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DOJ Enforcement Actions

					
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, as well as numerous other laws.


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 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 which could give  rise to a claim for a whistleblower reward, please contact us to speak with one of our experienced whistleblower attorneys.

				

			

			
						
					
			 			




	
		
		

			

				
				
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)				 					 

						
Tagged in:
													  FCA Federal, 
													  Improper Medical Personnel, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
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				 					 

						
Tagged in:
													  Financial Institution Fraud, 
													  Money Laundering, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
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				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
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				 					 

						
Tagged in:
													  FCA Federal, 
													  FIRREA, 
													  Housing and Mortgage Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
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)				 					 

						
Tagged in:
													  Drug Switching, 
													  Medicare, 
													  SNF, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
May 11, 2017

				 Benefits management company Carecore National LLC agreed to pay $54 million to settle charges of violating the False Claims Act by submitting Medicare and Medicaid claims for medical diagnostic procedures without properly assessing whether they were necessary or reasonable.  CareCore provides utilization management services including determinations of medical necessity to New York Medicaid Managed Care Organizations (MCOs). The agreement settles allegations that CareCore instituted a scheme to auto-approve or “Process As Directed” (“PAD”) hundreds of radiology service requests on a daily basis, deeming those diagnostic services as reasonable and medically necessary, even though there had been no evaluation of those cases by the appropriate medical personnel. Of the $54 million, $18 million will go to 20 state Medicaid programs. 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 (SDNY); NY, FL				 					 

						
Tagged in:
													  FCA Federal, 
													  Laboratory and IDTF, 
													  Lack of Medical Necessity, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
May 9, 2017

				 California-based radiation therapy center Valley Tumor Medical Group agreed to pay $3 million to resolve allegations it submitted fraudulent bills over a nearly 10-year period to three government-run healthcare programs for unsupervised radiation oncology services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Valley Tumor employee Jared Shindler.  He will received a whistleblower award of $555,000 from the proceeds of the government's recovery. DOJ (CDCA)				 					 

						
Tagged in:
													  FCA Federal, 
													  Provider Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			


 			




	
		
		

			

				
				
May 2, 2017

				 North Carolina-based Piedmont Pathology agreed to pay $601,000 to settle allegations it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Piedmont pathologist Dr. Kim Geisinger. She will receive a whistleblower award of roughly $120,000. DOJ (WDNC)				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Lack of Medical Necessity, 
													  Provider Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			


											

						

								

									
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