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Whistleblower Case

This archive displays posts tagged as involving a whistleblower case or claim. You may also be interested in our pages:

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Bristol-Myers Squibb Settlement Highlights a Common-Sense Law: The Medicaid Drug Rebate Program

Posted  04/2/21
Drug prices are out of control.  They now account for roughly 10% of our healthcare spending and America’s per capita outlay has nearly doubled over the past two decades.  For the least fortunate among us, many of these medications have become out of reach altogether. While new proposals are regularly made, one approach that often gets overlooked is simply enforcing the laws already on the books. That is just...

April 1, 2021

Pharma company Bristol-Myers Squibb will pay $75 million to settle a False Claims Act action, filed by a whistleblower, alleging that the company failed to pay amounts it owed under the Medicaid Drug Rebate Program. That program, the MDRP, requires drug manufacturers to report the Average Manufacturer Prices (AMPs) of their Medicaid-covered drugs to the government; the higher the reported AMPs, the greater the rebate owed by the pharma company to the government.  The whistleblower alleged that Bristol-Myers systematically under-reported their AMPs for a number of its drugs, including by reducing service fees it paid to wholesalers and excluding the value of price appreciation provisions in wholesale contracts. Of the total settlement, $41 million will be paid to the federal government, and the remainder to states participating in the settlement.  The government did not intervene, and the action was pursued by the whistleblower, Ronald J. Streck, who will receive an undisclosed share of the settlement.  USAO EDPA

March 29, 2021

The SEC has awarded an anonymous whistleblower $500,000 based on recoveries in a covered action and a related action that resulted in the shut-down of an ongoing fraudulent scheme. The whistleblower first reported the alleged misconduct to their employer, using the employer’s internal compliance procedures.  Then, within 120 days of reporting the violations internally, the whistleblower submitted a TCR to the SEC.  According to the SEC, the whistleblower provided significant information that prompted it to open an investigation, and provided ongoing assistance to Commission staff.  Separately, the employer began an internal investigation and ultimately made a report to a government agency.  Because the whistleblower reported internally and to the SEC within 120 days of their internal report, the SEC applied its “safe harbor” rule and treated the whistleblower’s SEC submission as if it had been made on the day that the whistleblower reported internally.  SEC

March 26, 2021

Following two whistleblower complaints, a former owner of a now-defunct diagnostic testing laboratory in North Carolina and South Carolina has agreed to pay $2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  Together with other agents of Physicians Choice Laboratory Services (PCLS), Phillip McHugh allegedly offered and provided benefits to physicians in exchange for referrals of patient samples, causing false claims to be submitted to Medicare.  A second defendant in the case, former sales representative and manager Manoj Kumar, has already paid approximately $650,000 to resolve similar claims.  USAO WDNC

Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

Posted  03/19/21
Doctor in handcuffs holding a stethoscope
Healthcare fraudsters routinely look for ways to extract money from federal health programs in ways that raise the least suspicion of their actions.  One of these methods is through unnecessary diagnostic testing, which can often be lucrative when conducted routinely on large groups of patients. This week we focus on a recent settlement with Dr. Dinesh Shah and Michigan Physicians Group, P.C. (“MPG”) for $2...

March 18, 2021

A Michigan-based cardiologist, Dinesh Shah, and his practice, Michigan Physicians Group, P.C. (MPG), have agreed to pay $2 million to resolve allegations of defrauding Medicare, Medicaid, and TRICARE by submitting claims for medically unnecessary diagnostic testing, in violation of the False Claims Act.  In separate qui tam suits filed by former employees Arlene Klinke and Khrystyna Mala, the whistleblowers alleged that between 2006 and 2017, Shah and MPG billed government healthcare programs for Ankle Brachial Index tests, Toe Brachial Index tests, and Nuclear Stress Tests that were ordered and provided without regard to necessity.  USAO EDMI

March 16, 2021

Jack Lee Stapleton and Jack Hunter Stapleton, the former owners of a Florida-based telemarketing company known as CV McDowell LLC or J&J Tel Marketing LLC (the Stapleton Entities), have agreed to pay at least $4 million to resolve a qui tam case by a former employee alleging violations of the False Claims Act.  According to whistleblower Dwayne Thornton, the Stapletons solicited prospective patients through telemarketing calls, convinced them to accept compounded drugs regardless of need, and then procured prescriptions and sent them to compounding pharmacies that agreed to pay the Stapletons half of all TRICARE reimbursements.  USAO MDFL

March 8, 2021

Vascular surgeon Feng Qin and his medical practice Qin Medical P.C. will pay $800,000 to resolve civil claims and criminal charges that Qin performed procedures on end-stage renal disease patients that were not medically reasonable and necessary, and fraudulently billed Medicare.  Qin performed vascular access procedures on patients on a routine scheduled basis, without documenting the required clinical findings.  The government’s investigation was initiated by the filing of a qui tam complaint by Mark Favors.   USAO SDNY

March 5, 2021

A substance abuse treatment facility and two inpatient psychiatric hospitals in Ohio, along with their corporate parent, have agreed to pay $10.25 million to resolve claims under the Anti-Kickback Statute and False Claims Act.  According to DOJ, between 2013 and 2019, The Woods at Parkside, Cambridge Behavioral Hospital, and Ridgeview Behavioral Hospital—all owned by Florida-based Oglethorpe Inc.—allegedly provided improper inducements in the form of free long-distance transportation in order to entice patients to seek treatment at their facilities, and then submitted claims for services provided to those patients to Medicare.  The case was initiated by a former client advocate working at Cambridge, Darlene Baker.  DOJ; USAO SDOH

March 2, 2021

Hedge fund manager Thomas E. Sandell has paid $105 million to resolve claims first brought by a whistleblower under the New York False Claims Act alleging that Sandell evaded tens of millions in state and local taxes by falsely claiming that $450 million in management and performance fees he recognized in 2017 were not earned for services performed in New York, despite the fact that his fund, Sandell Asset Management Corporation, operated in New York and represented to the SEC that New York City was its principal place of business.  In his effort to evade NY taxes, Sandell moved to London for a period of time, opened an office in Florida, and managed SAMC expenses through a shell company that he also owned and controlled, all while continuing to perform the investment services that generated the fee income in New York.  When Sandell’s accountant informed him that he would have to pay NY state taxes, he terminated them and retained a firm that took his preferred position.  The whistleblower will receive an award of $22.05 million, which is 21% of the government’s recovery. NY
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