Whistleblower Rewards

October 4, 2016

Arizona not-for-profit community health system Yavapai Regional Medical Center agreed to pay $5.85 million to resolve claims that it violated the False Claims Act by misreporting data about the hours worked by its employees on its annual cost reports, which improperly inflated the amount of money it received from the Medicare program.  According to the government, the artificially inflated wage index was used by the Medicare program when it calculated the amount of the payments it made to Yavapai.  The allegations originated in a whistleblower lawsuit filed by Gregory Kuzma under the qui tam provisions of the False Claims Act.  Mr. Kuzma will receive a whistleblower award of $1.17 million from the proceeds of the government's recovery.  DOJ (DAZ)

October 3, 2016

Major hospital chain Tenet Healthcare Corporation and two of its Atlanta-area subsidiaries, Atlanta Medical Center Inc. and North Fulton Medical Center Inc., agreed to pay over $513 million to resolve charges they violated the False Claims Act and Anti-Kickback statute through illegal kickbacks it paid in exchange for patient referrals.  The allegations originated in a whistleblower lawsuit filed by Ralph Williams under the qui tam provisions of the federal and Georgia False Claims Acts.  Mr. Williams will receive a whistleblower award of approximately $84 million from the proceeds of the federal and state civil recoveries.  DOJ

October 3, 2016

California orthopedic clinics Orthopedic Associates of Northern California, San Bernardino Medical Orthopaedic Group Inc. (doing business as Arrowhead Orthopaedics) and Reno Orthopaedic Clinic agreed to pay a combined $2.39 million to resolve federal and state False Claims Act allegations that they improperly billed federal and state health care programs for reimported osteoarthritis medications, known as viscosupplements.  According to the government, the clinics purchased deeply discounted viscosupplements that were reimported from foreign countries and billed them to state and federal health care programs in order to profit from the reimbursement system, when such reimported viscosupplements were not reimbursable by those programs.  The reimported products allegedly included labeling in foreign languages and in English for additional uses not approved in the United States.  The government further alleged there was no manufacturer assurance that the drugs had not been tampered with or that it was stored appropriately.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a Senior Musculoskeletal Specialty Manager in the Biosurgery Division of Sanofi S.A.  The whistleblower will receive a whistleblower award of approximately $430,000 from the proceeds of the government's recovery.  DOJ (EDCA)

September 30, 2016

Daniel Scott Goldman and his companies, Ecologic Industries LLC and OMNI SCM LLC, agreed to pay $1,525,000 to settle charges of violating the False Claims Act by making false statements to avoid paying duties on wooden bedroom furniture imported from China.  According to the government, the defendants misclassified or conspired with others to misclassify wooden bedroom furniture on documents presented to U.S. Customs and Border Protection to avoid paying antidumping duties on Chinese imports of wooden bedroom furniture.  Specifically, Goldman and his companies allegedly classified the furniture as office and other types of furniture not subject to duties while selling the furniture in the student housing market for use in dormitory bedrooms.  The allegations originated in a whistleblower lawsuit filed by Matthew L. Bissanti, Jr. under the qui tam provisions of the False Claims Act.  Bissanti will receive a whistleblower award of $228,750 from the proceeds of the government's recovery.  DOJ (WDTX)

September 28, 2016

Pennsylvania-based hospital chain Vibra Healthcare LLC agreed to $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services.  According to the government, Vibra admitted numerous patients to five of its long term care hospitals and one of its inpatient rehab facilities who did not demonstrate signs or symptoms that would qualify them for admission.  In addition, Vibra allegedly extended the stays of its long term care patients without regard to medical necessity, qualification and/or quality of care.  In some instances, Vibra allegedly ignored the recommendations of its own clinicians, who deemed these patients ready for discharge.  The allegations originated in a whistleblower lawsuit filed by Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of at least $4 million from the proceeds of the government's recovery.  Whistleblower Insider

Bay Sleep Clinic - Healthcare Fraud/Kickbacks ($2.6 million)

Constantine Cannon represented a whistleblower under the False Claims Act case alleging Bay Sleep Clinic billed Medicare for sleep studies by unlicensed technicians and paid kickbacks to doctors for patient referrals.  In December 2016, the company agreed to pay $2.6 million to settle the matter.  Our client received a whistleblower award of roughly 21% of the government’s recovery.  Read more -- SF Gate, DOJ, PR Newswire, CC.

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 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)