qui tam

Recovery Home Care Settles False Medicare Claims for $1.1M; Whistleblower to Get $198K

Submitted by mma on March 9, 2015
March 9, 2015
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Recovery Home Care and National Home Care Holdings LLC have agreed to pay $1.1 million to resolve allegations that the Recovery Home Care entities knowingly submitted or caused the submission of false claims to Medicare, the U.S. Department of Justice announced today.  The Recovery Home Care entities provide home health care services to Medicare beneficiaries and were purchased by National Home Care Holdings LLC in 2012, after the conduct addressed by the settlement occurred.

Recovery Home Care allegedly paid dozens of physicians thousands of dollars per month to perform patient chart reviews.  According to the government’s lawsuit, the physicians were over-compensated for any actual work they performed and, in reality, payments to the physicians were used to induce them to refer their patients to Recovery Home Care, in violation of the Anti-Kickback Statute and the Stark Law.

The Anti-Kickback Statute and the Stark Law are intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives.  The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by federal health care programs, including Medicare.  The Stark Law forbids a home health care provider from billing Medicare for certain services referred by physicians who have a financial relationship with the entity.

The settlement partially resolves allegations made in a lawsuit filed in federal court in Tampa, Florida, by Gregory Simony, a former employee of Recovery Home Care.  The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery.  The act also allows the government to intervene and take over the action, as it did in part in this case.  Simony will receive $198,000 of the recovered funds. 

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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Fla. Doctors Settle False Medicare Claims for $1.13M

Submitted by mma on February 23, 2015
February 23, 2015
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Two Florida medical doctors and their wives have agreed to pay, collectively, $1.13 million to settle allegations and they knowingly submitted or caused the submission of false claims to federal health care programs, the U.S. Department of Justice announced today.

 The United States alleged that A Plus and its owner, Tracy Nemerofsky, engaged in a scheme to increase Medicare referrals in the heavily saturated home health care market in South Florida.  Specifically, the United States alleged that A Plus paid spouses of referring physicians for sham marketing positions in order to induce patient referrals.  The United States alleged that the spouses were required to perform few, if any, of the job duties they were allegedly hired for and instead, the spouses’ salaries were intended as an inducement for the husband physicians to refer their Medicare patients to A Plus. 

The United States previously settled with A Plus, Tracy Nemerofsky and five other couples that allegedly accepted payments from A Plus.

The settlements announced today resolve allegations that were brought by William Guthrie, a former director of development at A Plus, under the qui tam or whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the United States for the submission of false claims and to receive a share of any recovery.

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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Importers Settle False Claims for $3.05M; Whistleblower to Get $555K

Submitted by mma on February 18, 2015
February 18, 2015
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Import companies C.R. Lawrence Co. Inc., Southeastern Aluminum Products Inc., and Waterfall Group LLC have agreed to pay, collectively, $3.05 million to resolve allegations that the companies knowingly submitted or caused the submission of false claims to the federal government in connection with false customs declarations on imports of aluminum extrusions from the People’s Republic of China (PRC), the U.S. Department of Justice announced last week.  The companies sell shower doors and shower enclosures made with the PRC-manufactured aluminum extrusions.

The government’s complaint alleged that C.R. Laurence, Southeastern and Waterfall made false declarations to the U.S. Department of Homeland Security’s Customs and Border Protection (CBP) to avoid paying antidumping and countervailing duties on aluminum extrusions imported from manufacturer Tai Shan Golden Gain Aluminum Products Ltd. in the PRC.  The Department of Commerce assesses, and CBP collects, antidumping and countervailing duties 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.  C.R. Laurence, Southeastern, and Waterfall allegedly misrepresented that the “country of origin” of the aluminum extrusions was Malaysia, when the goods were manufactured in the PRC and merely shipped through Malaysia – a practice called “transshipping.”  Imports of PRC-manufactured aluminum extrusions have been subject to antidumping and countervailing duties since 2010.  No such duties are due on imports of such items from Malaysia.

The government’s complaint also alleged that C.R. Laurence, Southeastern and Waterfall purchased PRC-made aluminum extrusions imported by other domestic companies and caused or conspired with those importers to make false declarations to CBP to evade duties. 

qui tam provisions of the False Claims Act.  The act permits private parties to sue on behalf of the government those who falsely claim federal funds or, as in this case, avoid paying funds owed to the government.  The United States may intervene in and take over the lawsuit, as it did in this case.  The act allows the whistleblower to receive a share of any funds recovered through the lawsuit.  Valenti will receive $555,100 as his share of these settlements.

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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AstraZeneca Settles False Claims for $7.9M; Whistleblowers to get $1.4M

Submitted by mma on February 13, 2015
February 13, 2015
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AstraZeneca LP has agreed to pay the federal government $7.9 million in order to settle allegations that AstraZeneca knowingly submitted or caused the submission of false claims to federal health care programs, the U.S. Department of Justice announced earlier this week.

The settlement resolves allegations that AstraZeneca agreed to provide remuneration to Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities related to those Medco formularies.  The United States alleged that AstraZeneca provided some or all of the remuneration to Medco through price concessions on drugs other than Nexium, namely on Prilosec, Toprol XL and Plendil.  The United States contended that this kickback arrangement between AstraZeneca and Medco violated the Federal Anti-Kickback statute, and thereby caused the submission of false or fraudulent claims for Nexium to the Retiree Drug Subsidy Program.

This civil settlement resolves a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens with knowledge of false claims to bring civil actions on behalf of the government and to share in any recovery.  The lawsuit was filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle, who will collectively receive $1,422,000. 

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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Medtronic to Settle False Medicare Claims for $2.8M; Whistleblower to Get $602K

Submitted by mma on February 11, 2015
February 11, 2015
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Medtronic Inc. has agreed to pay the federal government $2.8 million to resolve allegations that the company knowingly submitted or caused the submission of false claims to federal health care programs in connection to a medical procedure known as “SubQ Stimulation,” the U.S. Department of Justice announced last week.

The United States alleged that Medtronic knowingly caused dozens of physicians located throughout more than 20 states to submit claims to Medicare and TRICARE for investigational medical procedures known as SubQ stimulation that were not reimbursable.  In these procedures, Medtronic’s spinal cord stimulation devices were placed just beneath the skin near an area of pain, most often in the lower back, where the devices could provide electrical impulses to create a “tingling” sensation intended to alleviate chronic pain.  The United States alleged that even though the safety and efficacy of SubQ stimulation had not been established as required by the Food and Drug Administration (FDA), the company promoted this procedure by, among other strategies, arranging to have physician-customers attend Medtronic-sponsored “on-site training programs” regarding the use of Medtronic spinal cord stimulation devices for SubQ stimulation.        

The civil settlement resolves a lawsuit filed under the whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery.  The lawsuit was filed by Jason Nickell, who formerly worked as a Medtronic sales representative.  Nickell will receive $602,000. 

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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Good Shepherd Hospice Settles False Medicare Claims for $4M; Whistleblowers to Get $680K

Submitted by mma on February 9, 2015
February 9, 2015
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Good Shepherd Hospice Inc. and its related entities has agreed to pay $4 million to resolve allegations that Good Shepherd knowingly submitted or caused the submission of false claims to Medicare for hospice patients who were not terminally ill, the U.S. Department of Justice announced last Friday.  Good Shepherd provides hospice services in Oklahoma, Missouri, Kansas, and Texas.

The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain, symptoms or stress) for a terminal illness and have a life expectancy of six months or less if their illness runs its normal course.  When a Medicare patient receives hospice services, that individual is no longer entitled to Medicare coverage for care designed to cure his or her illness.

The government alleged that Good Shepherd knowingly submitted or caused the submission of false claims for hospice care for patients who were not terminally ill.  Specifically, the United States contended that Good Shepherd engaged in certain business practices that contributed to claims being submitted for patients who did not have a terminal prognosis of six months or less, by pressuring staff to meet admissions and census targets and paying bonuses to staff, including hospice marketers, admissions nurses and executive directors, based on the number of patients enrolled.  The United States further alleged that Good Shepherd hired medical directors based on their ability to refer patients, focusing particularly on medical directors with ties to nursing homes, which were seen as an easy source of patient referrals.  The United States also alleged that Good Shepherd failed to properly train staff on the hospice eligibility criteria. 

As part of the settlement, each Good Shepherd entity agreed to enter into a corporate integrity agreement with the U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG), which will provide for procedures and reviews to be put into place to avoid and promptly detect conduct similar to that which gave rise to the settlement. 

The settlement resolves allegations filed by relators Kathi Cordingley and Tracy Jones, former employees of Good Shepherd, under the qui tam or whistleblower provisions of the False Claims Act, which authorize private parties to sue for fraud on behalf of the United States and share in the recovery.  The relators will receive approximately $680,000.

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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ev3 Settles False Medicare Claims for $1.25M; Whistleblower to Get $250K

Submitted by mma on February 6, 2015
February 6, 2015
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ev3, Inc., formerly known as Fox Hollow Technologies Inc., has agreed to pay $1.25 million to settle allegations that the company knowingly submitted or caused the submission of false claims to Medicare for unnecessary inpatient admissions, the U.S. Department of Justice announced yesterday.

The United States alleged that Fox Hollow knowingly caused 12 hospitals located throughout nine states to submit claims to Medicare for medically unnecessary inpatient stays for certain Medicare beneficiaries undergoing elective atherectomy procedures.  Atherectomy is a minimally-invasive surgical procedure that uses a small cutting device to remove atherosclerosis, or hardening of the arteries, from large blood vessels within the body, and it is intended to open up narrowed coronary arteries to increase blood flow and circulation.  One such device used in atherectomy procedures is the Silver Hawk Plaque Excision System sold by Fox Hollow.  The United States alleged that Fox Hollow advised hospitals that they should bill Silver Hawk atherectomy procedures as more expensive inpatient claims, as opposed to less costly outpatient claims.  As a result, certain hospitals allegedly claimed greater reimbursement than they were entitled to for treating Medicare beneficiaries who underwent Silver Hawk atherectomy procedures. 

The civil settlement resolves a lawsuit filed under the whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery.  The lawsuit was filed by Amanda Cashi, who formerly worked as a Fox Hollow sales representative.  Cashi will receive $250,000. 

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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Composite Engineering Settles False Claims for $2M

Submitted by mma on January 30, 2015
January 30, 2015
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Composite Engineering Inc., a subsidiary of Kratos Defense & Security Solutions, has agreed to pay $2 million to settle allegations that the company knowingly submitted or caused the submission of false claims to the U.S. Air Force, the U.S. Attorney’s Office for the Eastern District of California announced on Monday.

The contract at issue was a firm fixed-price contract modification for the procurement of spare parts to meet the requirements of the Air Force’s Subscale Aerial Target (AFSAT) program. The United States alleges that, in submitting its contract proposal, CEI knowingly or recklessly included significantly overstated materials costs and labor hours, resulting in a windfall to CEI. The False Claims Act allows the government to recover damages and penalties for the presentation of false claims for payment to the United States. By basing its contract price with the government on overstated materials and labor costs, CEI caused the United States to pay artificially inflated prices.

The whistleblower provision of the False Claims Act allows private parties with knowledge of fraud against the government to sue on the government’s behalf and share in the recovery. Had there been a whistleblower in this case, they would have been entitled to up to 30 percent 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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Associates in Dermatology Settles False Claims for $3M; Whistleblowers to Get $500K+

Submitted by mma on January 26, 2015
January 26, 2015
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Florida-based Associates in Dermatology and its owner, Dr. Michael Steppie, has agreed to pay $3 million to settle allegations that the practice knowingly submitted or caused the submission of false claims to federal health care programs for unnecessary medical procedures that were, in some cases, allegedly performed by unlicensed, uncredentialed, and unsupervised employees, the U.S. Attorney's Office for the Middle District of Florida announced last week.

In reaching this settlement, the parties resolved allegations that Dr. Steppie operated a dermatology practice that had an unlicensed medical assistant performing radiation therapy without proper supervision.  The medical assistant allegedly lacked the basic knowledge to perform the tests she was performing. In addition, the allegations included that the clinic performed unnecessary destructions of skin lesions and that these destructions lacked proper documentation. 

This lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act by Katherine Brown, Amber Bradshaw, and Vanessa Santos, former employees at the clinic. Under those provisions, a private party, known as a relator, can file an action on behalf of the United States and receive a portion of the recovery. The three relators will receive more than $500,000 as part of today’s 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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Office Depot Settles False Claims for $68.5M; Whistleblower Award TBD

Submitted by mma on January 21, 2015
January 21, 2015
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Office Depot has agreed to pay $68.5 million to resolve allegations that the company knowingly submitted or caused the submission of false claims to California government entities for office supplies, Corporate Crime Reporter reported last week.

The California entities were participants in the U.S. Communities purchasing program and thus guaranteed to receive Office Depot’s best available prices for government purchasers.  However, Office Depot allegedly gave Los Angeles, Santa Clara, and other California cities, counties, and school districts a lower discount rate than other government entities, resulting in overcharges.

The lawsuit was originally filed by former Office Depot employee David Sherwin under the whistleblower provisions of the False Claims Act, which allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Sherwin’s 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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