News & Cases


Bay Area Home Healthcare Provider Amity Faces $115 Million Kickback Scheme Allegations, 30 Defendants Charged, Including CEO

Bay Area Home Healthcare Provider Amity Faces $115 Million Kickback Scheme Allegations, 30 Defendants Charged, Including CEO

The CEO of Amity Home Health Care, Ridhima Singh, 13 doctors, five nurses, a social worker, and 10 others have been charged with participating in a massive kickback scheme created by Singh. According to prosecutors, the CEO paid about $115 million in bribes to the other defendants in exchange for referrals of Medicare beneficiaries.

Allegedly, the defendants systematically referred patients for hospice care to both Amity and Advent Care Inc., instead of referring them to appropriate facilities based on their particular situation. In some cases, Medicare beneficiaries were referred to hospice in exchange for kickbacks that included a ‘longevity’ bonus (as long as the patient was alive, the referring doctor would benefit financially).

According to its website, Amity “is a home health agency that is committed to providing the best quality of skilled care to [their] patients in the comforts of their own home.” ...


Largest CFTC and SEC Whistleblower Awards

Largest CFTC and SEC Whistleblower Awards

Blowing the Whistle About Fraud in The Finance Sector

In spite of a legal framework that vows to encourage transparency, securities and commodities trading fraud are rampant in the U.S. In order to deter fraudsters and protect investors, the Securities and Exchange Commission and the Commodity Futures Trading Commission have both established whistleblower programs.

In the wake of the 2008 crisis, President Obama signed into law the Dodd-Frank Wall Street Reform and Consumer Protection Act enhancing the CFTC’s “regulatory authority to oversee the more than $400 trillion swaps market,” and allowing the SEC to exert more control over financial products and corporate governance and disclosure, improving consumer protections and transparency.

Dodd-Frank also gave rise to the above-mentioned whistleblower programs. The 2010 Act established that the CFTC would pay an award to eligible whistleblowers “who voluntarily provide the Commission with original information about a violation of the CEA that leads to the successful enforcement of a covered judicial or administrative action, or a related action.” On the other hand, retaliation against tipsters who provide information about potential violations is strictly forbidden....


The Largest SEC Whistleblower Awards (2012-2019)

The Largest SEC Whistleblower Awards (2012-2019)

What Makes a Successful Whistleblower? The SEC and CFTC whistleblower programs were created to encourage insiders to come forward with original information that can lead to enforcement actions against unethical financial industry players.
By offering rewards to tipsters, the programs help protect investors and other potential victims of financial fraud. The agency’s whistleblower provisions, the SEC states, help “better preserve the integrity of the United States' capital...

Government Joins Seven Whistleblowers in $50 Million Lawsuit Against Sen. Steve Dickerson and CPS Pain Clinics Over Fraudulent Urine Test Billings

Government Joins Seven Whistleblowers in $50 Million Lawsuit Against Sen. Steve Dickerson and CPS Pain Clinics Over Fraudulent Urine Test Billings

In November 2017 a Bloomberg headline ironically advised, “Want to turn that pain clinic into a real moneymaker? Open your own urine-testing lab and start billing Medicare.”

Back in July of 2016, when neither the public nor the authorities were aware that certain pain clinics executives were referring to these pricey urine tests as “liquid gold,” the CEO of Tennessee’s Comprehensive Pain Specialists (“CPS”) said in a press release, “Since January, CPS has seen a 19% increase in referrals from Primary Care Physicians. . . . By taking a seat on a patient’s care team, CPS is able to work with their physicians to address both the cause and the treatment of their pain. Putting patients on long term pain medication certainly isn’t the goal.”

While the press release included ‘politically correct’ statements about “treating the epidemic of chronic pain without escalating the epidemic of opioid misuse,” it didn’t shy away from boasting of the potential for large profits resulting from the passing of the Comprehensive Addiction and Recovery Act (“CARA”).

Prosecutors now believe CPS, which operated its own lab, did exactly what Bloomberg advertised, and with the help of a senator....


Beaver Medical Group and One of Its Doctors Will Pay $5 Million to Resolve Medicare Advantage Fraud Allegations

Beaver Medical Group and One of Its Doctors Will Pay $5 Million to Resolve Medicare Advantage Fraud Allegations

California-based Beaver Medical Group and Dr. Sherif Khalil have agreed to pay $5 million to settle allegations that they conspired to defraud Medicare by providing false information about individuals participating in the Medicare Advantage program.

Medicare Advantage Organizations (“MAOs”) provide comprehensive health care services to individuals enrolled in Medicare Advantage. Medicare pays them a fixed amount per individual, depending on the state of the beneficiaries’ health. The sicker the Medicare beneficiaries, the higher the payments. If they provide false diagnoses to Medicare, healthcare providers can illegally boost their profits.

Beaver was under contract with numerous MAOs in California. According to the allegations, the company falsified diagnoses to boost the MAOs’ Medicare billings. The MAOs would then share some of those profits with Beaver, thus creating an illegal financial incentive, the DOJ said. Dr. Khalil was allegedly part of the scheme, as some of the false diagnosis records bore his signature. After analyzing the evidence, the DOJ found that there were no patient records or tests results to substantiate many of the diagnoses submitted by the MAOs. [break]

The...


Eagleville Hospital Will Pay $2.85 Million to Resolve Allegations of Medicare and Pennsylvania Medicaid Fraud Involving Fraudulent Billing

Eagleville Hospital, a provider of substance abuse treatments to beneficiaries of Medicare and Medicaid, has reached a $2.85 million settlement with the government to resolve allegations that it defrauded various federal health care programs. According to a False Claims Act lawsuit filed by a whistleblower, the hospital billed Medicaid, Medicare, and the Federal Employees Health Benefits Program for detoxification treatments for ineligible patients.

The anonymous whistleblower has been awarded $500,000 for his key role in the recovery of millions of taxpayer dollars. Under the False Claims Act, individuals with information about fraud can file a complaint while protected by anti-retaliation provisions, receiving between 15 and 30 percent of any resulting recoveries.

According to the complaint that originated the settlement, Eagleville Hospital systematically admitted various categories of patients to secure the highest reimbursement class of detoxification treatments, when there was no medical necessity for it. As a consequence, the hospital submitted false claims to the government in its billing for these services. The alleged misconduct took place between January 2011 and December 2018....


Inpatient Rehabilitation Facility Network Encompass Pays $48 Million to Resolve Medicare Fraud Allegations

Alabama-based Encompass Health Corporation (now HealthSouth Corp.) has agreed to pay $48 million to settle Medicare fraud allegations. According to prosecutors, Encompass’s Inpatient Rehabilitation Facilities (IRFs) falsified "disuse myopathy" diagnostics in order to maintain their standing as high-reimbursement Medicare-approved IRFs.

The alleged fraud was brought forward in three separate whistleblower lawsuits, later joined by the Department of Justice. According to the allegations, Encompass IRFs systematically admitted patients who were “too sick or disabled to participate in or benefit from intensive inpatient therapy."

According to U.S. Attorney Maria Chapa Lopez (Florida, Middle District), "This important civil settlement concludes a lengthy, comprehensive investigation that brought to light a nationwide scheme that the government contends was intended to defraud our fragile public health programs."...


Methodist University Hospital: A “Nonprofit” that Seeks Profits by Suing the Poor, Including Its Own Low-Wage Employees

Methodist University Hospital: A “Nonprofit” that Seeks Profits by Suing the Poor, Including Its Own Low-Wage Employees

When Carrie Barrett rushed to the ER at Methodist University Hospital in Memphis, she needed an emergency heart catheterization. The procedure required a two-night stay at the hospital. That was in 2007. In 2010, the hospital sued her for not having paid her share of the medical services it provided: $12,109, close to what Barrett makes in a year.

The woman did not remember receiving any notices to pay before she was notified of the hospital’s lawsuit. Methodist Le Bonheur, the hospital system affiliated with the United Methodist Church, which is supposed to be a nonprofit, was not only seeking payment of the $12,109, but also attorney’s fees, court costs, and added interest.

Today, Barrett’s debt amounts to $33,000. Over the years, the hospital has managed to garnish money from her meager paychecks on 15 occasions. ...


Chicago Nursing Homes and Service Providers Agreed to Pay About $9.7 Million to Settle Fraud Allegations

Chicago Nursing Homes and Service Providers Agreed to Pay About $9.7 Million to Settle Fraud Allegations

According to a recently resolved False Claims Act complaint, Orland Park-based Quality Therapy and Consultation Inc. (now defunct), and its owner, Frances Parise, systematically billed federal health care programs for services that were never rendered. The alleged misconduct took place as part of Quality Therapy’s work with various nursing homes in the state of Illinois.

The nursing homes mentioned in the whistleblower lawsuit have all agreed to a settlement. Under its terms, Lakeshore Healthcare will pay $2.7 million, Balmoral Home will pay $1.7 million, Ridgeview Rehab will pay $1 million, and Carlton at the Lake will pay the largest settlement: $3.6 million.

The alleged fraud was brought to the government’s attention in 2014, when Katherine Verhulst, a former occupational therapist with Quality Therapy, filed a qui tam lawsuit presenting evidence of her employer’s unlawful practices. As a False Claims Act whistleblower with original information about fraud, Verhulst will receive a $1.9 million award....


SEC Whistleblower from Brazil Gets $4.5 Million Award After Reporting Misconduct by Zimmer Biomet

SEC Whistleblower from Brazil Gets $4.5 Million Award After Reporting Misconduct by Zimmer Biomet

A whistleblower in Brazil has just received a $4.5 million award for his role in uncovering a kickback scheme allegedly run by a subsidiary of Zimmer Biomet Holdings Inc. (Zimmer Biomet), a medical device manufacturer. The tipster is a former orthopedic surgeon who became aware of the alleged misconduct while practicing medicine in his home country.

Based in Indiana, Biomet markets its orthopedic and dental implant devices on a global scale. The whistleblower, on the other hand, is a prominent surgeon in South America and former president of Brazil’s Orthopedic Sports Medicine Society. As it is customary with SEC whistleblowers, his name has not been made public.

In 2013, the whistleblower reported the alleged misconduct anonymously to Biomet executives. Within 120 days, he reported it to the SEC. According to his reports, the company was still running a kickback scheme in Brazil, in spite of having faced SEC penalties in the past for the same type of misconduct. ...