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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:

Page 49 of 111

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $60 million to settle a False Claims Act case brought by a whistleblower alleging that the retail pharmacy chain knowingly overcharged Medicaid when it charged the healthcare program more than "usual and customary price" for medications that participants in Walgreens "Prescriptions Savings Club" received at a lower price.  Of the settlement, approximately $32 million will be paid to the U.S. and $28 million to the affected states.  Whistleblower Marc D. Baker will receive a share of the total settlement, to be determined at a later date.  USAO SDNY

Tagged in: Drug and DME Pricing, FCA State, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $209.2 million to settle a False Claims Act case brought by two whistleblowers alleging that the retail pharmacy chain knowingly dispensed insulin pens to patients who did not need them, and billed Medicare, Medicaid, and other government insurance programs for those unnecessary items.  As part of the settlement, Walgreens admitted that it prevented pharmacists from dispensing fewer than five insulin pens at a time and altered records regarding dispensing information and days-of-supply so that patients received more insulin pens than they actually needed.  $168 million of the settlement will be paid to the U.S., and approximately $41.2 million to state governments. The whistleblowers, Adam Rahimi and S. Christopher Schulte, will receive a share of the total settlement, to be determined at a later date.  USAO SDNY.  See also, NY, OH

Tagged in: Dosage Fraud, FCA Federal, FCA State, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 21, 2018

The United States has partially intervened in a False Claims Act case initiated by a whistleblower against Wheeling Hospital Inc. along with Wheeling's management consultant R & V Associates Ltd., and Wheeling's CEO, Ronald Violi.  The defendants are alleged to have violated the Stark Law and Anti-Kickback Statute including through its payments to physicians based on referrals by those physicians and/or in excess of fair market value.  The whistleblower, Louis Longo, was previously Wheeling's executive vice president.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud, Whistleblower Case,

December 21, 2018

Sprint Communications will pay $330 million to the State of New York to resolve claims that for nearly a decade Sprint knowingly failed to collect and remit more than $100 million in state and local sales taxes owed on flat-rate wireless calling plans sold by Spriint to New York customers.  The investigation was initiated by a whistleblower lawsuit filed under the New York False Claims Act, which allows whistleblowers to bring claims based on a failure to pay taxes.  The unnamed whistleblower will receive $62.7 million of the settlement.  NY AG

Tagged in: FCA State, Tax Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — Hospice Provider to Pay $6 Million to Settle False Claims Act Suit

Posted  12/21/18
Younger person resting hand on hand of seated elderly woman with cane
SouthernCare, Inc., a hospice provider owned by Curo Health Services, has agreed to pay the federal government nearly $6 million dollars to settle a lawsuit alleging that the company defrauded Medicare by billing medically unnecessary hospice care. The fraud was unearthed by two whistleblowers formerly employed by the company, who filed suit under the qui tam provisions of the False Claims Act, where they will share...

Tagged in: Catch of the Week, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case,

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December 19, 2018

A vascular surgeon and his practice group, Dr. Irfan Siddiqui and the Heart and Vascular Institute of Florida (HAVI), have agreed to pay $2.23 million to settle a False Claims Act brought by a whistleblower, Lois Hawks, who had been a patient of the doctor.  Defendants were alleged to have submitted false claims for vein ablation services that were not medically necessary, were performed by unqualified personnel, or were based on medical records containing false diagnoses and symptoms.  In addition, defendants were alleged to have upcoded evaluation and management service claims.  Ms. Haws will receive a relator's share of $446,000.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

December 13, 2018

Hospice care provider SouthernCare, Inc. has agreed to pay $5,863,426 for submitting fraudulent claims to Medicare between 2009 to 2014. Under Medicare's eligibility rules, in order for hospice care to be reimbursed, a patient must have a life expectancy of six months or less as certified by a physician, and terminal illnesses must be documented with appropriate records. However, according to qui tam complaints by former employees Dawn Hamrock and Patricia Beegle, SouthernCare billed Medicare for care provided to patients who were not Medicare eligible or who had no proof of Medicare eligibility. As part of the settlement, Hamrock and Beegle will share a $1.1 million whistleblower reward. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

December 13, 2018

Relationship Toward Self-Discovery (RTS), the operator of a residential care facility for developmentally disabled adults, has been ordered to pay $2.79 million in the first ever Medicaid False Claims Act trial in the State of Washington. Initially filed by a former bookkeeper turned whistleblower, the lawsuit alleged that from 2012 to 2015, RTS billed Medicare for 60,328 "sleep hours" spent by overnight employees at its facility. Per state law, a "sleep rate" is required to be paid to overnight employees for every hour spent on call on site; if the employees are called to work, a regular rate is paid instead. Although Medicare reimbursed the company for $928,221, RTS allegedly paid its employees only a fraction of the amount owed to them, and in a single year, the difference between the amount RTS reported to Medicare that it paid and the actual amount it paid totaled as much as $200,000. WA AG

Tagged in: FCA State, Medicaid, Whistleblower Case,

December 12, 2018

Finance of America Mortgage LLC has agreed to pay $14.5 million to the United States to resolve its liability under the False Claims Act in connection with deficient mortgage loans originated by a company it acquired. The acquired company, Gateway Funding Diversified Mortgage Services, L.P. (Gateway), had participated in the Federal Housing Administration's insurance program as a direct endorsement lender (DEL), which gave it the authority to originate, underwrite, and endorse mortgages with minimal oversight from the FHA. However, as reported by a former Gateway employee in a qui tam complaint, the company failed to comply with the stricter procedures required of DELs, including failing to conduct audits on early-payment default loans, repeatedly failing to correct high rates of default, and failing to self-report deficient loans to the FHA. For exposing the fraud, the unnamed relator will receive a share of $2,392,500. USAO NDNY

Tagged in: FCA Federal, Housing and Mortgage Fraud, Whistleblower Case, Whistleblower Rewards,

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  

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

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