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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.

				

			

			
						
					
			

	
		
		

			

				
				
December 8, 2021

				 The owner and medical director of Georgia’s Milton Hall Surgical Associates, Jeffrey M. Gallups, will pay $3 million, and medical device manufacturer Entellus Medical will pay $1.2 million, to resolve claims that they entered into an unlawful kickback arrangement.  The government alleged that Gallups received cash payments and all-expense paid trips from Entellus in return for directing MHSA physicians to utilize sinuplasty related medical devices exclusively from Entellus and increase the number of sinuplasty procedures performed.  In addition, Gallups was alleged to have received “commissions” from medical testing laboratory NextHealth, in exchange for directing MHSA doctors to order medically unnecessary toxicology and genetic tests from NextHealth.  The settlement resolves a qui tam action initiated by former MHSA physician Myron Jones, M.D., who will receive approximately $614,000 from the settlement.  USAO ND GA				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 8, 2021

				 Pharmacist Riad “Ray” Zahr and two pharmacies he owned and operated, Plymouth Towne Care Pharmacy Inc. and Shaska Pharmacy LLC will pay $1 million to resolve a lawsuit initiated by a whistleblower alleging that the pharmacies submitted false claims for Evzio, a naloxone hydrochloride product used for the rapid reversal of an opioid overdose.  The government alleged that the claims included false and misleading prior authorization requests, including forged physician authorizations.  In addition, defendants dispensed Evzio without collecting or attempting to collect co-payments. DOJ; USAO MA				 					 

						
Tagged in:
													  Drug and DME Pricing, 
													  FCA Federal, 
													  Lack of Medical Necessity, 
													  Pharma Fraud, 
													  Whistleblower Case, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 7, 2021

				 New Jersey-based Princeton Pathology Services P.A. will pay $2.4 million to resolve allegations that it overbilled Medicare by submitting claims using a Current Procedural Terminology (CPT) code that required written analysis by a pathologist, when no such analysis was required or had been prepared.  A whistleblower, Jayant Barai, M.D., initiated the matter by filing a qui tam complaint under the False Claims Act, and will receive an award of $456,000.  USAO NJ				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Provider Fraud, 
													  Upcoding, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 2, 2021

				 Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations.  According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold.  Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement.  DOJ				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medicaid, 
													  Medicare, 
													  Other Government Health Programs, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 1, 2021

				 The former CFO of Roadrunner Transportation Systems Inc., Peter R. Armbruster, has been sentenced to two years in prison for participating in a complex accounting fraud scheme that resulted in the company filing materially false statements with the SEC, and eventually tens of millions of dollars in losses to investors.  Armbruster was found to have misrepresented Roadrunner’s expenses, which falsely inflated the company’s reported income.  DOJ				 					 

						
Tagged in:
													  Accounting Fraud, 
													  Certifications, 
													  Criminal Proceedings, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 1, 2021

				 A collection of hospices known as Crossroads Hospice has agreed to pay $5.5 million to settle allegations raised in two qui tam suits by former employees Leanne Malone, Jackie Burns, and Angela Heck, and a home health physician in Tennessee, Dr. David Weber.  In their lawsuits, the whistleblowers alleged that between 2012 and 2014, Crossroads billed Medicare for hospice care for patients who were not terminally ill, including patients with Alzheimer’s or dementia.  Malone, Burns, and Heck will divide a million-dollar relator’s share.  USAO WDTN				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Home Health and Hospice, 
													  Medicare, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
November 29, 2021

				 General contractor J.A. McDonald, Inc. has agreed to pay $637,500 to settle allegations of presenting false claims to the United States and State of Vermont in connection with the federally-funded construction of several bridges.  Employees at the company allegedly made material alterations, then took steps to conceal those alterations from the Vermont Agency of Transportation, which then caused the agency to submit false claims to the Federal Highway Administration.  USAO VT				 					 

						
Tagged in:
													  FCA Federal, 
													  FCA State, 
													  Government Procurement Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
November 23, 2021

				 A number of related entities operating in Ohio and Tennessee as Crossroads Hospice have agreed to pay $5.5 million to resolve allegations that they submitted false claims for hospice services that were not covered by Medicare.  Specifically, the government alleged that over a period of three years, Crossroads submitted claims for dementia or Alzheimer’s patients who were not terminally ill for at least a portion of the more than three years that the patients received care.  Two qui tam actions were filed regarding the false claims; the three individuals who jointly filed the first action, Leanne Malone, Jackie Burns and Angela Heck, were previously employees of Crossroads, and will receive approximately $1.045 million.  DOJ				 					 

						
Tagged in:
													  Healthcare Fraud, 
													  Home Health and Hospice, 
													  Lack of Medical Necessity, 
													  Medical Billing Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
November 22, 2021

				 Home health provider PruittHealth, Inc. has agreed to pay $4.2 million to resolve allegations that they knowingly submitted false claims for services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services.  Tina Peery, who initiated the government action by filing a qui tam complaint, will receive an award of $700,000.  USAO ND Ga				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Home Health and Hospice, 
													  Lack of Medical Necessity, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			


 			


											

						

								

									
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