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Whistleblower Case

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Page 98 of 111

May 27, 2015

Durable medical equipment suppliers Orbit Medical Inc. and its partial successor, Rehab Medical Inc., agreed to pay $7.5 million to settle False Claims Act charges that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.  According to the government, Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get Orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.  The allegations were first raised in a whistleblower lawsuit filed by former Orbit employees Dustin Clyde and Tyler Jackson under the qui tam provisions of the False Claims Act.  They collectively will receive a whistleblower award of approximately $1.5 million.  Whistleblower Insider

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Pharmacy benefits manager Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, agreed to pay $7.9 million to settle allegations it engaged in a kickback scheme in violation of the False Claims Act.  According to the government, Medco solicited remuneration from AstraZeneca in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  AstraZeneca allegedly compensated Medco in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  In January 2015, the government reached a $7.9 million settlement with AstraZeneca to resolve kickback allegations arising out of the same conduct.  The allegations first arose in a whistleblower lawsuit filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle under the qui tam provisions of the False Claims Act.  They will receive a whistleblower reward from the recovery that has yet to be determined.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

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

May 19, 2015

Atlanta-based world-wide package delivery service United Parcel Service agreed to pay $25 million to resolve allegations it violated the False Claims Act by submitting false claims to the federal government in connection with its delivery of Next Day Air overnight packages.  According to the government, UPS engaged in multiple practices to conceal its failure to comply with its delivery guarantees, thereby depriving federal customers of the ability to request refunds for late deliveries.  The government’s allegations arose out of whistleblower lawsuit filed by former UPS employee Robert K. Fulk under the qui tam provisions of the False Claims Act.  Mr. Fulk will receive a whistleblower award of $3.75 million.  DOJ

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

May 7, 2015

Tennessee-based Jackson-Madison County General Hospital agreed to pay $1,328,465 to resolve allegations it improperly billed Medicare and Medicaid for the placement of unnecessary cardiac stents and other unnecessary cardiac procedures including angioplasty, catheterization, and ultrasound imaging.  The allegations were first raised in a whistleblower lawsuit filed by Dr. Wood D. Deming under the qui tam provisions of the False Claims Act.  Mr. Deming will receive an undisclosed portion of the settlement as a whistleblower award.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

April 29, 2015

The Hospital Authority of Irwin County (ICH) and several doctors agreed to pay $520,000 to settle charges they violated the False Claims Act, the Anti-Kickback Statute, the Stark Law and related Georgia Medicaid policies in connection with the amount of compensation paid by ICH to one of the doctors, ICH’s leases with the doctors, and the supervision of certain diagnostic imaging services at ICH.  The allegations first arose in a whistleblower lawsuit filed by Connie Brogdon and Summer Holland under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  They will receive an undisclosed portion of the settlement payment.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

April 21, 2015

Family Dermatology P.C., which owns and operates a dermatopathology lab in Georgia and several dermatology practices throughout the Eastern United States, agreed to pay $3,247,835 to settle allegations it violated the False Claims Act and the Stark Statute by engaging in improper financial relationships with a number of its employed physicians.  According to the government, Family Dermatology routinely required its dermatologists to use Family Dermatology’s in-house pathology lab, which operated under the name Nelson Dermatopathology, for their pathology services.  The allegations first arose in three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Scott M. Ross MD, Mark F. Baucom and Harold Milstein MD.  They will collectively receive a whistleblower award of more than $584,000.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 21, 2015

Texas-based Citizens Medical Center agreed to pay $21,750,000 to settle allegations it violated the False Claims Act and Stark Statute by engaging in improper financial relationships with referring physicians.  According to the government, the hospital provided compensation to several cardiologists that exceeded the fair market value of their services and paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals.  The allegations first arose in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dakshesh “Kumar” Parikh, Harish Chandna and Ajay Gaalla.  They will collectively receive a whistleblower award of $5,981,250.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

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