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This archive displays posts tagged as relevant to the federal False Claims Act. You may also be interested in the following pages:

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Visiting Nurse Service of New York – Medicare/Medicaid Home Health Care Fraud ($57 million)

Constantine Cannon represented whistleblower Edward Lacey against Visiting Nurse Service of New York – the largest not-for-profit home health care agency in the United States.  VNSNY agreed to pay $57 million to resolve allegations it failed to provide home health care visits and services to tens of thousands of New Yorkers and fraudulently billed Medicare and Medicaid.  Mr. Lacey was an executive at VNSNY for 16 years.  In his complaint, Mr. Lacey alleged that VNSNY failed to provide its patients all the critical nursing and therapy visits and services their doctors prescribed under the patient Plans of Care.  He contended that by failing to provide this care, VNSNY endangered the welfare of tens of thousands of its patients while maximizing the company's Medicare and Medicaid reimbursement.  Mr. Lacey's claims concerning alleged Plan of Care failures impact the entire home health care industry.  This is the first reported False Claims Act settlement involving allegations of a home health agency failing to follow patient Plans of Care.  It also is the largest non-kickback False Claims Act settlement ever against a home health care company and the second largest settlement of any home health care fraud case.  Read more: Press Release; Whistleblower Insider.

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Posted  07/2/20
Newsboy hawking paper
The record-setting $57 million settlement in U.S. ex rel. Lacey v. Visiting Nurse Service of New York, a False Claims Act case brought by Constantine Cannon client Edward Lacey, received extensive coverage in the media, with stories noting that the wrongdoing alleged was “pervasive” in the home health industry. As a whistleblower, Lacey alleged that home health agency VNSNY failed to adhere to the plans of care...

Catch of the Week: Novartis Pays $729 Million to Settle Two Kickback Cases on Heels of $345 Million Foreign Bribery Settlement

Posted  07/2/20
Novartis corporate building
This week and last, pharmaceutical manufacturer Novartis reached three settlements involving very different forms of unlawful kickbacks and bribes.  First, this week the company agreed to pay a total of $678 million to resolve a New York case alleging that it paid inflated “speaking fees” and provided other incentives to doctors to induce them to prescribe Novartis drugs.  Second, Novartis will pay $51.25...

July 1, 2020

Novartis Pharmaceuticals Corporation will pay a total of $678 million to resolve a case brought by a whistleblower, Oswald Bilotta, alleging that between 2002 and 2011 the pharmaceutical company violated the Anti-Kickback Statute and False Claims Act by providing doctors with cash payments and luxury travel and meals to induce them to prescribe Novartis cardiovascular and diabetes drugs reimbursed by federal healthcare programs.  The total settlement consists of $591.4 million as federal FCA damages, $48.2 million as state FCA damages for Medicaid false claims, and $38.4 million as forfeiture under the Anti-Kickback Statute.  The whistleblower award has not yet been determined.  In addition to the monetary settlement, Novartis entered into a Corporate Integrity Agreement obligating the company to, among other things, significantly reduce its volume and spending on paid speaker programs.  DOJ; USAO SDNY

July 1, 2020

Novartis Pharmaceuticals Corporation will pay $51.25 million to resolve claims that it unlawfully funneled money to three different foundations – The Assistance Fund, the National Organization for Rare Disorders, and the Chronic Disease Fund – so that those organizations could fund co-payments owed by Medicare beneficiary patients prescribed the Novartis drugs Gilenya (for multiple sclerosis) and Afinitor (for renal cell carcinoma and certain pancreatic cancers).  The payments were alleged to be in violation of the Anti-Kickback Statute and False Claims Act.  USAO Mass; DOJ

July 1, 2020

Genetic testing company Agendia, Inc., which offers the MammaPrint test analyzing genes within breast cancer tumors to predict recurrence, will pay $8.25 million to resolve claims of Medicare fraud in a case brought by a whistleblower under the False Claims Act.  Agendia was alleged to have conspired with hospitals to delay the performance of MammaPrint tests for patients discharged from those hospitals.  Under the Medicare 14-Day Rule in effect during the relevant time period, Agendia was allowed to bill Medicare directly for the test if it was performed more than 14 days after the patient was discharged from the hospital; if the test was performed within 14 days of discharge, then it would be billed through the hospital.  If Agendia received a physician’s order for a Medicare patient within 14 days of the patient’s discharge, it would either cancel the order and require the physician to resubmit it, or otherwise improperly delay the test and claim it was ordered and performed on a later date.  The whistleblower was a former employee of a Kentucky hospital, Mercy Health- Lourdes, which worked with Agendia to allow it to separately bill Medicare for the test, including by holding tissue specimens for 14 days or longer after patients were discharged. The hospital previously paid $211,039 to settle its liability.  No reward amount for the whistleblower was made public.  USAO WDKY  

June 30, 2020

Ophthalmic Consultants, P.A. and its principal Robert K. Snyder have agreed to pay $4.8 million to resolve claims that they unlawfully billed federal healthcare programs for the drugs ranibizumab (Lucentis®) and aflipercept (Eylea®).  While the drugs are sold in single-use vials, defendants used single vials to provide doses to multiple patients, allowing them to obtain excessive reimbursement from Medicare, TRICARE, and the Federal Employees Health Benefits Program.  USAO MD FL

June 30, 2020

The University of Virginia will pay $1 million to resolve claims that it received rebates and credits on the purchase of materials and failed to account for those rebates and credits and reduce charges to the federal government in connection with federal grants and awards the university received.  USAO EDVA

COVID Frauds of the Week: Fraud on the PPP

Posted  06/26/20
hundared dollar bill zoomed in to president's face
This week’s COVID-19 frauds centered on (temporarily) successful attempts to receive Paycheck Protection Program (PPP) funds for nonexistent companies and fabricated or inflated employee headcounts. First up is the owner of a wedding planning company that sought personal enrichment via more than $3 million in forgivable PPP loans for his 120 nonexistent employees. Fahad Shah, 44, of Murphy, Texas, was arrested...

Under Cover of Pandemic, Nursing Home Residents Illegally Evicted

Posted  06/26/20
By Jessica T. Moore
wheelchair in the hospital lobby
“It felt opportunistic, where some homes were basically seizing the moment when everyone is looking the other way to move people out.”  (Laurie Facciarossa Brewer, long-term care ombudsman in New Jersey).  With nursing homes involved in more than 40% of coronavirus deaths, in depth reporting by Jessica Silver-Greenberg and Amy Julia Harris at the New York Times reveals a new threat to residents’ care and...
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