, the Justice Department announced last week. 

The Humane Society of the United States (HSUS) alleges that Westland Meat Co., Westland, M&M Management and Cattleman’s Choice knowingly engaged in inhumane cattle handling and improper downer cattle inspection practices at slaughterhouses and meat processing facilities. The lawsuit, brought about after an HSUS investigator videotaped these practices, additionally claims that the defendants concealed their ineligibility to process beef because a convicted felon, Aaron Magidow, was a partner in and otherwise responsibly connected with the facility’s operations.  U.S. Department of Agriculture (USDA) regulations applicable to suppliers of the National School Lunch Program prohibit the inhumane handling of cattle, require the proper inspection and disposition of downer cattle and require suppliers to identify convicted felons who are responsibly connected to the suppliers’ operations. 

The National School Lunch Program, administered by the USDA, is a federally assisted meal program operating in public and nonprofit private schools and residential child-care institutions. The program provides nutritionally balanced, low-cost or free lunches to children each school day.  All ground beef products from the defendants were recalled and the defendants no longer supply beef to the National School Lunch Program.

Under the settlements, Westland Meat Co. and its owner, Steve Mendell, will pay $240,000. Westland will enter into a consent judgment for $155.68 million. M&M Management, Cattleman’s Choice and the estate of Cattleman’s deceased owner, Arnie Magidow, and Magidow’s surviving spouse will pay a total of approximately $2.45 million. Donald R. Hallmark and Donald W. Hallmark will also settle allegations for $304,130.

The lawsuit was originally filed by HSUS under the whistleblower provision of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  HSUS will receive $600,000 as their portion 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 uncover fraud of every kind perpetrated against our 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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Vantage Settles False Medicare Claims For $2.1M; Whistleblower to Get $3.5K

Submitted by kludowitz on November 27, 2013
November 27, 2013

Vantage Oncology LLC (Vantage) has agreed to pay the government more than $2.08 million to settle allegations, under the False Claims Act, that it knowingly submitted false claims to Medicare for radiation oncology services, the Justice Department announced last week. 

The government alleged that Vantage double billed and overbilled Medicare for certain procedures, billed for services that lacked supporting documentation and improperly billed for radiation treatment provided to patients without proper physician supervision. 

The lawsuit was originally filed by Suleiman Refaei, a former Vantage employee, under the whistleblower provision of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Refaei will receive $354,450 as his portion 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 uncover fraud of every kind perpetrated against our 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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Basco to Settle False Customs Claims For $1.1M; Whistleblower Amount TBD

Submitted by kludowitz on November 25, 2013
November 25, 2013

Basco Manufacturing Co. (Basco) has agreed to pay $1.1 million to resolve allegations that it violated the False Claims Act by making false customs declarations to avoid paying duties on products imported from the PRC (People’s Republic of China), the Department of Justice announced last week.

The U.S. government alleged that Basco made false declarations to the U.S. Department of Homeland Security Customs and Border Protection to avoid paying antidumping and countervailing duties on aluminum extrusions imported from the PRC.  These companies allegedly misrepresented that the aluminum extrusions, used in the manufacturing of shower enclosures and other products, were imported from Malaysia.

Antidumping and countervailing duties exist to protect U.S. businesses and level the playing field for domestic products. Antidumping duties protect against foreign companies “dumping” products on U.S. markets at prices below cost, while countervailing duties offset foreign government subsidies. Unlike the PRC, there are no duties due for aluminum extrusions imports made in Malaysia.

Basco allegedly engaged in a scheme to avoid duties by shipping the aluminum extrusions manufactured by in the PRC through Malaysia, a practice called transshipping.   The U.S. government alleges that Basco and the defendants knew that the aluminum extrusions were merely repackaged in Malaysia and did not undergo a substantial transformation that may have justified changing the product’s country of origin from the PRC to Malaysia.

The lawsuit was originally filed by James F. Valenti Jr., a public policy lawyer, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Valenti’s portion of the settlement has yet to be decided.

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 uncover fraud of every kind perpetrated against our 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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Iraqi Construction Co. to Settle False Claims and Bribery Charges for $2.7M

Submitted by kludowitz on November 22, 2013
November 22, 2013

Iraqi Consultants and Construction Bureau (ICCB) has agreed to pay the U.S. $2.7 million to resolve allegations that it violated the False Claims Act by bribing a U.S. government official to obtain U.S. government contracts in Iraq, the Department of Justice announced earlier this month. 

The government alleged that ICCB, a privately owned construction company headquartered in Baghdad, Iraq, paid bribes to an Army Corps of Engineers procurement official, John Markus, to obtain information that gave it an advantage in bidding on several construction contracts with the Department of Defense in Iraq.  The contracts supported reconstruction efforts involving the Iraq war, including infrastructure and security projects and the building of medical facilities and schools.  The U.S. government also alleged that ICCB knowingly overcharged the U.S. for services provided under the contracts. As part of the investigation, Markus pleaded guilty to wire fraud, money laundering and failure to report a foreign bank account in connection with more than $50 million in contracts awarded to foreign companies in Gulf Region North, Iraq.  Markus was sentenced to 13 years in prison.

Under the False Claims Act, private parties with knowledge of fraud against the government may sue on behalf of the government and share in the recovery.  Had there been a whistleblower in this case, their portion of the settlement may have been anywhere from 15 to 30 percent.

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 uncover fraud of every kind perpetrated against our 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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Baptist Health to Settle False Medicare Claims For $3.7M; Whistleblower to Get $6.5K

Submitted by kludowitz on November 22, 2013
November 22, 2013
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Baptist Health Systems has agreed to pay $3.7 million to the United States Department of Justice to settle allegations that it violated the federal False Claims Act by filing false claims for reimbursement under the Medicare program, the U.S. Attorney’s Office announced earlier this week. 

Baptist Health Systems allegedly filed improper claims with the Medicare program by failing to disclose on the claim that the patient receiving treatment had another insurance policy that covered the care.  Under the law, a health care provider is required to disclose the fact that a patient has other insurance when it files its claim with Medicare.  The claim is processed under the other insurance policy and, in most cases, Medicare compensates the patient for whatever was paid for out of pocket (such as a deductible or copayment).   If the insurance company is slow to pay and the health care provider receives a double payment, then the health care provider must reimburse Medicare.

The lawsuit was originally filed by Norma Rivera, a former insurance auditor for Baptist, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Rivera will receive $600,500 for her portion of the settlement as well as a full reimbursement from Baptist Health Systems for her legal fees.

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 uncover fraud of every kind perpetrated against our 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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Ensign Settles Medicare Fraud Claims for $48M; Whistleblower Amount TBD

Submitted by kludowitz on November 20, 2013
November 20, 2013

The Ensign Group Inc. (Ensign) has agreed to pay $48 million to resolve allegations, under the False Claims Act, that it knowingly submitted or caused the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services, the Justice Department announced today. 

Ensign, a skilled nursing provider, allegedly submitted false claims to the government for physical, occupational and speech therapy services provided to Medicare beneficiaries that were not medically necessary. The investigation alleged that Ensign provided therapy to patients whose conditions and diagnoses did not warrant it, solely to increase its reimbursement from Medicare.  The government further alleged that Ensign created a corporate culture that improperly incentivized therapists and others to increase the amount of therapy provided to patients to meet planned targets for Medicare revenue.  These targets were set without regard to patients’ individual therapy needs and could only be achieved by billing at the highest reimbursement levels.  The government also alleged that Ensign billed for inflated amounts of therapy it had not provided and that certain patients were kept in these facilities for periods of time exceeding what was medically necessary for treatment of their conditions. 

In addition to the settlement amount, Ensign also agreed that each of its skilled nursing facilities across the nation would be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG).

The lawsuit was originally filed by Gloria Patterson and Carol Sanchez, two former Ensign therapists, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  The amount that the whistleblowers will receive has not 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 uncover fraud of every kind perpetrated against our 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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