DOJ Fraud Settlements

The Department of Justice is the principal federal agency authorized to enforce the laws and defend the interests of the United States. As such, it oversees the enforcement of the False Claims Act, the foundation of the American whistleblower system, and by far the most widely used statute by whistleblowers to report corporate fraud and misconduct.

The agency traces its origins to the Judiciary Act of 1789 which created the Office of the Attorney General, and the 1870 Act to Establish the Department of Justice, which established the agency as "an executive department of the government of the United States" with the Attorney General as its head.

The agency is comprised of numerous divisions with the Civil Division and in some instances, the Criminal Division, overseeing investigations and prosecutions under the False Claims Act. The U.S. Attorneys Office of the federal district where the False Claims Act case is filed also plays a key role in False Claims Act enforcement.

Below are summaries of the most recent DOJ settlements or successful resolutions under the False Claims Act as well as other successful prosecutions for fraud and misconduct. If you believe you have information about fraud against the government, including against the Medicare or Medicaid systems, please contact us to speak with one of our experienced whistleblower attorneys.

June 22, 2017 - 

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

June 20, 2017 - 

Egyptian-based Egyptian Tanker Company and Singapore-based Thome Ship Management pleaded guilty and agreed to pay a $1.9 million penalty for violating the Act to Prevent Pollution from Ships (APPS) and for obstruction of justice for covering up the illegal dumping of oil-contaminated bilge water and garbage from one of their ships into the sea. DOJ

June 20, 2017 - 

New Jersey family doctor Bernard Greenspan was sentenced to 41 months in prison and to pay a $125,000 fine and a roughly $200,000 forfeiture for violating the Anti-Kickback Statute by accepting bribes in exchange for test referrals as part of a long-running scheme operated by Biodiagnostic Laboratory Services LLC, its president and numerous associates. Greenspan’s referrals generated approximately $3 million in lab business for BLS. DOJ (DNJ)

June 16, 2017 - 

Pennsylvania-based skilled nursing facility operator Genesis Healthcare Inc. agreed to pay roughly $53.6 million to settle charges that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Joanne Cretney-Tsosie, Jennifer Deaton, Kimberley Green, Camaren Hampton, Teresa McAree, Terri West, and Brian Wilson, former employees of companies acquired by Genesis. They collectively will receive a whistleblower award of $9.67 million from the proceeds of the government’s recovery. DOJ

June 15, 2017 - 

Kentucky allergists Bruce Wolf and Kiro John Yun agreed to pay $740,578 to resolve allegations their medical practice group of otolaryngologists Wolf and Yun, P.S.C., specializing in allergy, asthma and immunology, violated the False Claims Act by billing the government for Sublingual Immunotherapy serum preparation and overstated units of serum preparation for injection vials. Sublingual immunotherapy is an alternative way to treat allergies without injections whereby an allergist prescribes a patient with an allergen that is sprayed under the tongue to boost tolerance to substances and reduce symptoms but it is not covered by Medicare because it is considered investigational. DOJ (WDKY)

June 15, 2017 - 

Magdiel Garcia and the durable medical equipment company he owned, MAK Healthcare PC (d/b/a Multicare Plus), agreed to pay $225,000 to settle claims they violated the False Claims Act and The Stark Law by improperly self-referring Medicare beneficiaries for services and equipment to MAK. DOJ (EDPA)

June 14, 2017 - 

Mildrey Gonzalez and her daughter Milka Alfaro were sentenced to 135 and 151 months in prison, respectively, and to pay roughly $22.9 million in restitution for their roles in a $20 million Medicare fraud conspiracy that involved paying illegal health care kickbacks to patient recruiters and medical professionals. They previously admitted they secretly co-owned and operated seven home health agencies in the Miami area, yet failed to disclose their ownership interests in any of these agencies to Medicare, as required by relevant rules and regulations. They further admitted to paying illegal health care kickbacks to a network of patient recruiters in order to bring Medicare beneficiaries into the scheme, to paying bribes and kickbacks to medical professionals in return for providing home health referrals, and to directing co-conspirators to open shell corporations, into which millions of dollars’ worth of fraud proceeds were funneled. DOJ

June 14, 2017 - 

Michael Gluk, former chief financial officer of ArthroCare, pleaded guilty to conspiring with others to falsely inflate ArthroCare’s sales and revenue through a series of end-of-quarter transactions involving ArthroCare’s distributors. He further admitted that he and other co-conspirators caused ArthroCare to file a Form 10-K for 2007 and Form 10-Q for the first quarter of 2008 with the SEC that materially misrepresented ArthroCare’s quarterly and annual sales, revenues, expenses and earnings. DOJ

June 13, 2017 - 

Egyptian-based construction company Misr Sons Development S.A.E. agreed to pay $1.1 million to settle allegations it submitted false claims in connection with U.S. Agency for International Development (USAID) contracts. Specifically, the settlement concerns USAID-funded contracts for the construction of water and wastewater infrastructure projects in the Arab Republic of Egypt in the 1990s. DOJ

June 13, 2017 - 

New Jersey doctor Robert Claude McGrath and his chiropractor son Robert Christopher McGrath admitted to conspiring to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients. Together with their practice, the Atlantic Spine & Joint Institute, they also agreed to pay $1.78 million to resolve allegations they violated the False Claims Act through the illegal billings. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Linda Stevens, a former billing manager at Atlantic Spine. She will receive a whistleblower award of roughly $338,200 from the proceeds of the government’s recovery. DOJ (DNJ)

June 12, 2017 - 

A Kentucky federal jury convicted clinical psychologist Alfred Bradley Adkins on multiple fraud counts in connection with his role in a massive fraud against the Social Security Administration (SSA). According to the evidence presented at trial, Adkins and Kentucky lawyer Eric Christopher Conn submitted false medical documentation to the SSA, and former SSA administrative law judge David Black Daugherty awarded disability benefits based on the fraudulent submissions. The evidence showed the scheme caused the SSA to pay more than $600 million in disability benefits in more than 2,000 cases to claimants in Kentucky and elsewhere, irrespective of the claimants’ actual entitlement to benefits. Whistleblower Insider

June 8, 2017 - 

Kevin David McGovern was sentenced to 24 months in prison and he and his companies, CMG Construction, Inc. and MC Equipment Holdings, LLC, to pay roughly $4.6 million for engaging in a pay-to-play scheme on the Rocky Boy’s Indian Reservation. DOJ (DMT)

June 7, 2017 - 

Texas-based medical and physical therapy provider Union Treatment Center agreed to pay $3 million to settle charges it violated the False Claims Act by defrauding the federal workers’ compensation (FECA) program.  The company will also waive claims for payment exceeding $1.6 million and be permanently excluded from participating in federal health care programs.  According to the government, UTC fraudulently billed the FECA program for services it did not render, routinely overcharged for medical examinations, falsely inflated the time patients spent in therapy, billed for unnecessary services and supplies, and paid kickbacks in exchange for patient referrals.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

June 5, 2017 - 

Texas-based Integrated Medical Solutions Inc. and the company’s former president Jerry Heftler agreed to pay roughly $2.5 million to settle allegations they violated the False Claims Act and Anti-Kickback Act in connection with the U.S. Bureau of Prisons. DOJ

June 2, 2017 - 

Fredericksburg Hospitalist Group, P.C. agreed to pay roughly $4.2 million to settle charges it violated the False Claims Act by upcoding evaluation and management (E&M) codes to the highest code levels in billing Medicare and other federal healthcare payors in connection with their providing hospitalist services to patients at Mary Washington Hospital and Stafford Hospital.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery. DOJ (EDVA)

May 31, 2017 - 

Massachusetts-based eClinicalWorks, one of the country’s largest vendors of electronic health records software, along with certain of its employees, agreed to pay $155 million to resolve charges the company violated the False Claims Act by misrepresenting the capabilities of its software.  The company also allegedly paid kickbacks to certain customers in exchange for promoting its product.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement.  He will receive a whistleblower award of roughly $30 million from the proceeds of the government’s recovery. DOJ

May 31, 2017 - 

New Jersey-based skilled nursing facility Andover Subacute and Rehab Center Services Two Inc. agreed to pay $888,000 to resolve charges it violated the False Claims Act by providing materially substandard or worthless nursing services to patients. DOJ (DNJ)

May 30, 2017 - 

Florida-based managed care service provider Freedom Health Inc. agreed to pay roughly $32 million to settle charges it violated the False Claims Act by engaging in illegal schemes to maximize its Medicare Advantage plan payments from the government.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Freedom Health employee and Constantine Cannon client Darren D. Sewell.  He will receive a yet-to-be-determine whistleblower award from the proceeds of the government’s recovery.  Whistleblower Insider

May 26, 2017 - 

Kuwaiti-based Agility Public Warehousing Co. KSC agreed to globally resolve criminal, civil, and administrative cases arising from allegations that it overcharged the United States when performing contracts with the Department of Defense to supply food for U.S. troops from 2003 through 2010.  As part of the settlement, Agility agreed to pay $95 million to resolve civil fraud claims, to forgo administrative claims against the United States seeking $249 million in additional payments under its military food contracts, and to plead guilty to a criminal misdemeanor offense for theft of government funds.  According to the government, Agility overcharged the DOD for locally available fresh fruits and vegetables that Agility purchased through the Sultan Center Food Products Company, K.S.C. (TSC).  Agility charged the full amount of TSC’s invoices despite agreeing with TSC it would pay 10 percent less than the amount billed.  The government further alleged Agility failed to disclose and pass through rebates and discounts it obtained from U.S.-based suppliers. The allegations originated in a whistleblower lawsuit filed against Agility and TSC under the qui tam provisions of the False Claims Act by Kamal Mustafa Al-Sultan, a former vendor of Agility.  Mr. Al-Sultan will receive a whistleblower award of $38.85 million from the proceeds of the government’s recovery. DOJ

May 26, 2017 - 

Abington Memorial Hospital agreed to pay $491,672, to resolve allegations it violated the False Claims Act through the conduct of employee forging physician signatures on forms submitted to Medicare for home care services. DOJ (EDPA)

May 23, 2017 - 

New York endocrinologist Dr. Michael Esposito agreed to pay $100,000 to settle charges of violating the False Claims Act for billing Medicare despite his exclusion from all federal health care programs. DOJ (NDNY)

May 22, 2017 - 

Los Angeles-based Citigroup subsidiary Banamex USA agreed to forfeit $97.44 million to resolve an investigation into BUSA’s Bank Secrecy Act (BSA) violations.  In its agreement, BUSA admitted to criminal violations by willfully failing to maintain an effective anti-money laundering compliance program to guard against money laundering and willfully failing to file Suspicious Activity Reports. DOJ

May 18, 2017 - 

Missouri health care providers Mercy Hospital Springfield and its affiliate Mercy Clinic Springfield Communities agreed to pay $34 million to settle charges they violated the False Claims Act by engaging in improper financial relationships with referring physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Mercy physician Dr. Viran Roger Holden.  Dr. Holden will receive a whistleblower award of $5,440,000 from the proceeds of the government’s recovery. DOJ

May 16, 2017 - 

Austin-based Financial Freedom agreed to pay more than $89 million to resolve charges it violated the False Claims Act and the Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA) in connection with its participation in a federally insured Home Equity Conversion Mortgages or “reverse mortgage” program.  According to the government, Financial Freedom sought to obtain insurance payments for interest from the Federal Housing Administration despite failing to properly disclose the mortgagee was not eligible for such interest payments because it had failed to meet various deadlines relating to appraisal of the property, submission of claims to HUD, and pursuit of foreclosure proceedings.  The allegations originated in a whistleblower declaration filed pursuant to FIRREA by Sandra Jolley, a consultant for the estates of borrowers who took out HECM loans.  She will receive a whistleblower award of $1.6 million from the proceeds of the government’s recovery. DOJ

May 16, 2017 - 

Omnicare Inc. agreed to pay $8 million to settle charges it violated the False Claims Act by submitting claims for generic drugs different from those actually dispensed to Medicare and Medicaid beneficiaries.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Elizabeth Corsi and Christopher Ezzie.  They will receive a whistleblower award of more than $2 million from the proceeds of the government’s recovery. DOJ (DNJ)