Archive for the ‘Whistleblower Lawsuit’ Category

Shands Healthcare of Florida Settles $26 Million False Claims Act Allegations

Shands Teaching Hospital & Clinics Inc., Shands Jacksonville Medical Center Inc., and Shands Jacksonville Healthcare Inc. (Shands Healthcare), which operate a network of health care providers in Florida has entered an agreement with the government to settle allegations that six of the Shands Healthcare’s hospitals submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services.

The government alleged that the six hospitals – Shands at Jacksonville; Shands at Gainesville, Shands Alachua General Hosptial; Shands at Lakeshore; Shands Starke and Shands Live Oak – knowingly submitted inpatient claims, from 2003 through 2006, to Medicare, Medicaid and TRICARE for services and procedures the hospitals knew were supposed to be billed as outpatient services or procedures.

Terry Myers, the president of the helathcare consulting firm YPRO Corp. filed the underlying qui tam lawsuit in the federal district court in Jacksonville, Florida.  The government and Shands Healthcare settled the allegations raised in the qui tam lawsuit for $26 million of which $25,170,400 will be reimbursed to Medicare and the other federal health care programs.  The State of Florida will recieve $829,600.  Mr. Myers’ share of the settlement as a whistleblower under the Federal False Claims Act has yet to be decided.

Posted in False Claims, Federal False Claims Act, Healthcare Fraud, Qui Tam, Settlements, Whistleblower LawsuitNo Comments

Tennessee Nursing Home Managers Agree to Pay $2.7 Million to Settle False Claims Act Allegations

Grace Healthcare LLC and its affiliate Grace Ancillary Service LLC (collectively referred to as Grace) located in Chattanooga, Tennessee agreed to pay $2.7 million to resolve allegations that the companies violated the False Claims Act by knowingly submitting or causing to be submitted false claims for medically unreasonable and unnecessary rehabilitation therapy to the Federal Medicare program and the state TennCare/Medicaid program.  The therapy services included physical, occupational, and speech therapy.

The settlement resolves the qui tam action brought under The False Claims Act by a former Grace employee that alleged that in ten nursing homes between 2007 through June 2011 Grace pressured therapists to increase the amount of therapy they provided to residents regardless of the medical necessity of such services in order to meet targets for Medicare revenue.  These targets were established without regard to the patients’ actual need for therapy and could only be achieved by billing for a large amount of therapy for each patient.  Grace Ancillary Service LLC provided the therapy in some of the skilled nursing facilities owned and/or managed by Grace Healthcare LLC in Tennessee and elsewhere.

The whistleblower will receive $405,000 of the government’s recovery in accordance with the False Claims Act provisions.

Posted in False Claims, Federal False Claims Act, Healthcare Fraud, Mens Rea, Settlements, State False Claims Acts, Whistleblower Lawsuit, Worthless ServiceNo Comments

Corning Incorporated Settles False Claims Act Allegations for $5.65 Million

Corning Incorporated, (Corning) headquartered in the State of New York, has settled False Claims Act allegations that through its Corning Life Science division it submitted false claims to the United States for reimbursement of laboratory research products sold to various federal agencies.  The false claims relate to a contract Corning Incorporated entered into in 2005 to sell laboratory research products to federal government entities through the General Services Administration’s Multiple Award Schedule program.  Under the Multiple Award Schedule program, a company enters a contract with the General Services Administration (GSA) and in exchange for gaining access to the government marketplace and the hundreds of government purchasers, a company agrees to disclose its commercial pricing policies and practices and abide by the contract terms.

The settlement resolves a qui tam lawsuit filed by whistleblower Kevin Jones under the False Claims Act provisions.  Mr. Jones was a former Corning Life Science sales representative.  The settlement resolves allegations that Corning did not disclose its commercial pricing policies and practices during contract negotiations with GSA and during the course of the contract’s administration.  Specifically, Corning knowingly failed to provide GSA with current, accurate and complete information regarding its commercial sales practices, including discounts offered to other commercial customers and that Corning knowingly made false statements regarding its sales practices and discounts.  Additionally, allegations were settled that Corning knowingly failed to comply with the price reduction clause of the GSA contract by not disclosing those discounts and that the discounts were actually higher than what Corning had disclosed to GSA.   Corning also failed to pass those discounts onto its government customers.  The United States government alleged that because of Corning’s actions, it received lower discounts and paid far more than it should have for Corning’s products.

For his role as a whistleblower, Mr. Jones will receive $904,000 of the government’s recovery under the provisions of the False Claims Act.

Posted in False Claims, Federal False Claims Act, Government Intervention, Healthcare Fraud, Mens Rea, Qui Tam, Settlements, Whistleblower LawsuitNo Comments

Morton Plant Mease Health Care Inc. settles $10.1 Million False Claims Allegations with United States Government

Morton Plant Mease Health Care Inc. and its affiliated Florida hospitals have agreed to pay a little over $10.1 million to the United States government for submitting fraudulent health care claims for services provided to Medicare beneficiaries.

The settlement announced by the Department of Justice on November 20, 2012, resolves allegations that the Morton Plant Mease Health Care Inc.’s affiliated hospitals improperly billed for services between July 1, 2006 and July 31, 2008.  The affiliated hospitals submitted bills to Medicare that charged for certain interventional cardiac and vascular procedures as inpatient care when those services should have been properly charged at less costly outpatient care or as observational status.

The fraudulent activity was brought to the United States government’s attention through a qui tam lawsuit filed by Randi Ferrare. Ms. Ferrare was a former director of Health Management Services at Morton Plant Hospital, one of the several affiliated hospitals of Morton Plant Mease Health Care Inc.  For bringing the whistle blower action, Ms. Ferrare will receive $1.8 million as provided in accordance with the False Claims Act.

Posted in False Claims, Federal False Claims Act, Healthcare Fraud, Qui Tam, Settlements, Upcoding, Whistleblower LawsuitNo Comments

United States Intervenes in False Claims Case Involving Overcharging for Delivery of Humanitarian Food Aid

On Friday, October 19, 2012, the Department of Justice announced that the United States government was intervening in the False Claims Act case United States ex rel. John Raggio v.  Jacintoport International LLC, alleging that Jacintoport International LLC, (Jacintoport) a cargo handling and stevedoring firm headquartered in Houston, fraudulently exceeded the explicit caps set on the rates Jacintoport could charge for loading humanitarian food aid onto cargo ships.

The government’s complaint alleges that in 2007 Jacintoport entered into a warehousing and logistics contract with the U.S. Agency for International Development (USAID) for the storage and redelivery of emergency humanitarian food aid bound for crisis areas around the world.  By that contract’s terms, Jacintoport agreed to explicit caps on the rate that Jacintoport could charge for stevedoring.   In the shipping industry, stevedoring refers to the actual loading of the cargo onto ships.  The government alleges that between January 2008 and at least October 2009, Jacintoport regularly charged rates that exceeded those explicit caps, resulting in inflated rates charged to the United States for the delivery of more than 50 thousand tons of humanitarian food aid.

This qui tam action was originally brought by the whistleblower John Raggio.  Mr. Raggio allegedly received an invoice from Jacintoport that contained the excessive stevedore rates.  The claims alleged in United States’ complaint are only allegations and do not constitute a determination of liability.

Posted in False Claims, Federal False Claims Act, Government Intervention, Other Kinds of Fraud, Qui Tam, Whistleblower LawsuitNo Comments

El Paso Based ReadyOne Industries, Inc. Settles Qui Tam Case for $5 Million

On Monday, October 1, 2012, the Department of Justice announced that ReadyOne Industries, Inc. entered a settlement to pay $5 million to resolve a qui tam lawsuit alleging it knowingly submitted false certifications regarding the annual percentages of direct labor hours performed by people with severe disabilities to the federal agency the Committee for Purchase From People Who Are Blind or Severely Disabled.

The Committee for Purchase From People Who Are Blind or Severely Disabled oversee the AbilityOne Program.  The AbilityOne Program creates employment opportunities for people who are blind or have other significant disabilities in the manufacture and delivery of products and services to the federal government.  The program uses the power of the federal government to buy approved products and services from participating, community based nonprofits agencies.  ReadyOne Industries, formerly National Center for Employment of the Disabled, participates in the AbilityOne Program.  In order to participate in this program, ReadyOne Industries must ensure and certify that seventy-five percent of all annual direct labor hours on its contracts are performed by employees who are blind or severely disabled.

ReadyOne Industries, headquartered in El Paso, Texas, is a manufacturer of apparel, boxes and other products.  The United States, in the qui tam lawsuit U.S. ex rel. Mike Ahumada v. National Center for Employment of the Disabled, et al., alleged that between 2000 and 2006 ReadyOne Industries employed a large number of non-disabled employees to work on contracts for the manufacture of its products and did not appropriately account for these employees’ hours as part of the overall ratios it certified and submitted to the Committee for Purchase From People Who Are Blind or Severely Disabled.

The claims settled are allegations only, and there has been no determination of liability.

Posted in False Certifications, False Claims, Qui Tam, Settlements, Whistleblower LawsuitNo Comments

Berg & Androphy Represent Whistleblower in American Grocers, Inc. Lawsuit

Last month the Department of Justice announced that American Grocers, Inc., has agreed to pay $13.2 million to settle a lawsuit that charged the Houston company with changing "use-by" labels on food sold and shipped to U.S. troops in the Middle East during the Iraq war.

The case began in 2005 after Delma Pallare, despite fears of retaliation, blew the whistle on American Grocers, Inc. and its owner Samir Itani, and brought to light the illegal conduct.

Ms. Pallares, represented by the law firm of Berg & Androphy, brought her lawsuit, also known as a qui tam action, under the Civil False Claims Act in the Southern District of Texas. The Houston law firm spent 5 years relentlessly pursuing the case along with Assistant U.S. Attorney Michelle Zingaro. As a result, the government issued a search warrant for American Grocers’ warehouse, indicted Itani, and intervened in the qui tam action.

View Press Release
View Los Angeles Times Cover Story
View Houston Press Cover Story

Posted in Qui Tam, Settlements, Whistleblower LawsuitNo Comments

Whistleblower Complaints Lead to Probe of Allergan’s Marketing of Botox

Allergan Inc., has agreed to settle a federal investigation over how it marketed Botox, said the Associated Press (AP). Allergan Inc. allegedly promoted Botox Therapeutic for unapproved medical uses through Medicaid resulting in a combined $600 million in civil and criminal penalties. The settlement becomes official once a federal judge approves it, said the AP.

A whistleblower complaint led to the probe that lasted one year, with the Justice Department looking at Allergan’s marketing of Botox from 2001 through 2008. The five whistleblowers will split $37.8 million of the government’s settlement.

Private citizens who file lawsuits on behalf of the government alleging fraud are eligible for up to 18 percent of whatever is recovered as the result of a qui tam lawsuit. According to a press release, Allergan Inc. agreed to pay state governments and the federal government a combined $225 million civil settlement to compensate Medicaid, Medicare and other federal health programs for reimbursements wrongly paid for Botox Therapeutic. This includes $210 million to the federal government—the rest to a number of states—connected to the probe.

Off-label marketing violates the civil and criminal laws.” says Joel Androphy, Partner at the prestigous Nationwide law firm of Berg and Androphy. “In addition to misbranding a drug, many pharmaceutical companies pay kickbacks to doctors to induce more prescriptions. As long as companies compete for patients, off-label marketing will continue.”

Posted in Off-Label Marketing, Whistleblower LawsuitNo Comments

Sheriff’s Office’s former IT Director fired for blowing the whistle

A lawsuit was filed Monday, July 19th by Wilfrido Willie Mata, the former IT director of the Harrison County sheriff’s office’s claiming he was illegally fired for being a whistle blower.

“You can’t say to somebody, ‘Thanks for reporting. You’re fired,'” Houston whistleblower attorney Joel Androphy said.

According to the lawsuit, instead of looking the other way while an outsider hacked into the county’s computer system, Mata went to the FBI. In October, Mata disclosed his cooperation to the sheriff’s office. In February, the suit says his performance review was rated average. In May, he was fired.

“That timing is too close to not raise a lot of suspicion that he was fired because of complaining,” Androphy said. The lawsuit alleges the sheriff’s office violated the Whistleblower Act.

Watch the complete story as reported on WKTRK Eyewitness News.

Posted in False Claims, Qui Tam, Whistleblower LawsuitNo Comments

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