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WB Group Successes

Members of the Constantine Cannon Whistleblower Lawyer Team have been responsible for a string of major whistleblower successes over more than a decade.  Please see our Whistleblower Team Successes page.

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Sutter Health – Medicare Advantage Fraud ($90 million)

Constantine Cannon represented whistleblower Kathy Ormsby in a False Claims Act litigation against Sutter Health and its affiliates that resulted in a $90 million settlement – the largest Medicare Advantage FCA settlement to date against a hospital system, and the second largest reported Medicare Advantage fraud settlement to date.  Ms. Ormsby, a former Risk Adjustment Factor Project Manager at Sutter Health affiliate Palo Alto Medical Foundation, alleged the Sutter Health defendants inflated the number and severity of Medicare Advantage patient diagnoses, manipulated patient records, ignored audit “red flags,” and engaged in other misconduct to increase patient risk scores and obtain Medicare Advantage payments to which they were not entitled.  In Spring 2019, the Government intervened in Ms. Ormsby’s case as to PAMF, and Ms. Ormsby continued to pursue her claims against the other Sutter Health affiliates on a non-intervened basis. This settlement resolves all claims and follows Sutter’s unsuccessful effort to dismiss both the complaints.  Read more: Press Release; Whistleblower Insider.

Kaiser Permanente – Medicare Advantage Risk Adjustment Fraud (Case Intervention)

Constantine Cannon represents Dr. James Taylor, a highly placed physician and healthcare coding expert, in False Claims Act litigation against Kaiser Permanente.  He is among a group of ten whistleblowers who accuse the large Medicare Advantage organization of knowingly submitting false claims for risk-adjusted payments to the Centers for Medicare & Medicaid Services (CMS).  The suit alleges that Kaiser routinely obtained fraudulently inflated risk-adjusted payments by knowingly submitting diagnosis codes for patients that were unsupported by the patients’ medical records, and the government’s intervention focuses on unsupported diagnosis codes that Kaiser allegedly improperly added through addenda to patients’ medical records.  The qui tam whistleblower suit was unsealed on July 29, 2021. See:  Taylor Amended Complaint; DOJ Press Release

ITG – Securities violations (30% SEC whistleblower award)

Constantine Cannon’s team secured another multi-million-dollar SEC whistleblower award for an anonymous whistleblower whose original information and assistance led to an enforcement action against brokerage firm ITG.  The SEC has repeatedly fined ITG in recent years, including for violations related to the firm’s dark pool, POSIT.  A dark pool is an alternate trading system that is supposed to allow investors to place buy and sell orders without alerting predatory traders who can manipulate prices.  ITG told its customers that they could trade in POSIT anonymously and confidentially, but the SEC twice concluded this was false.  The SEC awarded our client 30 percent of the recovery, the maximum amount allowed under the SEC Whistleblower Program.  For more information, see Constantine Cannon Client Receives Maximum Award for Blowing the Whistle on ITG

Group Health Cooperative (now a subsidiary of Kaiser Permanente) – Medicare Advantage Fraud ($6.375 million)

Constantine Cannon represents whistleblower Teresa Ross against Group Health Cooperative, an insurance company that participates in the Medicare Advantage program. GHC has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how sick its beneficiaries were. Ms. Ross is a former employee of GHC, where she worked for 14 years; her most recent position was the director of risk adjustment services. In her complaint, Ms. Ross alleged that GHC had improperly relied on coders’ interpretations of diagnostic tests, prescriptions, and entries in problem lists to come up with diagnoses and that it had also submitted other codes that were false because they were diagnosed by inappropriate providers, fell outside service year, or the patient had no evidence of a current condition. See Press Release and Whistleblower Insider for more.

Securities Fraud ($1.7 million SEC whistleblower award)

Constantine Cannon’s whistleblower team secured a $1.7 million award for an SEC whistleblower client.  The client, a former company insider, provided extensive and ongoing assistance to the SEC in its investigation of a major international company.  Significantly, Constantine Cannon convinced the SEC to increase our client’s award, acknowledging not only our client’s significant investigative assistance but also the risks the client took to alert investors to the misconduct and the justified fear of retaliation the client faced as an employee of the company.  The SEC increases a whistleblower’s award in fewer than 7% of cases.  See Constantine Cannon Client Scores SEC Whistleblower Win for more information.

Mid Dakota Clinic – Medicare Fraud/ASC Kickbacks ($5.45M)

The Constantine Cannon team represented Jeffery Neuberger, the former CEO of a medical group in North Dakota, in a 2017 False Claims Act case alleging a scheme in violation of the Anti-Kickback Statute (AKS) between the medical group and its wholly owned ambulatory surgery center (ASC).  The AKS is intended to prevent abuses (such as unnecessary treatments) that can occur when a doctor makes money from referring patients for goods or services.  The ASC safe-harbor to the AKS is limited; it essentially permits ASC ownership only by surgeons who perform procedures or surgeries in the ASC as a functional extension of his or her office.  The lawsuit alleges that all of the multi-practice physician owners profited from referrals, not only the surgeons, and that they refused to give up this lucrative income stream despite knowing that it violated the AKS.  In November 2019, Mid Dakota Clinic, its affiliated building partnership, and insurer agreed to pay the United States $4.15 million to resolve the case.  The clinic additionally paid $1.3 million for the whistleblower’s attorneys’ fees and costs, for a total payment of $5.45 million.  The United States awarded Mr. Neuberger a 25% relator’s share of its recovery.

Wireless Carriers – Government Contracting Fraud ($138.7 million)

Constantine Cannon represented whistleblower OnTheGo Wireless, LLC, in state False Claims Act litigation against the four largest U.S. wireless carriers, AT&T Mobility, Verizon Wireless, Sprint, and T-Mobile, that resulted in the recovery of $138.7 million for the states of California, Nevada, and other jurisdictions, including political subdivisions in those states.  The whistleblower, an industry expert but not an insider at any of the carriers, alleged that the carriers knowingly failed to comply with contractual promises to deliver service “at the lowest cost available,” and provide rate plan “optimization” reports each quarter.  The contracts in questions were cooperative purchasing contracts that allowed different government entities to purchase under the terms and conditions of a master contract negotiated by a lead government agency.  For the carriers, becoming providers under the cooperative purchasing agreements gave them access to a multi-billion dollar market and, eager to have that access, the carriers agreed to provide rate plan optimization, but then, according to the whistleblower, failed to provide it.  The contracts were long-standing and the terms highly specialized.  And, many government agencies agreed to purchase under the contracts based solely on the fact they were put together by the Western States Contracting Alliance (“WSCA”).  This created an opportunity, OnTheGo alleged, that the carriers knowingly exploited to breach their promise to deliver low cost service and rate plan optimization, resulting in hundreds of millions of overcharges to government entities.  Over 30 California political subdivisions intervened in the California action and were also represented by Constantine Cannon; the State of Nevada intervened in the Nevada action. Plaintiffs ultimately recovered $138.7 million, and the whistleblower received a relator share of nearly 40%.  See Press Release and Whistleblower Insider for more.

Centric Parts – Customs Fraud ($8 million)

In a customs fraud victory, the Constantine Cannon team represented whistleblower Steve Hughes in his successful False Claims Act action against his former employer, auto parts distributor CWD, LLC.  Hughes alleged that CWD, which does business as Centric Parts, misclassified brake pads imported from Asia as “unmounted” brake pads when they were, in fact, brake pads mounted to a metal backing plate, and therefor subject to a 2.5% tariff.  When Hughes learned of the misclassification, he immediately advised the CEO and CFO to disclose the issue to U.S. Customs and Border Protection.  Instead, the company concealed the misclassification and retaliated against Hughes.  As a result of Centric’s alleged omissions and false statements regarding its imported products, the company knowingly evaded millions of dollars of customs duties it owed to the United States.  The $8 million settlement resolved the Hughes lawsuit and one other qui tam action filed by a different whistleblower.  The whistleblowers shared a $1.48 million whistleblower award, representing 18.5% of the government’s recovery.  Whistleblower Insider; Press release

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.
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