A former “sleep technician” at American Sleep Medicine LLC will receive a $2.6 million reward for helping the government uncover false claims for reimbursement submitted by the operator of sleep diagnostic centers. Daniel Purnell’s whistleblower lawsuit alleged that American Sleep Medicine billed Medicare, TRICARE, and the Railroad Retirement Medicare Program for sleep diagnostic services that were performed by technicians who lacked the required credentials and certifications. Under federal program requirements for reimbursement of sleep disorder testing, initial sleep studies must be conducted by technicians who are licensed or certified by a state or national credentialing body as sleep test technicians. A claim for reimbursement is considered a “false claim” if the testing was conducted by a technician who is not licensed or certified. Mr. Purnell brought the lack of certification to the attention of the government by filing a qui tam lawsuit under the False Claims Act. The law allows private citizens with knowledge of fraud to start a lawsuit on behalf of the United States and share in any recovery. The individual who files the lawsuit is known as a “relator.” The lawsuit is initially filed “under seal” (in secret) to give the government time to conduct an investigation before the defendant knows that they are the target of a Medicare fraud investigation. After conducting an investigation, the government intervened in Mr. Purnell’s lawsuit and negotiated a settlement. Under the terms of the settlement, American Sleep Medicine will pay $15,301,341 to resolve allegations that it billed Medicare, TRICARE – the health care program for Uniformed Service members, retirees and their families worldwide – for services that were not eligible for reimbursement. Mr. Purnell will receive $2,601,228 as his whistleblower reward for alerting the government and bringing the lawsuit. If you are aware of false claims being submitted to Medicare, Medicaid or another government program, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. You may be eligible for legal protections as a whistleblower and a significant reward. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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The company that operates “Golden Living” nursing homes agreed to pay $613,300 to resolve allegations that it provided inadequate and worthless wound care services to residents. The government claimed that GGNSC Holdings LLC, the operator of skilled nursing facilities under the “Golden Living” name, fraudulently billed Medicare, Medicaid and TriCare for nursing services which were substandard and resulted in harm to patients. The government alleges that the claims for reimbursement were false because GGNSC provided residents with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds. By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care. A representative of the U.S. Department of Health and Human Services said that its Medicare and Medicaid fraud investigators will aggressively investigate nursing home fraud involving allegations of substandard care. “Quality of care in nursing homes is a top priority for the Office of Inspector General. Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.” The substandard care allegations were first raised by Dr. Joseph L. Micca, a medical director at one of the company’s nursing homes. Dr. Micca started a lawsuit against the company under the qui tam, or whistleblower, provisions of the False Claims Act. This statute allows a private citizen to bring a lawsuit on behalf of the United States and share in any recovery. The lawsuit was filed “under seal” (in secret) to allow the government to investigate the allegations before Golden Living knew that it was being sued. As a reward for helping the government stop fraud and prevent harm to patients, Dr. Micca will receive a share of the settlement payment. The statute provides for a reward of between 15% and 30% of the amount recovered by the government. If you are aware that a nursing home or other healthcare provider is submitting Medicare or Medicaid claims for substandard care, treatment that was never provided, or based on false medical records, then you should consult with an experienced False Claims Act attorney immediately. You may be entitled to legal protections and a substantial reward as a False Claims Act whistleblower. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach our offices via email. No legal fees are charged unless your case is successful. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A former clinical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced to more than eight years in prison for helping his employer commit Medicare fraud. Rafael Alalu is just the latest person whose life has been devastated because he went along with his employer’s fraud. So far, the owners of Biscayne Milieu and more than 25 doctors, managers, therapists, and other employees have pleaded guilty or have been convicted at trial. Biscayne Milieu purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness. According to the government, the clinic submitted more than $50 million in false and fraudulent claims to Medicare for individuals who were not eligible for PHP or who never received treatment. Many of the patients were not eligible for PHP because they were chronic substance abusers or suffered from severe dementia and would not benefit from group therapy. Other patients had no mental health diagnosis and never intended to get treatment. Mr. Alalu, the clinical director, was convicted of treating ineligible patients and helping to conceal the fraud by falsifying patient files, writing fraudulent group therapy notes, and instructing others to do the same. His participation in the mental health fraud earned him an eight-year prison term. This is a very sad situation, especially for the employees. Mr. Alalu and his co-workers not only could have avoided prison, but could have earned substantial rewards if they had consulted with an experienced False Claims Act attorney. The False Claims Act provides legal protections and substantial rewards to whistleblowers who help the government uncover fraud. Under the qui tam provisions of the law, an individual citizen can start a lawsuit on behalf of the government to recover for false and fraudulent claims. The lawsuit is initially filed “under seal” (in secret) to give the government an opportunity to conduct an investigation. A False Claims Act whistleblower, who is called a “relator,” is entitled to a reward of up to 30% of the amount the government actually collects. In this case, the reward could have amounted to more than $1 million. Unfortunately, the employees are going to prison instead because they chose to go along with the fraud. Do not go to prison for your employer’s fraudulent or false claims. If you are aware that false medical records are being created or false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. You may be eligible for whistleblower protections and a very substantial reward. Call John Howley, Esq. at (917) 652-6504 to arrange a free and confidential consultation, or click here to reach our offices via email. There are no legal fees unless your case is successful. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A former pharmaceutical sales representative has earned a $1.7 million reward for blowing the whistle on Medicare fraud. The reward will be paid out of an $11.4 million settlement by Victory Pharma Inc., a specialty pharmaceutical company, to resolve allegations that it paid kickbacks to doctors to induce them to write prescriptions for Victory’s products. Chad Miller, the former sales representative, brought the lawsuit under the whistleblower or qui tam provisions of the False Claims Act. He alleged that his former employer paid doctors kickbacks to induce them to write prescriptions for Naprelan, Xodol, Fexmid and Dolgic. The kickbacks included tickets to sporting events, concerts and plays; spa, golf and ski outings; dinners at expensive restaurants; and numerous other out-of-office events. Victory also promoted a program of paid “preceptorships,” which involved sales representatives “shadowing” doctors in their offices. The settlement resolves allegations that Victory improperly used these preceptorships to induce doctors to prescribe Victory’s products. The Anti-Kickback Statute makes it a crime for anyone to give, receive, solicit or help arrange anything of value to induce a doctor to prescribe products that will be paid for, in whole or in part, by Medicare, Medicaid or other government healthcare programs. The underlying rational is that physicians should make treatment decisions based solely on their own independent medical judgment, without being influenced by kickbacks or other improper benefits. A conviction for violating the anti-kickback law can result in jail time, monetary penalties, and exclusion from Medicare, Medicaid and other federal healthcare programs. Violation of the anti-kickback statute can also result in violation of the False Claims Act. Once a prescription is tainted by a kickback, any claim for reimbursement from Medicare or Medicaid is considered a “false claim” under the False Claims Act. This pharmaceutical kickbacks case was settled when Victory agreed to pay $1.4 million to resolve federal Ant-Kickback Statute allegations and $9,938,310 to resolve False Claims Act allegations. The whistleblower in this case will receive a reward of $1.7 million or approximately 17% of the False Claims Act portion of the settlement. If you are aware of kickbacks or false claims being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately. You may be entitled to a very substantial reward. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
John Howley, Esq.
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