Healthcare and Pharma Cases

2016: A Stellar Year for Whistleblowers, $4.7 Billion in False Claims Act Recoveries

2016: A Stellar Year for Whistleblowers, $4.7 Billion in False Claims Act Recoveries

America’s courageous whistleblowers filed over 700 qui tam suits in fiscal year 2016 and received $519 million in awards for their valuable tips and assistance in fighting various types of fraud.

Since the 2009 Fraud Enforcement and Recovery Act made groundbreaking improvements to the False Claims Act’s whistleblower provisions, the government has recovered close to $24 billion, paying a sizable $4 billion in whistleblower awards.

As legislation tries to catch up with the rampant reports of fraud across a variety of industries, the federal False Claims Act remains the star when it comes to facilitating the exposure of government-defrauding schemes across America....

Hudson Valley Oncology Medicare Fraud Exposed by Whistleblower Medical Coder: $5.31MM Settlement

Hudson Valley Oncology Medicare Fraud Exposed by Whistleblower Medical Coder: $5.31MM Settlement

Hudson Valley Hematology Oncology Associates will pay the government $5.31 million to resolve allegations in a whistleblower lawsuit that it systematically billed Medicare and Medicaid for ineligible and non-existent services.

Between 2010 and 2015, Hudson Valley was allegedly involved in two different fraudulent schemes. On the one hand, it waived Medicare beneficiaries’ copayments and billed Medicare instead. On the other hand, it routinely billed both Medicare and Medicaid for services that were either not performed or not medically necessary. 

Whistleblower Lucille Abrahamsen: Medical Coder Hudson Valley Employee

Hudson Valley’s wrongdoing was first brought to light by Lucille Abrahamsen, a resident of  Highland, New York,  who filed a lawsuit under the False Claims Act in April, 2014. Abrahamsen became aware of her employer’s improper billing practices while working for them as a medical coder....

Life Care Pays $145MM on Medicare – TRICARE Billing Fraud Allegations

Life Care Pays $145MM on Medicare – TRICARE Billing Fraud Allegations

Life Care will pay $145 million to resolve charges that it caused skilled nursing facilities (SNFs) to submit false claims to both Medicare and TRICARE for unnecessary rehabilitation services. The SNF giant, which operates over 200 facilities, was allegedly involved in a scheme to systematically increase its billings to government health programs TRICARE and Medicare. The allegations were first brought to light by two whistleblowers, Tammie Taylor and Glenda Martin, both former Life Care employees. 

Spanning seven years, the alleged misconduct targeted a particular type of Medicare reimbursement, associated with patients who require extensive and frequent therapy. When a patient needs over 720 minutes of two types of skilled therapy per week, including one that is requires five times a week, their treatments qualify for Ultra High reimbursements from Medicare.

Whistleblowers Glenda Martin & Tammie Taylor Said Unnecessary Rehab Services

According to the whistleblower False Claims Act lawsuit filed by Glenda Martin and Tammie Taylor, in order to increase billings, Life Care had internal policies in place to ensure that the largest possible number of patients qualified for the Ultra High category....

Tenet Healthcare and Subsidiaries to Pay $513 Million: Expectant Mother Referrals Kickback Scheme

Tenet Healthcare Corporation, alongside two subsidiaries have agreed to pay over $513 million to resolve charges that it was involved in a large-scale kickback scheme to obtain patient referrals. Two of the hospital chain’s Georgia-based subsidiaries, Atlanta Medical Center Inc. and North Fulton Medical Center Inc., have pleaded guilty of violations of the Anti-Kickback Statute (AKS).

The fact that the DOJ was able to negotiate some degree of admission of guilt is excellent news for whistleblowers and for the public as a whole. In a recent conference, government officials had expressed the need to go beyond monetary settlements and to ensure resolutions of healthcare fraud lawsuits included admission of guilt whenever the allegations were substantiated.

Tenet HealthSystem Medical Inc. and its subsidiaries (known collectively as THSM) entered into a non-prosecution agreement (NPA) with the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Northern District of Georgia. According to the NPA’s terms, THSM will not be prosecuted provided that it cooperates with the government’s investigation and retains a compliance monitor to prevent future violations of the AKS....

Visiting Nurse Service of New York Faces Medicaid and Medicare Fraud Lawsuit

Visiting Nurse Service of New York Faces Medicaid and Medicare Fraud Lawsuit

A whistleblower lawsuit has accused the Visiting Nurse Service of New York (VNSNY) of defrauding Medicaid and Medicare and receiving millions of dollars for care ordered by doctors, which the patients never received. According to the allegations, VNSNY systematically billed for the full number of nursing and rehabilitation visits ordered by doctors, but patients received only a fraction of them.

The lawsuit was initiated by whistleblower Edward Lacey, VNSNY's former VP of Operations Improvement and Integration, who had been with the organization for 16 years. Investigations into fraudulent conduct are, however, nothing new for the healthcare provider Visiting Nurse Service of New York. In 2014, VNSNY paid the government $35 million to settle a lawsuit alleging that it had enrolled over 1,700 ineligible individuals into Medicaid plans. 

Under the False Claims Act, whistleblowers such as Edward Lacey who have information about fraud against the government can file a lawsuit on the government's behalf and are entitled to a portion of any received damages and civil penalties. Whistleblower rewards range from 15 to 30% of the total recovery....

Vibra Healthcare Info Coder Wins $4M+ Whistleblower Award in FCA Lawsuit

Vibra Healthcare Info Coder Wins $4M+ Whistleblower Award in FCA Lawsuit

Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, will receive a whistleblower award of at least $4 million after filing a qui tam lawsuit alleging the hospital billed Medicare for medically unnecessary services, the Department of Justice announced Wednesday. Vibra Healthcare LLC, a Mechanicsburg, Pennsylvania-based national hospital chain, has agreed to pay $32.7 million plus interest to resolve claims its facilities violated the False Claims Act.

“Medicare beneficiaries are entitled to receive care that is determined by their clinical needs and not the financial interests of healthcare providers,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, commenting on the settlement of Sylvia Daniel’s whistleblower lawsuit against Vibra Healthcare. 

“All providers of taxpayer-funded federal healthcare services, whether contractors or direct billers, will be held accountable when their actions cause false claims for medically unnecessary services to be submitted.”...

Feds Sue Vanguard Healthcare Nursing Homes: "Grossly Substandard" Care

Feds Sue Vanguard Healthcare Nursing Homes: "Grossly Substandard" Care

The United States filed a False Claims Act lawsuit against Brentwood, Tennessee-based Vanguard Healthcare LLC., alleging the company submitted false claims to Medicare and TennCare, provided either non-existent or “grossly substandard” care for elderly patients in six of its Tennessee nursing homes, and forged signatures on required nursing facility Pre-Admission forms, the Department of Justice announced today.

Nursing Home Residents Suffer Non-Existent, Substandard Care

According to the False Claims Act lawsuit, between January 2010 and December 2015, six Vanguard Healthcare nursing homes exhibited ongoing staffing and medical supply shortages, failed to practice standard infection control procedures, failed to deliver prescribed medications, failed to follow physicians’ orders in caring for wounds, failed to practice proper pain management, gave “unnecessary and excessive” psychotropic medications to residents and used unnecessary physical restraints....

Kindred Healthcare Hit with Historic CIA Penalty

Kindred Healthcare Hit with Historic CIA Penalty

Louisville-based post-acute care provider, Kindred Health Care, Inc., has paid the largest penalty ever imposed by the Office of the Inspector General (OIG) for failing to comply with a corporate integrity agreement (CIA). The record penalty amounted to over $3 million, the Department of Health and Human Services’ (HHS) Inspector General Daniel R. Levinson announced today.

OIG Imposes CIA In Exchange for Exclusion from Medicare Program

Kindred Health Care provides hospice services for Medicare patients with life expectancies of six months or less. Patients receiving hospice care agree to cease curative care and only receive palliative care to lessen their symptoms....

Feds Recover $30mm: Claim Skilled Nursing Facilities Billed for Unnecessary Rehab Therapy

California’s Orange County-based North American Health Care Inc. (NAHC) has agreed to pay the U.S. government $28.5 million to resolve long-running allegations it billed Medicare and TRICARE for medically unnecessary rehabilitation therapy services in violation of federal and state False Claims Acts. NAHC’s senior vice president of reimbursement analysis and chairman of the board will pay an additional $1.5 million, the Department of Justice announced today.

California North American Health Care Alleged False Claims Act Violations

False Claims Act and other charges claim NAHC’s inpatient skilled nursing facilities subjected its residents to unnecessary occupational, physical and speech therapy sessions while the government footed the bill. The private, for-profit company operates 35 facilities across California, billing Medicare and California Medicaid (Medi-Cal) for eligible services. For services to be eligible for payment, however, they must be “reasonable and necessary for the diagnosis or treatment of illness or injury.”...

Thalidomide, Really? Again?! Whistleblower Documents Unsealed - Celgene Corp in Hotseat

Hundreds of recently unsealed documents may supply priceless evidence to bolster California whistleblower Beverly Brown’s claims alleging Celgene Corporation marketed thalidomide for off-label cancer treatments, Bloomberg announced Monday.

Yes, thalidomide, the once popular morning sickness pill used to treat pregnant women in the 50s and 60s. The same thalidomide that caused over 10,000 infants to be born with severe limb malformation, organ deformities and blindness. Only 50% of the children survived.

Morning Sickness Drug Thalidomide Banned For Causing Birth Defects

Officials promptly banned prescription of thalidomide as an anti-nausea medication for pregnant women, but in 1998, Celgene gained U.S. Food and Drug Administration (FDA) approval to use thalidomide, brand name Thalomid, to treat complications associated with leprosy. With around 200,000 cases of leprosy worldwide, Celgene wasn’t going to get rich off Thalomid sales, but more than 1.68 million Americans are diagnosed with cancer every year....