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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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December 11, 2018

Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AG   Tags: Medical Billing fraud, HealthCare Fraud, Pharma Fraud, Medicaid, FCA State, Whistleblower Case, Whistleblower reward  

Listen: Expected Dismissal of Providence Health Upcoding Suit

Posted  12/7/18
Constantine Cannon partner Mary Inman joins the RAC Monitor “Monitor Monday” podcast to comment on the government’s decision to decline to intervene in a $188.1 million whistleblower lawsuit Med Analytics, LLC filed against Providence Health (now known as Providence St. Joseph) alleging Providence upcoded diagnoses it submitted to government health programs for reimbursement. Several reports have indicated the allegations are likely to be dropped on Jan. 14, 2019. Listen to...

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 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

Catch of the Week — Bottini Fuel Busted for Illegal “Family and Friends” Scheme

Posted  11/30/18
Bottini Fuel, a fuel and heating company based in New York, has agreed to a $3.3M settlement to resolve allegations that it defrauded customers by keeping rather than returning overpayments. For over a decade, the company used the ill-gotten gains to pay the fuel expenses of company employees, family members, and friends. The whistleblower who brought the fraud to light in a case filed under the New York State False...

November 27, 2018

In New York, Bottini Fuel pleaded guilty to unlawfully retaining overpayments made by fuel oil customers, including public entity customers.  Rather than inform customers that they had made overpayments, or refund those payments, Bottini admitted that it diverted the customers' credit balances to the personal accounts of company owners, employees, and other friends and family.  Bottini agreed to pay over $3.2 million in restitution and civil damages.  The investigation was initiated by the filing of a whistleblower complaint under the New York False Claims Act; the unnamed whistleblower will receive $491,358 of the settlement.  NY AG
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