Whistleblower Case

July 14, 2023

Electronic health record technology vendor NextGen Healthcare Inc. has agreed to pay $31 million to resolve a whistleblower’s allegations that it misrepresented the capabilities of certain software and improperly induced users to recommend the software.  According to two users of the NextGen’s software, Toby Markowitz and Elizabeth Ringgold, the company allegedly violated the False Claims Act by concealing from a certifying entity that its technology lacked critical but required functions. Additionally, the company allegedly violated the Anti-Kickback Statute by giving credits worth up to $10,000 to customers whose recommendation of NextGen’s EHR software led to a new sale.  For launching a successful qui tam case, the whistleblowers will receive and share a $5.6 million share of the recovery.  DOJ

June 15, 2023

Two compounding pharmacies, Smart Pharmacy, Inc. and SP2, LLC, and their owner, Gregory Balotin, have agreed to pay at least $7.4 million to resolve two qui tam lawsuits by whistleblowers Amy Sanchez and Ashok Kohli, both former employees of Smart Pharmacy.  According to the suits, in order to increase orders for expensive compounded pain creams, the pharmacy routinely waived mandatory patient co-payments for them, and in order to boost reimbursements from Medicare and TRICARE, it added the antipsychotic drug aripiprazole to the topical creams.  DOJ

May 31, 2023

VHS of Michigan Inc., d/b/a, The Detroit Medical Center, Vanguard Health Systems Inc., and Tenet Healthcare Corporation will pay nearly $30 million for causing the submission of false or fraudulent claims to Medicare. From January 1, 2014 through December 31, 2017, DMC, Vanguard, and Tenet violated the Anti-Kickback Statute when they provided the services of mid-level practitioners to 13 physicians at no cost or below fair market value. The physicians were selected for their high number of referrals, which DMC hoped would cause an increase in referrals to their facilities. Whistleblower Dr. Jay Meythaler will receive $5.2 million as part of the settlement. DOJ

May 25, 2023

Vascular surgeon Vasso Godiali of Michigan has been ordered to pay $19.5 million in restitution and serve over 6 years in prison to resolve criminal allegations of defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. Godiali also agreed to pay up to $43.4 million to resolve civil allegations of violating the False Claims Act.  Although Godiali allegedly began submitting false claims in 2009, his misconduct did not come to light until a 2015 qui tam suit by Innovative Solutions Consulting LLC, which alleged Godiali billed government programs for arterial thrombectomies and stent placements that were not medically necessary and not actually performed.  Additionally, Godiali allegedly falsified medical records to justify the procedures, and improperly used a modifier code to increase his reimbursements. DOJ