Every day, the government announces another multi-million dollar Medicare or Medicaid fraud settlement. Today there was not one announcement, but three.
First, a Johnson & Johnson subsidiary agreed to pay $18 million to settle claims that it caused physicians to submit false claims to Medicare by marketing a medical device for use as a drug-delivery device for prescription corticosteroids, when that use was not approved by the FDA. Second, a hospital in South Carolina agreed to pay $17 million to settle claims that it submitted false claims to Medicare and Medicaid, and that it provided financial incentives to doctors for patient referrals. Third, a diagnostic imaging company agreed to pay $3.5 million to settle claims that it billed Medicare and Medicaid for services that were provided without adequate supervision. Three settlements. Almost $40 million. All announced in just one, typical day in the healthcare fraud arena. Why is there so much fraud in Medicare and Medicaid? Because the government cannot find fraud without help from insiders. Medicare and Medicaid receive more than 1 million claims for reimbursement every day. There is no way for the government to know whether each of those one million claims involved services that were medically necessary, or were properly supervised, or were billed using the proper billing code and not a code for a more expensive procedure. That is why the government relies on – and rewards – whistleblowers who come forward with evidence of fraud. In the South Carolina hospital case, for example, the government began its investigation only after a physician who worked for the hospital came forward with evidence of improper billing and financial incentives. Now that doctor will receive a whistleblower reward of between 15% and 25% of the amount recovered – which will be somewhere in the range of $2.5 million and $4.25 million. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to legal protections and a substantial reward. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Do not delay. There are strict time limits and procedural requirements to qualify as a whistleblower.
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Whistleblowers Are Urgently Needed to Stop this Type of Massive Fraud
The government has charged three individuals with a conspiracy to collect more than $1 Billion from Medicare and Medicaid for services that patients did not require or were not eligible to receive. The three individuals are the owner of more than 30 nursing homes and assisted living facilities, a hospital administrator, and a physician’s assistant. Yes, you read that correctly. Three individuals are accused of stealing more than $1 Billion from Medicare and Medicaid. According to the FBI, the three individuals were the leaders of a complex conspiracy that included filing false claims with the help of other healthcare providers, and an intricate money laundering scheme designed to hide the flow of payments and kickbacks. The indictment charges that Philip Esformes operated a network of more than 30 nursing homes and assisted living facilities that provided services to thousands of patients. Esformes and his co-conspirators allegedly billed Medicare and Medicaid for medically unnecessary services for many of these patients. The co-conspirators are also charged with receiving kickbacks in return for steering residents to other healthcare providers, who provided additional, medically unnecessary services. The kickbacks allegedly were paid in cash or were disguised as payments for leases, services, or charitable donations to avoid discovery. This case illustrates the critical importance of whistleblowers to uncover billions of dollars in healthcare fraud, waste, and abuse. The government receives millions of claims every day for reimbursement from Medicare, Medicaid, and other government healthcare programs. The claims often set forth nothing more than the patient’s and provider’s identifying information, billing and diagnostic codes, an actual or electronic signature, and a request for payment. Without help from a whistleblower on the inside, it is impossible for the government to determine whether the services were medically necessary, whether they were actually provided to the patients, or whether improper kickbacks were exchanged in return for patient referrals. If you have evidence of Medicare or Medicaid fraud, it is your patriotic duty to come forward and stop the fraud. In return, you are entitled to legal protections and a reward of up to 30% of the amount recovered by the government. In Medicare and Medicaid fraud cases, it is not unusual for those rewards to reach millions of dollars. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley Esq. at (212) 601-2728. Do not delay. There are strict time limits and procedural requirements in order to qualify for a whistleblower reward. William LaCorte, a physician in Louisiana, has earned a $59 million whistleblower reward after Pfizer agreed to pay $784 million to settle allegations of false claims to Medicaid for Protonix, a heartburn medication. The complaint alleged that Pifzer’s subsidiary, Wyeth, failed to pay rebates to Medicaid to account for price discounts that Wyeth had provided to other customers.
Dr. LaCorte is no stranger to high-stakes whistleblower litigation. He received $38 million in whistleblower rewards from prior qui tam or whistleblower lawsuits against other pharmaceutical companies, including one in which Merck agreed to pay $250 million to settle allegations that it offered hospitals better terms than Medicaid for its heartburn medicine, Pepcid. Because of whistleblowers like Dr. LaCorte, the government recovered $2.8 billion in settlements last year under the False Claims Act, which allows individuals to commence whistleblower lawsuits on behalf of the government and share in any recovery. In return, the government paid whistleblower rewards totaling $597 million. Pharmaceutical cases tend to result in the largest whistleblower rewards. For example, a former sale representative for Endo Pharmaceuticals recently collected a $33.6 million whistleblower reward after the company agreed to pay $140 million to settle allegations that it engaged in off-label marketing of Lidoderm, a pain medication. In 2012, the government distributed $300 million in whistleblower rewards when GlaxoSmithKline agreed to pay $2 billion to settle allegations of off-label marketing and illegal kickbacks involving a number of its drugs. The key to a successful whistleblower case is having evidence of fraud or false claims submitted to Medicare or Medicaid. Mere allegations or suspicions of fraud are not enough. A successful whistleblower case requires evidence. And that creates some risks for potential whistleblowers. Gathering the evidence to support Medicare or Medicaid fraud claims may expose whistleblowers to allegations that they violated HIPAA privacy restrictions, company confidentiality policies, and even criminal statutes such as the Federal Computer Fraud and Abuse Act. If you have evidence of healthcare fraud or false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. But you also need legal advice to comply with your own obligation to maintain the privacy of confidential information. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Two compounding pharmacies and four physicians have agreed to pay $10 million to settle allegations of false claims submitted to TRICARE, the military’s healthcare program.
The government alleged that one of the compounding pharmacies, Topical Specialists, was created by the four physicians and a pharmacist. The physicians referred their military patients to Tropical Specialists, but it was unable to obtain contracts with government healthcare programs. Topical Specialists then sent its prescriptions to another pharmacy, WELLHealth, which submitted the prescriptions to the federal government. The government alleged that the physicians steered military patients to Tropical Specialists with hundreds of costly prescriptions for pain and scar creams that may not have been medically necessary. Many of the patients told the government that they never used the creams. While the pharmacies billed the federal government tens of thousands of dollars for the creams, the actual cost of compounding the creams was only 4-5% of the amount billed to TRICARE. The government alleged that profits of up to 90% were passed on to the four doctors behind Tropical Specialists. The government also alleged that the four doctors recruited other doctors to write prescriptions to be filled by Tropical or WELLHealth, and passed along 40% of the reimbursement to those doctors. The doctors and the pharmacies settled the government’s fraud claims by agreeing to pay $10 million. False claims to government healthcare programs are very difficult to detect. For this reason, the government offers substantial rewards to whistleblowers who come forward with evidence of false claims to Medicare, Medicaid, and TRICARE. The whistleblower rewards range from 15% to 30% of the amount to government actually recovers plus attorneys’ fees and costs. Anyone who has evidence of false claims can become a whistleblower. This includes physicians, medical and billing staff, patients, vendors and competitors. If you have evidence of false claims submitted to Medicare, Medicaid or TRICARE, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and legal protections. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Whistleblower cases are taken on a contingency fee basis, which means there are no legal fees unless you win. A former Abbott Laboratories employee will receive a $1 million whistleblower reward for reporting kickbacks between the pharmaceutical giant and the second largest nursing home consulting pharmacy in the country.
Meredith McCoyd and another former Abbott Laboratories employee brought lawsuits under the qui tam or whistleblower provisions of the False Claims Act. Under that law, an individual citizen who has evidence of false claims submitted to government programs may start a lawsuit on behalf of the government. The lawsuit is filed “under seal” (in secret) and the evidence is disclosed only to the government. The government then investigates the claims and decides whether to pursue the suit. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered. Ms. McCoyd filed a qui tam lawsuit alleging that Abbott Laboratories paid kickbacks to pharmacies in exchange for promoting the company’s prescription drug Depakote for nursing home patients. She alleged that the kickbacks were disguised as rebates, educational grants and other financial support. Under the Anti-Kickback Law, it is illegal for a pharmaceutical company or healthcare provider to offer or pay anything of value in return for referrals of Medicare or Medicaid patients. If kickbacks are paid, then every resulting claim for reimbursement is deemed a “false claim.” Both the entity that pays the kickbacks and the entity that receives the kickbacks may be liable for treble damages and penalties. In this case, the consulting pharmacy agreed to pay $6.5 million to the federal government and $2.5 million to state governments to resolve claims that it accepted kickbacks from Abbott Laboratories. The whistleblower who started the qui tam lawsuit will receive a reward of $1 million from the federal government. She may also receive whistleblower rewards from the state governments under their false claims acts. If you have evidence that a pharmaceutical company or healthcare provider is paying or receiving anything of value in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial reward and legal protections as a whistleblower. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Whistleblowers Reported Kickbacks for Patient Referrals and Claims for Inpatient Detoxification Services Provided Without the Necessary License
Three New York hospitals and a Missouri-based management company agreed to pay more than $8 million to resolve claims that they submitted false claims to Medicare and Medicaid for inpatient detoxification treatment provided to patients at the hospitals. The defendants are Benedictine Hospital, Columbia Memorial Hospital, St. Joseph’s Medical Center, and SpecialCare Hospital Management Corporation. The hospitals operated inpatient drug and alcohol detoxification programs under the name "New Vision" without the necessary licenses from the New York State Office of Alcoholism and Substance Abuse Services. When claims are submitted to Medicare and Medicaid for treatment provided without a proper license, the claims are considered “false claims” even if the treatment was medically necessary and properly performed. The government also alleged that two of the hospitals, Columbia Memorial and St. Joseph’s, paid SpecialCare for patient referrals. Paying or exchanging anything of value in return for referrals of Medicare or Medicaid patients violates the Anti-Kickback law. Any claims submitted to Medicare or Medicaid for services provided after a kickback has been paid are considered “false claims” for purposes of the False Claims Act, even if the services were medically necessary and properly provided. The government began its investigation after whistleblowers commenced qui tam or whistleblower lawsuits under the False Claims Act. Under that statute, individual citizens who have evidence of fraud may start a lawsuit on behalf of the government and earn a reward of between 15% and 30% of the amount the government recovers. While the amount of the whistleblowers’ rewards have not yet been determined, the rewards should be in the range of $1.2 million and $2 million in this case based on the size of the settlement. If you have evidence that a healthcare provider has paid kickbacks for patient referrals or submitted false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. Call John Howley, Esq. at (212) 601-2728 to arrange a free and confidential consultation. Dr. Jean Moore, a physician, will receive an $825,000 whistleblower reward for reporting that his employer, a hospital and an affiliated medical clinic, submitted false claims to Medicare. The hospital and affiliated clinic have agreed to pay $5.5 million to settle the claims.
Dr. Moore alleged that the hospital and its affiliated clinic were paying bonuses to physicians in return for patient referrals. The bonuses were paid based on a formula that took into account the value of the physicians’ patient referrals. Paying anything of value in return for referrals of Medicare patients violates the anti-kickback statute. It also renders all resulting claims to Medicare “false claims” for purposes of the False Claims Act. Dr. Moore started a qui tam or whistleblower lawsuit under the False Claims Act. That law allows individual citizens to commence a lawsuit on behalf of the government for false claims submitted to Medicare, Medicaid, and other government programs. The lawsuit is filed “under seal” (in secret), and the whistleblower provides all of his evidence to the government. The government then investigates the claims. If the government recovers money as a result of the qui tam lawsuit, then the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered. The key to a successful whistleblower lawsuit is having evidence of the false claims. It is not enough that you suspect that false claims are being filed. You must give the government evidence to support your suspicions. If you have evidence that a healthcare provider is paying kickbacks in return for patient referrals, or that it is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower. You may not file a whistleblower lawsuit on your own. The law requires that an attorney file the lawsuit for you. You will also need careful legal advice on gathering and presenting your evidence, especially if HIPAA-protected medical records are part of your evidence. Contact our law office for a free and confidential consultation. If you have a case, we will represent you on a contingency fee basis. You will not owe any legal fees unless you win. John Howley, Esq. (212) 601-2728 Ambulance Company Accused of Improperly Receiving $28 Million from Medicare and Medicaid by Offering Discounts in Return for Patient Referrals and by Submitting False Claims for Medically Unnecessary Ambulance Transports
The U.S. government has agreed to join a lawsuit that was started by a whistleblower against an ambulance company under the False Claims Act and the Anti-Kickback Statute. The complaint alleges that the ambulance company improperly received $28 million in reimbursements from Medicare and Medicaid as a result of the false claims. The lawsuit was originally filed under the whistleblower or qui tam provisions of the False Claims Act by Shawn Pelletier, a former employee at Liberty Ambulance. Under the False Claims Act, he will be entitled to a whistleblower reward of between 15% and 25% of the amount the government recovers because of his lawsuit. In this case, that could mean a whistleblower reward of as much as $4.2 million to $7 million. The complaint alleges two types of false claims: one that is fairly common under the False Claims Act; and a second that explains the broad reach of the Anti-Kickback Statute. The first set of claims allege that Liberty Ambulance submitted false claims for ambulance transports that were medically unnecessary, predicated on false statements, and should not have been reimbursable. The complaint alleges that the ambulance company trained its employees to falsify records and to make false statements to support claims for medically unnecessary ambulance transports. The second set of claims allege that the ambulance company violated the Anti-Kickback Statute by offering discounts to private healthcare providers – such as hospitals and skilled nursing facilities – in return for referrals of patients who were covered by Medicare and Medicaid. The complaint alleges that the ambulance company failed to offer these same discounts to the government. Under the Anti-Kickback Statute, it is illegal to offer or accept anything of value in return for referrals of patients covered by Medicare or Medicaid. Kickbacks obviously include cash payments, but they may also include non-cash benefits such as discounted rates on services for hospitals and nursing homes, free medical supplies or gift cards for patients, free office space or subsidized office staff for doctors, excessive compensation for medical directorships, or anything else of value. Once a kickback has been paid, any claims submitted to Medicare or Medicaid are considered “false claims,” even if the services were medically necessary and actually provided to the patient. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid – or that a healthcare provider is offering anything of value in return for patient referrals – then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and protections as a whistleblower. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. OIG Announces Increased Scrutiny of Compensation for Medical Directorships for Possible Violations of the Anti-Kickback Statute.
The government sent a stern warning to physicians that their compensation for medical directorships will be scrutinized for compliance with the Anti-Kickback Statute. In a recent press release, the Office of Inspector General (OIG) at the Department of Health and Human Services announced that it will be paying careful attention to two aspects of medical directorship compensation. First, the compensation must reflect the fair market value of bona fide services that the physician actually provides. Second, the amount of compensation must not be based, in whole or in part, on the volume or value of patients referred by the physician. Many physician compensation arrangements are legitimate. A compensation arrangement may violate the Anti-Kickback Statute, however, if any part of it is based on the physician's past or future referrals of patients who receive Medicare, Medicaid, or other government healthcare benefits. The compensation arrangements subject to increased scrutiny are not limited to cash payments. Physicians may violate the Anti-Kickback Statute if they accept free services, subsidized office staff, below-market rent for office space, or anything of value in return for patient referrals. Once a kickback has been paid, every resulting claim for reimbursement submitted to Medicare or Medicaid is considered a "false claim" under the False Claims Act, even if the services were medical necessary and actually provided. Individuals responsible for submitting false claims may be required to pay back three times the amount the government paid for the services, plus a penalty of up to $11,000 per claim. If you have evidence that a physician is accepting kickbacks in return for patient referrals to a hospital, diagnostic imaging center, medical lab, or other healthcare provider, then you should consult with an experienced whistleblower lawyer immediately. You may be eligible for a reward of up to 30% of the amount the government recovers. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Hospital Allegedly Paid Obstetric Clinic for Referrals of Pregnant Women
Health Management Associates and Clearview Regional Medical Center agreed to pay almost $600,000 to settle claims that the hospital paid kickbacks to an obstetric clinic in return for referrals of pregnant women for labor and delivery. The hospital's former Chief Financial Officer will receive a whistleblower reward of approximately $120,000 for helping the government pursue the claims. He may receive more money depending on the outcome of related cases against additional defendants. The hospital was accused of paying kickbacks to an obstetric clinic that provided services to undocumented pregnant women. In return for the payments, the clinic allegedly referred patients to the hospital for deliveries that were reimbursed by Medicaid. While undocumented aliens are not eligible for regular Medicaid benefits, Medicaid will reimburse hospitals for emergency services, including childbirth, for undocumented individuals. The Anti-Kickback Statute prohibits healthcare providers from paying or receiving anything of value in return for referrals of patients covered by a government healthcare program. Prohibited payments include cash, excessive compensation, low-cost office space, or anything else of value. In this case, the hospital allegedly disguised the kickbacks as payments to the clinics for services. Once a kickback has been paid, no reimbursement may be sought from Medicare, Medicaid, or any other government healthcare program for any resulting services. It does not matter if the services were medically necessary and actually provided. The kickback renders all resulting claims for reimbursement "false claims" under the False Claims Act. The former CFO pursued the case against the hospital and others under the qui tam, or whistleblower, provisions of the False Claims Act. These provisions allow private citizens to pursue claims on behalf of the government and to share in any recovery. Successful whistleblowers are entitled to rewards of between 15% and 30% of the amount the government recovers. If you have evidence that a hospital or other healthcare provider is paying kickbacks in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately. Call John Howley, Esq. at (212) 601-2728 to schedule a free and confidential consultation. |