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Defendants

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November 25, 2019

Two entities agreed to pay a total of $1.2 million to resolve claims that the Puerto Rico Municipality of Sabana Grande improperly subcontracted work to be performed under a grant from the U.S. Dept. of Education to the Puerto Rico Department of Education for teacher training. The grant required that the work could not be performed by private entities, but the municipality subcontracted with and disbursed grant funds to private entity the Puerto Rico Olympic Committee (COPUR), which further subcontracted with the company Administrative, Environmental and Sports Consultants (AESC).  The municipality will pay $500,000, and COPUR agreed to pay $700,000.  In addition, the United States seized more than $1 million from bank accounts belonging to AESC owner Irving Riquel Torres in connection with related criminal proceedings against him.  USAO PR

Florida Pharma Whistleblower Case Results in FCA Settlement by Private Equity Firm

Posted  09/27/19
Last week, the government announced that compounding pharmacy Diabetic Care Rx LLC, known as Patient Care America (“PCA”), its executives, and the private equity firm managing the pharmacy Riordan, Lewis & Haden Inc., had agreed to pay over $21 million to settle allegations they violated the False Claims Act (“FCA”) by executing a kickback scheme to generate referrals of TRICARE patients. The allegations...

September 18, 2019

Florida-based compounding pharmacy Diabetic Care Rx LLC, also known as Patient Care America, together with two of its executives, CEO Patrick Smith and VP of Operations Matthew Smith, and the private equity firm Riordan, Lewis & Haden Inc., will pay $21.36 million to resolve a case brought by two whistleblowers under the False Claims Act alleging that they paid unlawful kickbacks to secure referrals for patients covered by TRICARE, the federal healthcare program that covers military members and their families.  The pharmacy paid patient recruiters to target military members and their families for the prescription of compounded creams and vitamins formulated to ensure the highest possible reimbursement from TRICARE.  The marketers in turn paid doctors who issued the prescriptions, often without seeing or even speaking to the purported patients.  In addition, the pharmacy and marketing company often covered patient copayments through a sham charitable organization affiliated with the marketing company.  Private equity investor RLH was alleged to have known about and agreed to the kickback scheme.  Whistleblowers Marisela Medrano and Ada Lopez were, respectively, the former Director of Marketing and the Reimbursement Services Manager of PCA.  They will receive a yet-to-be-determined share of the U.S. recovery.  DOJ; SD FL

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

Posted  08/29/19
The landmark $572M opioid verdict in Oklahoma against Johnson & Johnson stemmed from a single claim: “public nuisance” under state law.  Other cases against opioid manufacturers, including whistleblower cases, involve claims for fraud, unlawful marketing, improper prescriptions, kickbacks, violating the Controlled Substances Act by failing to report suspicious purchases, and even flooding the black market.  But...

May 21, 2019

DeKalb County, Georgia has agreed to pay the federal government $750,000 to settle claims that the county misused Department of Labor On-the-Job Training program grant funds.  OTJ funds are required to be used to reimburse employers that hire individuals with identified skills gaps.  The government alleged that DeKalb county falsely certified that it was complying with OTJ regulations, and used the funds to subsidize the wages of highly qualified county employees, allegedly requiring some to sign paperwork saying that they had received OTJ services when they had not.  USAO ND GA

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted  05/10/19
By Jessica T. Moore
Handcuffed business-leader walking through jail.
In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

April 30, 2019

The former CEO of hospital chain Health Management Associates LLC, Gary D. Newsome, has agreed to pay $3.46 million to resolve claims in a whistleblower lawsuit that he personally caused HMA to submit false claims to federal healthcare programs in violation of the False Claims Act.  Newsome was alleged to have caused HMA to pressure emergency department physicians to increase inpatient admissions without regard to medical necessity, so that the hospital chain could bill for more costly inpatient services.  In addition, Newsome was alleged to have caused HMA to make bonus payments to emergency department physicians, and contract concessions to the company, EmCare, that provided emergency department physician staffing, to increase inpatient admissions.  Newsome was the CEO from 2008 through 2013, prior to HMA's acquisition by Community Health Systems Inc.  HMA settled related claims in September 2018, and EmCare settled related claims in December 2017.  Two whistleblowers, Jacqueline Meyer, a former employee of EmCare, and J. Michael Cowling, a former employee of HMA, will receive approximately $725,000 from this settlement.  DOJ

September 19, 2018

A nonprofit organization and its management company have agreed to pay $528,575.82 to settle False Claims Act-based allegations of grant fraud in connection with the Department of Justice's National Justice Information Sharing Initiative. In applying for grants, the National Association of State Chief Information Officers, Inc. (NASCIO) allegedly failed to follow rules requiring the disclosure of conflicts of interest relating to American Management Resources, Inc. (AMR), which if disclosed would have disqualified NASCIO from receiving any grants. USAO EDKY

Catch of the Week -- Prime Healthcare

Posted  08/9/18
upcoding
Prime Healthcare, a nationwide healthcare provider that operates 45 hospitals and employs over 40,000 people, has settled allegations under the False Claims Act that 14 of its California hospitals improperly billed Medicare for admitting patients who only required outpatient care, and billed Medicare for treating more severe diagnoses than patients actually had. The company will pay just under $62 million to settle...

August 3, 2018

A former subcontractor, Andrew Nolan, has pleaded guilty to falsifying quality testing results for the concrete used on the Dulles Metrorail Project. The actual results would have caused the concrete to be rejected in the project, which is partially funded by the Department of Transportation. Nolan is being prosecuted under both the federal False Claims Act and the Virginia Fraud Against Taxpayers Act and faces a maximum of five years in prison. USAO EDVA
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