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Constantine Cannon Celebrates a Record-Shattering Year of Whistleblower Rewards

It has been a big year for our whistleblower clients

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Successes

Members of the Constantine Cannon Whistleblower Lawyer Team have been responsible for a string of major whistleblower successes over more than a decade, and had a record-shattering year in 2020.  Our successes include the following:

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.

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

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.

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