Whistleblower Case

September 23, 2015

The Florida Attorney General announced a $3.5 million settlement with Adventist Health System Sunbelt Healthcare Corporation and Adventist Health System/Sunbelt, Inc. to resolve two suits brought by whistleblowers alleging that Adventist maintained improper financial relationships with physicians and submitted claims to Florida Medicaid for services and items the physicians referred. The settlement resolves claims that Adventist submitted false Medicaid claims and awarded referring doctors based on the number of tests and procedures the doctors ordered. Adventist also entered into separate civil settlements with the federal government, North Carolina and Texas, agreeing to pay more than $115 million. FL.

August 24, 2015

The New York Attorney General announced settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs in exchange for kickbacks. Investigation of the defendants began after whistleblowers Mathew I. Gelfand, M.D. and Enrico Montaperto filed complaints under New York’s False Claims Act. NY

August 3, 2015

19 states and the federal government have joined in a settlement valued at over $2.7 million with Georgia-based company Pediatric Services of America, Inc. (“PSA”). The case began as a whistleblower action, filed in the Southern District of Georgia under the federal False Claims Act and various state false claims statutes, and was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Attorney’s Office for the Southern District of Georgia, the U.S. Department of Health and Human Services, and the Office of the Inspector General. In addition, a National Association of Medicaid Fraud Control Units (NAMFCU) Team participated in the investigation and conducted the settlement negotiations with PSA on behalf of the states and included representatives from the Offices of the Attorneys General for the states of Massachusetts, Georgia, Virginia, Texas, Illinois, and Washington. MA

July 17, 2015

The SEC announced its 18^th whistleblower award since the program’s inception – this one for over $3 million, the third highest to date.  This puts the award total at over $50 million.

June 29, 2015

New York announced a settlement with pharmacy Trinity Homecare LLC that returns $2.5 million to the state’s Medicaid program. A whistleblower filed a lawsuit in 2009 alleging that Trinity pushed infusion drugs, which are prescribed to manage symptoms, to hemophilia patients and presented claims to Medicaid for unneeded or excessive quantity of these drugs. The whistleblower alleged improper billing for drug deliveries, including ones that patients refused to accept and excess shipments. In at least one instance, these expensive drugs were allegedly left outside a patient’s home without signature by the patient. NY