Archive

August 18, 2017

California announced a tentative settlement that provides over $51 million in debt relief for Californians who attended Corinthian Colleges. Corinthian intentionally targeted low-income, vulnerable individuals through deceptive and false advertising that misrepresented job placement rates and school programs. These unlawful activities were enabled by Aequitas Capital Management Inc., a private equity firm currently under U.S. Securities and Exchange Commission-imposed receivership. Federal student loans made up almost 90 percent of Corinthian’s revenue. To maintain this revenue, Corinthian needed its mostly low-income students to receive these loans. Federal rules require for-profit colleges receive at least 10 percent of their revenue from sources other than federal student aid. To help fill this gap, Aequitas and Corinthian created a financial arrangement whereby Aequitas provided private loans to Corinthian students, and Corinthian guaranteed Aequitas a profit and agreed to buy back all non-performing loans. CA, FL

August 4, 2017

Georgia announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent). Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. Additionally, Navicent’s current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organization, to insure compliance with the laws and regulations regarding participation in federally funded programs. GA

July 26, 2017

Washington recovered nearly $750,000 in Medicaid reimbursement this week from pharmaceutical company Celgene Corporation for promoting medications to treat conditions they were not approved for, including certain types of cancer. The company is also accused of paying kickbacks to doctors for prescribing the medications and helping them change billing codes to ensure Medicaid would pay for their use. Off-label marketing, fraudulent billing and providing kickbacks to doctors are all violations of the Medicaid False Claims Act. WA

July 17, 2017

New York-based home health care company Visiting Nurse Service of New York and its subsidiaries VNS Choice and VNS Choice Community Care agreed to pay roughly $4.4 million to settle charges of violating the False Claims Act by improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan.  Once VNS disenrolled the members, it did not repay Medicaid for the funds it had improperly received. By knowingly retaining overpayments for many of these members for more than 60 days, the VNS entities violated both the federal and state false claim acts. As a result, New York State will receive $2.63 million as part of the settlement agreement.The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an undisclosed whistleblower.  The whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)  NY

May 24, 2017

New York announced that 42 states and the District of Columbia have reached a $33 million settlement with Johnson & Johnson and Johnson & Johnson Consumer Inc., resolving allegations that the company’s subsidiary, McNeil-PPC, Inc., employed deceptive practices to market and promote numerous popular over-the-counter (“OTC”) drugs. In addition to reforming these practices, the corporation has agreed to pay New York State a total of $1.3 million. Between 2009 and 2011, McNeil-PPC, Inc.—then a wholly-owned subsidiary of Johnson & Johnson—manufactured and distributed OTC drugs that purported to comply with federally mandated current Good Manufacturing Practices (“cGMP”). However, an investigation conducted by the FDA and Attorneys General across the country revealed that a number of McNeil manufacturing facilities and the medications they produced did not meet the national cGMP standards. NY, NJ, TX, FL

April 20, 2017

California announced a $9.8 million settlement with Walgreens, one of the largest drugstore chains in the United States. The settlement involved allegations that Walgreens failed to adhere fully to requirements imposed by California law for the dispensing of certain prescriptions drugs under Medi‑Cal. The settlement is the result of lawsuits filed by whistleblowers and investigated and resolved by federal and state prosecutors. The lawsuits alleged that for more than five years, Walgreens falsely certified that it had complied with diagnosis-related requirements for the lawful dispensing of prescriptions to Medi‑Cal patients. Through the Bureau of Medi‑Cal Fraud and Elder Abuse (BMFEA), the Attorney General’s office regularly works with whistleblowers and law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi‑Cal program. False claims lawsuits pursued by the Attorney General in the last two years have recovered tens of millions of dollars from some of the nation’s largest pharmaceutical companies for allegations of improper marketing, falsifying reports to inflate prices, and other wrongful practices. CA

April 18, 2017

In the largest-ever recovery of its kind, New York announced a $40 million settlement with Alabama-based Harbert Management Corporation and top executives at the firm. Harbert Management was the fund sponsor for Harbinger Capital Partners, a $26 billion hedge fund based in New York City (“Harbinger Fund”). The settlement resolves whistleblower allegations that members of Harbinger’s investment manager failed to pay millions in New York State tax on performance income for several years. The settlement is the largest tax-related recovery by the Attorney General’s office, resulting from an action filed under the New York False Claims Act, which was amended to cover tax claims in 2010 in a bill sponsored by then-State Senator Eric Schneiderman. NY

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY

February 17, 2017

A Wellesley-based dental provider and its billing agent have agreed to pay $1.5 million to Massachusetts’ Medicaid program (MassHealth) to resolve allegations of improper billing for visits to MassHealth members living in nursing homes. The settlement resolves allegations that dental provider Alec H. Jaret, DMD, PC d/b/a HealthDrive Dental Group and its billing agent, HealthDrive Corporation, overbilled MassHealth for nursing home visits. The AG’s Office filed a complaint against the defendants in March 2014 alleging that between July 2010 and September 2013, HealthDrive, on behalf of HealthDrive Dental Group, overbilled MassHealth for nursing home visits by charging a separate “house call” fee for multiple patients treated at the same facility on the same day. An investigation by the AG’s Office revealed that HealthDrive was paid for more than 34,700 excessive claims on a per-patient per-day basis, contrary to MassHealth’s regulations on dental house calls established in 2010. The parties have reached a civil settlement agreement pursuant to which HealthDrive and HealthDrive Dental Group will pay MassHealth $1,500,756 to resolve all claims. MA

January 11, 2017

Ireland-based Shire Pharmaceuticals LLC and certain subsidiaries agreed to pay $350 million to settle charges that Shire and the company it acquired in 2011, Advanced BioHealing violated the False Claims Act and Anti-Kickback Statute by using kickbacks and other unlawful methods to induce clinics and physicians to use or overuse their “Dermagraft” skin product. It is the largest False Claims Act recovery in a kickback case involving a medical device, and resolves claims brought by the federal government along with 37 states and the District of Columbia. The States will receive $6,104,000 for the State share of the Medicaid program. According to the government, Dermagraft salespersons unlawfully induced clinics and physicians with lavish dinners, drinks, entertainment and travel; medical equipment and supplies; unwarranted payments for purported speaking engagements and bogus case studies; and cash, credits and rebates. The allegations originated in six lawsuits filed brought by whistleblowers in, or transferred to, the United States District Court for the Middle District of Florida. Two of the qui tam actions named New York and other states and included allegations that Shire submitted or caused to be submitted false claims to the Medicaid program under federal and state False Claims Acts. The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government recovery. Whistleblower Insider, NY, FL