Whistleblower Case

September 26, 2016

New York announced that it has entered into a settlement agreement with First Call, Inc., to resolve allegations that it billed Medicaid for transportation services provided by unqualified drivers and without required documentation. The investigation settled False Claims Act allegations that are identified in the settlement agreement, pursuant to a qui tam lawsuit filed by whistleblower Thomas D. Ayers asserting claims under the New York False Claims Act. As a result of the settlement, the company will pay New York State $173,650.83 in restitution and damages pursuant to the New York False Claims Act. NY

September 21, 2016

Michigan doctor Hussein Awada agreed to pay $200,000 to resolve charges he violated the False Claims Act by writing prescriptions for oxycodone and other controlled medications and billing for medical services without medical justification.  According to the government, Awada conspired with patient “marketers” to write prescriptions for tens of thousands of dosages of oxycodone and other controlled medications for no medical purpose and then used the patient data to submit bills to Medicare for services that were either never performed or were medically unjustified.  Awada also caused these same patients to receive medically unnecessary monthly x-rays, and other invasive tests, to help conceal his fraud.  Awada previously pled guilty to these charges and was sentenced to 84 months in prison and pay $2.3 million in restitution.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Heather Henson, who worked as a receptionist for Awada at his medical practice.  She will receive a whistleblower award of $36,000.  DOJ (EDMI)

September 20, 2016

Partners Anne Hartman and Wayne Lamprey are quoted in the Law360 article, Wireless Carriers Can’t Dodge Calif. Overcharge Suit. Click here to read the article.

September 9, 2016

Los Angeles nursing home Westlake Convalescent Hospital and two physicians who worked there, Dr. Jasvant Modi and his wife Dr. Meera Modi, agreed to pay $3,563,140 to resolve charges they violated the False Claims Act by participating in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.  According to the government, Westlake paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to Westlake.  Jasvant Modi allegedly readmitted patients from Westlake to the now-closed Temple Community Hospital and then back to Westlake to extend the patients’ Medicare-covered stays at Westlake, knowing the patients did not require further services at either facility.  Meera Modi allegedly signed medical orders for non-payable services for these same patients. Westlake allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.  The allegations originated in a whistleblower lawsuit brought by former Westlake employee Ricardo Gonzales under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $534,471 from the proceeds of the government's recovery.  DOJ (CDCA)

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)

August 24, 2016

New York hospitals Beth Israel Medical Center (d/b/a Mount Sinai Beth Israel), St. Luke’s-Roosevelt Hospital Center (d/b/a Mount Sinai St. Luke’s) and Mount Sinai Roosevelt, and Continuum Health Partners, agreed to pay $2,950,000 to settle charges that they violated the federal and New York False Claims Act by willfully delaying repayment of over $800,000 in Medicaid overpayments that resulted from improper claims submitted because of a software error.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (SDNY)

August 24, 2016

The insurance carrier for defunct, for-profit cosmetology school B&H Education, Inc., which operated the Marinello Schools of Beauty in locations across Southern California, agreed to pay $8,631,000 to resolve allegations the school violated the False Claims Act by obtaining federal student loan funds for ineligible students who received bogus high school diplomas.  The allegations originated in a whistleblower lawsuit filed by six former B&H employees under the qui tam provisions of the False Claims Act.  The whistleblowers will collectively receive a whistleblower award of $2.5 million from the proceeds of the government's recovery.  In addition to the $8.6 million payment, the insurer will also pay $2,369,000 to the six whistleblowers’ attorneys.  DOJ (CDCA)

August 17, 2016

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, agreed to pay $690,441 to resolve allegations they violated the False Claims Act by submitting false health care billings for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising.  The allegations originated in whistleblower lawsuit filed Margaret Reynard under the qui tam provisions of the False Claims Act.  Ms. Reynard will receive a whistleblower award of roughly $124,000 from the proceeds of the government's recovery.  DOJ (EDPA)