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FCA Federal

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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DOJ Affirms its Materiality Provision but Threatens to Dismiss Gilead FCA Case

Posted  12/7/18
On November 30, 2018, the United States filed its amicus curiae brief before the Supreme Court in Gilead Sciences, Inc. v. United States ex rel. Campie (“Gilead”). The brief highlights two key topics in False Claims Act (“FCA”) litigation: (1) the interpretation of materiality under Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 19889 (2016) (“Escobar”) and (2) the impact of the January 2018 Granston...

December 6, 2018

Actelion Pharmaceuticals US, Inc., will pay $360 million to settle claims that it violated the False Claims Act by means of illegally using a foundation as a channel through which it paid the copays of thousands of Medicare patients who were taking Actelion’s pulmonary arterial hypertension drugs to induce patients to purchase the medications. Actelion collected data from the foundation on its spending for patients and used this information to calculate its donations to the foundation, ensuring that its contributions were adequate to cover the copays of patients taking the subject drugs. The company continued these practices despite allegedly receiving warnings from the foundation.   DOJ  

December 4, 2018

In connection with fraud involving two medical devices, Covidien and ev3 Inc. have agreed to pay a total of $31 million to resolve allegations of violating the False Claims Act. According to whistleblower and former employee of Covidien, Jeffrey Faatz, sister company ev3 Inc.'s Onyx Liquid Embolic System was only FDA approved for use within the brain, but was allegedly being marketed to surgeons for use outside the brain. Furthermore, ev3 reportedly incentivized its sales representatives to sell the device for unapproved purposes by setting up sales quotas and bonuses, and did so even as FDA officials expressed safety concerns to the company's executives. Separately, Covidien was accused of paying kickbacks to hospitals to induce use of its Solitaire mechanical thrombectomy device, causing false claims to be submitted to Medicare and Medicaid. For blowing the whistle on this case, Faatz will receive a relator's share of $2 million. DOJ; USAO CDCA; USAO SDFL; USAO MA

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

December 4, 2018

Medical device-maker LivaNova USA, Inc. has agreed to pay $1.87 million to resolve claims that it paid improper kickbacks to physicians who were among the largest referrers of patients for LivaNova's implanted epilepsy device.  The payments took the form of "speaking fees" for the doctors, although the doctors who received them were primarily speaking to their own staffs.  Ashley Case, a former employee of LivaNova, initiated the investigation by filing a case under the False Claims Act; she will receive an unspecified share of the settlement.  USAO NDGA

December 4, 2018

The New York law firm of Rosicki, Rosicki & Associates, P.C., and two firms affiliated with it, have agreed to settle a False Claims Act action alleging that in performing legal work including foreclosure and eviction services for the Federal National Mortgage Association (Fannie Mae) and the Veterans Administration, the entities submitted bills for costs that were not actual, reasonable, and necessary.  Instead, the false claims for payment included improper mark-ups and other unauthorized charges.  Defendants will pay a total of $6.1 million to the United States, and have agreed to implement a compliance program.  The case was originally brought by whistleblower Peter D. Grubea.  USAO SDNY

December 3, 2018

Feng Qin, M.D., a vascular surgeon who in 2015 settled claims that he performed medically-unnecessary vascular surgeries, has again been charged with such unlawful practices.  As reported by an unidentified whistleblower who brought a case under the False Claims Act, Qin routinely scheduled patients for surgeries months in advance, regardless of whether there was a justifiable clinical reason for the surgery.  At times, Qin would alter medical records.  Qin would then bill Medicare for these procedures, despite his knowledge that procedures on patients that are not medically reasonable and necessary are not covered by Medicare.  USAO SDNY

November 28, 2018

Dr. Thomas Baker, Dr. Carolyn Kochert, Dr. Larry L. Zhou, and Dr. Julie Y. Chao, have agreed to settle with the United States Government for violation of the Federal False Claims Act, the Physician Self-Referral law (“Stark”), and the Anti-Kickback Statute due to their involvement in a kickback scheme with Southwest Laboratories and Medscan Laboratory, thus causing false claims to be submitted to Medicare. The four physicians will pay a total amount of over $1.5 million. The individual amounts paid are as follows: Dr. Baker, of Tennessee - $484,481.80; Dr. Kochert, of Indiana - $129,682.84; Dr. Zhou, of Kentucky - $277,758.18; Dr. Chao, of Indiana - $650,000. DOJ

November 27, 2018

Twelve individuals have been charged by a federal grand jury in a 22-count indictment related to a multi-year conspiracy to defraud the Pennsylvania Medicaid Home Care Program. The indictment lists a multitude of fraudulent acts by the defendants, alleging that they: submitted false claims for services that were not provided, misused consumers’ personal identifying information, provided false documentation during state audits, and even submitted claims to Medicaid for home care services for consumers who were hospitalized or no longer alive. Ten of the defendants reside in Western Pennsylvania, one is a resident of Georgia, and the twelfth defendant is a resident of South Carolina. Between January 2011 and April 2017, the conspirators, who owned and operated the home health care companies, received more than $87,000,000 in Medicaid payments.  The conspiracy and health care fraud charges each carry a maximum total sentence of 10 years in prison, a fine of $250,000, or both.  DOJ

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services.  The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees.  Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000.  USAO S.C.
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