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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.  We had a record-shattering year in 2021, and have a track record of success in achieving the maximum possible awards for our clients.  Our successes include the following:

Bay Sleep Clinic – Medicare Fraud/Unapproved Facilities, Unlicensed Technicians, and Physician Kickbacks ($2.6M).

Constantine Cannon represented whistleblower Elma Dresser, a sleep technician and former Bay Sleep employee. Ms. Dresser alleged that Bay Sleep Clinic and associated businesses, a network of sleep clinics in the San Francisco Bay Area, fraudulently billed Medicare for sleep studies conducted by unlicensed technicians in unapproved locations; improperly dispensed durable medical equipment from unapproved locations using unlicensed technicians; and paid doctors for referrals in violation of the federal Anti-Kickback Statute. The government joined a portion of the case, and in 2016, defendants agreed to pay $2.6 million to settle the matter. For her significant contributions, the relator’s share award was almost 21% of the government’s recovery. See DOJ for more.

Skyline Urology — Healthcare Fraud ($2.1M)

Constantine Cannon represented a whistleblower in a qui tam lawsuit that alleged that from 2013 through 2016 a large urology practice had fraudulently and systematically misused a billing code in order to increase reimbursements from insurers, including Medicare and private insurers in California. The code, modifier 25, is properly used when a physician performs an evaluation and management service and a separate and distinct service on the same day. Billing with modifier 25 when no distinct service occurred can improperly inflate reimbursement rates and is known as “unbundling fraud.” The Federal Government recovered $1.85M and the State of California recovered $250,000 to resolve the allegations. For his efforts in uncovering the fraud, the whistleblower received a portion of both recoveries. See The National Law Review and Becker’s ASC Review for more.

Pure Collection – Customs Fraud ($908,100)

Constantine Cannon represented whistleblower Andrew Patrick, who worked for Pure Collection from 2010 to 2014, first as a sales representative in its U.K. call center and then in its U.K. packaging department. Mr. Patrick’s qui tam, or whistleblower, lawsuit alleged that since 2007 the defendants fraudulently and systematically avoided paying U.S. customs duties on its goods shipped from the United Kingdom to customers in the United States. Pure Collection and the e-retailer’s acting CEO, Samantha Harrison, have collectively agreed to a settlement of $908,100 to the U.S. Government. This lawsuit was one of the first to be brought by a U.K. whistleblower in which the U.S. Government intervened and successfully resolved the whistleblower’s False Claims Act allegations. Mr. Patrick will be awarded 18 percent of the total settlement.

Roof Systems of Maine – Government Contracting Fraud/Noncompliance with contract requirements ($439,500).

Two of our whistleblower attorneys led the representation of Brian Emery, an experienced roofer and former subcontractor to Roof Systems of Maine. Mr. Emery brought a qui tam action under the False Claims Act against Roof Systems of Maine alleging the company defrauded the government by violating contract requirements and industry standards in roofing and siding work done on behalf of the Departments of the Army and Navy, and the National Guard Bureau. According to the complaint, Roof Systems systematically used inferior products and improper installation techniques at three building sites along the Maine coast. The government joined the case, and in 2016, Roof Systems paid $439,500 to settle the case. Mr. Emery received a whistleblower award of $79,110. See Morning Sentinel for more.

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.

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 2023. See: Government Complaint in Intervention; Poehling Second Amended Complaint; Constantine Cannon Press Release.

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

Visa/MasterCard — Antitrust Violations ($3 billion).

Two of our whistleblower lawyers were on the lead counsel team representing Wal-Mart, Sears, Safeway and a class of roughly 5 million U.S. merchants in this antitrust class action alleging various forms of misconduct by Visa and MasterCard in their rules governing the use and marketing of Visa/MasterCard branded credit cards and debit cards. After winning summary judgment on a majority of the claims in this action and on the eve of trial, the parties settled the case with the plaintiff merchants recovering more than $3 billion in damages and injunctive relief valued by the court at tens of billions of dollars. This landmark victory remains one of the largest antitrust settlements in U.S. history. See NY Times for more.

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