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Visiting Nurse Service of New York – Medicare/Medicaid Home Health Care Fraud ($57 million)

Constantine Cannon represented whistleblower Edward Lacey against Visiting Nurse Service of New York – the largest not-for-profit home health care agency in the United States.  VNSNY agreed to pay $57 million to resolve allegations it failed to provide home health care visits and services to tens of thousands of New Yorkers and fraudulently billed Medicare and Medicaid.  Mr. Lacey was an executive at VNSNY for 16 years.  In his complaint, Mr. Lacey alleged that VNSNY failed to provide its patients all the critical nursing and therapy visits and services their doctors prescribed under the patient Plans of Care.  He contended that by failing to provide this care, VNSNY endangered the welfare of tens of thousands of its patients while maximizing the company's Medicare and Medicaid reimbursement.  Mr. Lacey's claims concerning alleged Plan of Care failures impact the entire home health care industry.  This is the first reported False Claims Act settlement involving allegations of a home health agency failing to follow patient Plans of Care.  It also is the largest non-kickback False Claims Act settlement ever against a home health care company and the second largest settlement of any home health care fraud case.  Read more: Press Release; Whistleblower Insider.

Sharp HealthCare — Medicare Fraud/Kickbacks (undisclosed settlement amount)

Three of our whistleblower attorneys represented a whistleblower in a qui tam action under the False Claims Act against Sharp HealthCare, a regional hospital system in San Diego.  Our client alleged that the Sharp Healthcare Center for Research, Sharp’s clinical-trial research arm, fraudulently billed government payers in violation of “secondary payer” rules that prohibit billing the government when other payers will pay for a patient’s care. Our whistleblower client also alleged that Sharp cultivated an illegal kickback scheme to entice prospective trial sponsors to host clinical trials at Sharp by regularly undervaluing Sharp’s costs involved in managing clinical trials.  By offering below-market value incentives and billing government and commercial insurers for injuries, the lawsuit alleged that Sharp sought to increase its attractiveness to trial sponsors. Sharp’s alleged purpose was to burnish the organization’s reputation and offer a lucrative stream of income for Sharp-affiliated physicians involved in clinical trials. Sharp settled the whistleblower’s case for an undisclosed amount.  Read more here.

Unitrans International Inc., Anham FZCO, et al. — Government Contract Fraud ($45 million)

Our attorneys represented Rory Maxwell, John Bush, and Supreme Foodservice GmbH in a qui tam action under the False Claims Act against Unitrans International Inc., a privately held Virginia defense contracting company, and Anham FZCO, an associated Dubai Free Zone company, for making false certifications of compliance with the U.S. sanctions regime against Iran to induce the U.S. Defense Logistics Agency and the U.S. Army to award Anham wartime contracts to provide food and transportation to U.S. troops.  Our whistleblower clients also alleged Anham knowingly and falsely represented construction progress on its Bagram warehouse in related bid proposals to the government.  In December 2019, Unitrans agreed to pay $45 million to resolve criminal and civil allegations related to this alleged misconduct, which includes $27 million to resolve our whistleblower clients’ False Claims Act allegations.  Read more about the case at the Department of Justice website here and in The Washington Post here.

Cisco Systems, Inc. – Government Contract Fraud/Non-Conforming Product ($8.6 million)

Constantine Cannon represented whistleblower James Glenn against Cisco in the first cybersecurity whistleblower case ever successfully resolved under the False Claims Act. Cisco Systems, Inc. agreed to an $8.6 million settlement to resolve allegations it knowingly sold vulnerable video surveillance software to federal, state and local government agencies, exposing government systems to the risk of unauthorized access and the manipulation of vital information. The whistleblower, who worked in Europe for a Cisco partner, had reported critical security vulnerabilities in the software to Cisco, but Cisco had continued to sell the technology to government entities, including the District of Columbia and 15 states, despite the fact that the software failed to comply with FAR procurement standards that require basic cybersecurity controls, including those set forth by the National Institute of Standards and Technology.  Read more: Press Release; Whistleblower Insider

Hyundai Oilbank Co., S-Oil Corporation, et al — Government Contract Fraud/Bid-Rigging ($363 million)

A team of our whistleblower attorneys led the representation of an anonymous whistleblower who provided extensive assistance to the U.S. government in its criminal and civil cases against several Korean oil and transportation companies, for their roles in a conspiracy to artificially inflate prices on fuel contracts for U.S. military bases in South Korea. In November 2018, SK Energy Co. Ltd., GS Caltex Corporation, and Hanjin Transportation Co. Ltd. collectively agreed to pay $154 million, to resolve the False Claims Act allegations brought by Constantine Cannon’s client, and an additional $82 million in criminal fines for their involvement in the conspiracy the whistleblower exposed. And in March 2019, the Department of Justice announced that two additional companies, Hyundai Oilbank Co. Ltd and S-Oil Corporation, would pay $75 million in criminal fines and $52 million to resolve these same False Claims Act and antitrust violations. This brings the settlement totals to $363 million and is the largest False Claims Act antitrust recovery as well as the largest False Claims Act settlement involving bid-rigging to date. Read more here.

Sutter Health, LLC – Medicare Advantage Risk Adjustment Fraud (Case Intervention)

Constantine Cannon represents the whistleblower, Kathy Ormsby, in False Claims Act litigation against Sutter Health and its affiliates including the Palo Alto Medical Foundation, where Ms. Ormsby worked as a Risk Adjustment Factor Project Manager and Coding Manager.  The Sutter Health defendants allegedly inflated the number and severity of Medicare Advantage patient diagnoses, manipulated patient records, ignored audit “red flags,” and engaged in other misconduct in order to increase patient risk scores and obtain Medicare Advantage payments to which they were not entitled. The United States filed a complaint in intervention in March, 2019, and the case continues to be actively litigated.  SeeGovernment Complaint in Intervention; Ormsby First Amended Complaint; DOJ Press Release

Skyline Urology — Healthcare Fraud ($2.1M)

Constantine Cannon represented a whistleblower in a qui tam lawsuit that alleged that from 2013 through 2016 a large urology practice had fraudulently and systematically misused a billing code in order to increase reimbursements from insurers, including Medicare and private insurers in California. The code, modifier 25, is properly used when a physician performs an evaluation and management service and a separate and distinct service on the same day. Billing with modifier 25 when no distinct service occurred can improperly inflate reimbursement rates and is known as “unbundling fraud.” The Federal Government recovered $1.85M and the State of California recovered $250,000 to resolve the allegations. For his efforts in uncovering the fraud, the whistleblower received a portion of both recoveries. See The National Law Review and Becker’s ASC Review for more.

Freedom Health, Optimum Healthcare - Medicare Risk Adjustment ($32.5 M)

Two of our whistleblower lawyers led the representation of the late Dr. Darren Sewell, M.D., the former chief medical officer and vice president of special projects for two large health insurers and operators of Medicare managed healthcare insurance plans based in Tampa, Florida. Dr. Sewell brought a qui tam case under the False Claims Act against Freedom, Optimum and Mr. Pagidipati alleging that they improperly gamed a feature of the Medicare Advantage program known as risk adjustment, or risk scoring, by fraudulently inflating their members’ risk scores and the corresponding risk adjustment payments they received from CMS, and that they fraudulently induced CMS to allow them to expand their health insurance offerings into new counties in Florida and the Carolinas by falsely representing that they had a sufficient network of doctors, clinics and hospitals available to serve their enrollees in the expanded service areas when they had no such networks in place. The Government joined the case and in 2017, defendants agreed to pay $32.5 million to settle the matter. The Government and the whistleblower are in the process of negotiating the amount of the relator’s share of the Government’s $32.5 million recovery that Dr. Sewell’s estate will receive. See NPR, DOJ for more.

UnitedHealth Group, Inc. – Medicare Advantage Risk Adjustment Fraud (Case Intervention)

Constantine Cannon represents the whistleblower in one of the largest Medicare Advantage risk adjustment cases in history.  Our client, Benjamin Poehling, alleges that UHG, the nation’s largest health insurer, together with its related Medicare Advantage Organizations, knowingly inflated Medicare Advantage risk scores by engaging in “one-way” chart reviews, even after he expressed concern about this practice to fellow executives.  The United States filed a complaint in intervention in May, 2017, and the case continues to be actively litigated, with trial scheduled in late 2021. See: Government Complaint in Intervention; Poehling Second Amended Complaint; Constantine Cannon Press Release.

Bay Sleep Clinic – Medicare Fraud/Unapproved Facilities, Unlicensed Technicians, and Physician Kickbacks ($2.6M).

Constantine Cannon represented whistleblower Elma Dresser, a sleep technician and former Bay Sleep employee. Ms. Dresser alleged that Bay Sleep Clinic and associated businesses, a network of sleep clinics in the San Francisco Bay Area, fraudulently billed Medicare for sleep studies conducted by unlicensed technicians in unapproved locations; improperly dispensed durable medical equipment from unapproved locations using unlicensed technicians; and paid doctors for referrals in violation of the federal Anti-Kickback Statute. The government joined a portion of the case, and in 2016, defendants agreed to pay $2.6 million to settle the matter. For her significant contributions, the relator’s share award was almost 21% of the government’s recovery. See DOJ for more.
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