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Hospital Countersues FCA Whistleblower for Failing to Report Information Internally

George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 13, 2019, a West Virginia hospital facing a whistleblower lawsuit countersued a former employee who filed the False Claims Act (FCA) lawsuit against the health system. Wheeling Hospital alleges that the former executive, who is the whistleblower/relator in the lawsuit, breached his fiduciary duty to the company by failing to report the unlawful conduct internally, first. Instead, he used the information as the basis for his whistleblower claim. In the countersuit filed in the U.S. District Court for the Northern District of West Virginia, the Hospital accuses the former executive-turned-whistleblower of attempting to ‘extort a settlement’ and filing the FCA whistleblower suit as an act of revenge.

The Whistleblower’s Complaint.

The whistleblower, a former accountant, and senior executive at Wheeling Hospital, was discharged in August 2015. In December 2017, he filed a complaint under the qui tam provisions of the False Claims Act (FCA). He alleged the hospital violated the federal Anti-Kickback Statute (AKS) by paying kickbacks to physicians for patient referrals to the Hospital. Based on this, it is alleged, the claims for the services the hospital provided to the referred patients were false claims, subject to recoupment by the government.

The Hospital’s Countersuit.

In an unusual strategy, the Hospital filed a counter-suit against the whistleblower, alleging that he breached his fiduciary duty to the Hospital and abused the legal process. The Hospital’s case asserts that instead of carrying out his duty to the Hospital, instead, he capitalized on his alleged knowledge of the conduct to “extort a settlement” through a “false and frivolous” FCA suit as an act of revenge.

Additionally, the Hospital alleges that “at no time during his employment, or in his role as a partner at Deloitte, did he report any suspicions of fraud or violations of federal regulations to Wheeling Hospital’s compliance officer.”

You can read Wheeling Hospital’s countersuit against the whistleblower on our website in full.

The Significance of This Case: Unique Defense Strategy for Defending a Whistleblower Suit.

This case shows a unique, but legally valid, defense strategy that might be used in other future whistleblower cases. Often the information about false claims is produced by a high-ranking hospital or institutional employees whose job duties may have required them to report what they knew to the company as part of their job. The company should then have the opportunity to investigate and correct any improper billing or other misconduct that an errant employee might be carrying out on his own. By failing to do this, the employee may breach his duties to the company, may violate his employment contract, and may be subject to a suit or counter-suit over this. To the extent that the actions of the ex-employee cause the employer damages, the employer may be entitled to indemnification from the ex-employee.

However, the other side of the story is when an employee does make his or her superiors aware of suspected misconduct and false claims within the company and the company does nothing about it. This is often the case that we have when potential blowers contact us about filing a False Claims Act case. Often the whistleblower attempts to do the right thing by reporting it within the company and is stymied by his or her superiors. To us, this opens the door to legitimate whistleblower suits.

To read one of my prior blogs about South Florida Hospital reaching a settlement for similar FCA
claims, click here.

Click here to learn more about who can file a whistleblower/qui tam lawsuit and the reward programs for coming forward with a false claim.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities that have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Pearlman, Steve and Freeman, Meika. “Top 10 Whistleblowing And Retaliation Events Of The Year.” Law360. (December 20, 2019). Web.

Goldberg, Pinchos. “Hospital Sues Whistleblower for Failing to Report Information And Choosing Instead to Use As Basis for Claim.” JD Supra. (May 8, 2019). Web.

Commins, John. “HOSPITAL COUNTERSUES FALSE CLAIMS WHISTLEBLOWER.” Health Leaders. (May 9, 2019). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law attorney, whistleblower attorney, whistleblower defense lawyer, Florida health law defense attorney, whistleblower defense attorney, whistleblower defense legal counsel, legal representation for whistleblower cases, qui tam lawyer, health law attorney, qui tam defense lawyer, qui tam plaintiff lawyer, whistleblower legal representation, False Claims Act lawyer, False Claims Act attorney, False Claims Act legal counsel, The Health Law Firm, DOJ defense lawyer, Office of Inspector General (OIG) defense counsel, Office of Inspector General (OIG) defense attorney, Office of Inspector General (OIG) legal representation, medcila legal defense attorney, health care fraud attorney, health care fraud lawyer, attorney legal representation for qui tam cases, Anti-Kickback Statute (AKS) attorney, Anti-Kickback Statute (AKS) lawyer, Anti-Kickback Statute (AKS) defense counsel, Medicare fraud defense lawyer attorney, Medicare fraud legal representation, Medicaid fraud defense lawyer attorney, legal representation for Medicare and Medicaid fraud, legal representation for Stark Law violations, healthcare fraud defense attorney, whistle blower lawyer attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida qui tam whistle blower lawyer attorney, Colorado qui tam whistle blower lawyer attorney, Louisiana qui tam whistle blower lawyer attorney, Kentucky qui tam whistle blower lawyer attorney, Virginia qui tam whistle blower lawyer attorney, District of Columbia (D.C.) qui tam whistle blower lawyer attorney, civil monetary penalties lawyer attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer attorney legal counsel, Virginia False Claims Act (FCA) and civil monetary penalties lawyer attorney, Virginia whistleblower lawyer attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer attorney, civil monetary penalties lawyer attorney

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2020 The Health Law Firm. All rights reserved

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Hospital Countersues FCA Whistleblower for Failing to Report Information Internally

Carole C. SchrieferBy Carole C. Schriefer, R.N., J.D.
On March 13, 2019, a West Virginia hospital facing a whistleblower lawsuit countersued a former employee who filed the False Claims Act (FCA) lawsuit against the health system. Wheeling Hospital alleges that the former executive, who is the whistleblower/relator in the lawsuit, breached his fiduciary duty to the company by failing to report the unlawful conduct internally, first. Instead, he used the information as the basis for his whistleblower claim. In the countersuit filed in the U.S. District Court for the Northern District of West Virginia, the Hospital accuses the former executive-turned-whistleblower of attempting to ‘extort a settlement’ and filing the FCA whistleblower suit as an act of revenge.

The Whistleblower’s Complaint.

The whistleblower, a former accountant, and senior executive at Wheeling Hospital, was discharged in August 2015. In December 2017, he filed a complaint under the qui tam provisions of the False Claims Act (FCA). He alleged the hospital violated the federal Anti-Kickback Statute (AKS) by paying kickbacks to physicians for patient referrals to the Hospital. Based on this, it is alleged, the claims for the services the hospital provided to the referred patients were false claims, subject to recoupment by the government.

The Hospital’s Countersuit.

In an unusual strategy, the Hospital filed a counter-suit against the whistleblower, alleging that he breached his fiduciary duty to the Hospital and abused the legal process. The Hospital’s case asserts that instead of carrying out his duty to the Hospital, instead, he capitalized on his alleged knowledge of the conduct to “extort a settlement” through a “false and frivolous” FCA suit as an act of revenge.

Additionally, the Hospital alleges that “at no time during his employment, or in his role as a partner at Deloitte, did he report any suspicions of fraud or violations of federal regulations to Wheeling Hospital’s compliance officer.”

You can read Wheeling Hospital’s countersuit against the whistleblower on our website in full.

The Significance of This Case: Unique Defense Strategy for Defending a Whistleblower Suit.

This case shows a unique, but legally valid, defense strategy that might be used in other future whistleblower cases. Often the information about false claims is produced by a high-ranking hospital or institutional employees whose job duties may have required them to report what they knew to the company as part of their job. The company should then have the opportunity to investigate and correct any improper billing or other misconduct that an errant employee might be carrying out on his own. By failing to do this, the employee may breach his duties to the company, may violate his employment contract, and may be subject to a suit or counter-suit over this. To the extent that the actions of the ex-employee cause the employer damages, the employer may be entitled to indemnification from the ex-employee.

However, the other side of the story is when an employee does make his or her superiors aware of suspected misconduct and false claims within the company and the company does nothing about it. This is often the case that we have when potential blowers contact us about filing a False Claims Act case. Often the whistleblower attempts to do the right thing by reporting it within the company and is stymied by his or her superiors. To us, this opens the door to legitimate whistleblower suits.

To read one of my prior blogs about South Florida Hospital reaching a settlement for similar FCA
claims, click here.

Click here to learn more about who can file a whistleblower/qui tam lawsuit and the reward programs for coming forward with a false claim.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities that have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Pearlman, Steve and Freeman, Meika. “Top 10 Whistleblowing And Retaliation Events Of The Year.” Law360. (December 20, 2019). Web.

Goldberg, Pinchos. “Hospital Sues Whistleblower for Failing to Report Information And Choosing Instead to Use As Basis for Claim.” JD Supra. (May 8, 2019). Web.

Commins, John. “HOSPITAL COUNTERSUES FALSE CLAIMS WHISTLEBLOWER.” Health Leaders. (May 9, 2019). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

Keywords: Florida health law attorney, whistleblower attorney, whistleblower defense lawyer, Florida health law defense attorney, whistleblower defense attorney, whistleblower defense legal counsel, legal representation for whistleblower cases, qui tam lawyer, health law attorney, qui tam defense lawyer, qui tam plaintiff lawyer, whistleblower legal representation, False Claims Act lawyer, False Claims Act attorney, False Claims Act legal counsel, The Health Law Firm, DOJ defense lawyer, Office of Inspector General (OIG) defense counsel, Office of Inspector General (OIG) defense attorney, Office of Inspector General (OIG) legal representation, medcila legal defense attorney, health care fraud attorney, health care fraud lawyer, attorney legal representation for qui tam cases, Anti-Kickback Statute (AKS) attorney, Anti-Kickback Statute (AKS) lawyer, Anti-Kickback Statute (AKS) defense counsel, Medicare fraud defense lawyer attorney, Medicare fraud legal representation, Medicaid fraud defense lawyer attorney, legal representation for Medicare and Medicaid fraud, legal representation for Stark Law violations, healthcare fraud defense attorney, whistle blower lawyer attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida qui tam whistle blower lawyer attorney, Colorado qui tam whistle blower lawyer attorney, Louisiana qui tam whistle blower lawyer attorney, Kentucky qui tam whistle blower lawyer attorney, Virginia qui tam whistle blower lawyer attorney, District of Columbia (D.C.) qui tam whistle blower lawyer attorney, civil monetary penalties lawyer attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer attorney legal counsel, Virginia False Claims Act (FCA) and civil monetary penalties lawyer attorney, Virginia whistleblower lawyer attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer attorney, civil monetary penalties lawyer attorney

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2019/2020 The Health Law Firm. All rights reserved

By |2019-12-30T20:53:58+00:00December 30th, 2019|Categories: Colorado Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care programs, by offering gift cards to pharmacy customers that exceeded legal limits. Roundy’s enacted a Script Saver Program that gave all customers “pharmacy club coupons” for pharmacy purchases. When they reached five of those coupons, they could be redeemed for a $10 gift card, the complaint states. At some stores, the number of coupons necessary for a gift card was lowered to three, Kotwica said.

Roundy’s has mounted a defense to these allegations. Despite that defense, the whistle blower maintains the gift cards were more than the legal nominal value allowed. The whistle blower claimed additionally that the “retailer reward exception” failed because the gift cards were tied to the services the government health care programs reimbursed and were meant to induce customers to transfer prescriptions to the store.

The pharmacist and whistle blower in the case, claimed that he heard corporate executives discussing having Medicare and Medicaid recipients excluded from the program because they were concerned their inclusion was illegal, but never acted on that concern. Therefore, Kotwica said that this shows that Roundy’s had the intent to violate the FCA. The whistle blower also claimed that the company retaliated against him for speaking out to the point where he resigned his position as a pharmacist with it.

The case was originally filed in June 2015. Like all federal False Claims Act (FCA) cases, it remained sealed until ordered unsealed by the court. It was unsealed in July 2016 after the U.S., and the states of Illinois, Minnesota and Wisconsin declined to intervene in the case. Click here to read the response in this case.

Fighting Government Fraud and Abuse.

This case was brought under the federal False Claims Act (FCA) or federal “whistle blower law.” This law contains standards for both civil and criminal penalties against those filing false claims for services paid for by the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistle blower) proceeding. This type of action involves a private party filing a lawsuit on behalf of the government against a defendant who allegedly defrauded the government. The “whistle blower” receives a percentage of the money recovered by the government (if any), through any judgment or settlement of the case. Often the amounts awarded to the whistle blower are in the millions of dollars. Whistle blowers are often protected from receiving any potential civil liability or prosecution for their involvement in the matter.

Our firm has been on both sides of both federal and state whistle blower or qui tam cases. We have represented nurses, physicians, pharmacists and other health professionals in bringing such cases. We have also defended physicians, health care providers, medical groups and health facilities in such cases.

We have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government. This means, for example, that of a defendant settles with the government paying back $5 million, the relator or whistle blower can receive up to $1.5 million, plus his attorney’s fees and costs. Usually, the biggest obstacle to bringing any such case is being able to show an actual false claim that was filed.

If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistle blowers to bring these issues to the government’s attention.

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, nurses, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in bringing or defending against False Claims Act, whistle blower or qui tam cases. We also defend health care providers in Medicare and Medicaid investigations, audits and recovery actions. We represent plaintiffs and defendants in complex health care litigation in state or federal courts.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistle blower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented number of doctors and other licensed health professionals as relators in bringing qui tam or whistle blower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistle blower cases.

To contact The Health Law Firm, please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.

Sources:

Kass, Dani. “Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Law360. (December 20, 2016). Web.

“Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Make Me Feed. (December 21, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, whistle blower defense attorney, qui tam defense attorney, legal representation for FCA claims, legal representation for qui tam cases, legal representation for whistle blower defense cases, Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for Medicare and Medicaid fraud investigation, Florida FCA defense attorney, Colorado FCA defense attorney, Kentucky FCA defense attorney, Louisiana FCA defense attorney, District of Columbia FCA defense attorney, Virginia FCA defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, complex health care litigation attorney, legal defense of complex health care business disputes, complex litigation defense counsel

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Home Health Provider Sues Medicare Contractor and HHS Over Unfair Audit and Denied Medicare Reimbursement Payments

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 2, 2017, an Illinois home health care provider launched a class action law suit against Medicare reimbursement auditor AdvanceMed and the U.S. Department of Health and Human Services (HHS) Secretary Tom Price. MedPro Health Providers LLC (MedPro) filed the complaint in an effort to collect $300,000 it says it is owed in Medicare payments. The complaint was filed in the U.S. District Court for the Northern District of Illinois. The plaintiff, MedPro, which is a home health services provider, seeks status in the law suit as a class representative for all similarly situated health care providers.

The Complaint.

AdvanceMed is a Zone Program Integrity Contractor (ZPIC), which investigates suspected fraud, waste and abuse, according to the Centers for Medicare and Medicaid Services (CMS). Under the Medicare Act, CMS is allowed to enter into contracts with outside organizations to perform certain services, such as those of the ZPIC.

According to allegations made in the complaint, AdvanceMed contended that it found “reliable information” that MedPro had been overpaid for services and stopped reimbursements to the company. When MedPro provided a rebuttal statement to the findings, AdvanceMed allegedly ignored it.

According to the complaint, AdvanceMed’s evaluation of MedPro was not fair. MedPro did not have the opportunity to show its own evidence that its operations were in order. MedPro expended significant resources and financial capital to prepare and transmit the response to AdvanceMed. When AdvanceMed finally responded to its rebuttal, its language was “basically boilerplate” and did not address MedPro’s argument. MedPro said that new HHS Secretary Tom Price should take responsibility for AdvanceMed’s failure to reply as a ZPIC auditor.

So far, MedPro’s fraud allegation is only against AdvanceMed, not Price and HHS. However, in its complaint, it states, “The Secretary, through its ZPICs, has a plainly defined and nondiscretionary duty to properly and completely respond to MedPro’s Rebuttal Statement. MedPro has been irreparably injured because of the Secretary’s failure to carry out that duty.”

To read the complaint in full, click here.

For more information on AdvanceMed and ZPIC Audits, click here and here to read two of my prior blogs.

For a blog I wrote about a similar suit filed against Medicare contractors by the American Hospital Association several years ago, click here.

The Health Law Firm Previously Filed Similar Suit in Michigan.

Prior to MedPro’s class action suit, on September 1, 2016, New Vision Home Health Care, Inc., filed a similar suit in which The Health Law Firm now represents it. It is New Vision Home Health Care, Inc., et al. v. Anthem, Inc. (f/k/a WellPoint, Inc.), TrustSolutions, LLC, and National Government Services, Inc., U.S. District Court for the Eastern District of Michigan, case number 2:16-cv-13173. The New Vision suit did not seek class action status, but raised some of the same legal issues against CMS Medicare contractors. To see a copy of the Second Amended Complaint filed in federal court, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent health care providers in disputes with Medicare, insurance companies and complex litigation. Additionally, they represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Miesel, Hanna. “Health Provider Sues Medicare Middleman For Reimbursements.” Law360. (March 2, 2017). Web.

“Health Provider Sues Medicare Middleman For Reimbursements.” LexisNexis. (March 2, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

KeyWords: Legal representation for Medicare and Medicaid audits, legal representation for Medicare and Medicaid fraud, Zone Program Integrity Contractor (ZPIC) audit lawyer, legal representation for ZPIC audit, ZPIC attorney, legal representation for CMS investigations, Medicare audit and investigation defense attorney, Medicaid audit and investigation defense attorney, CMS defense attorney, legal representation for allegations of over-billing Medicare and Medicaid, legal representation for Medicare and Medicaid reimbursements, law suit against Anthem, Inc. (f/k/a WellPoint, Inc.), law suit against ZPIC TrustSolutions, LLC, law suit against National Government Services, Inc. (NGS), Medicare reimbursement defense attorney, Medicaid reimbursement defense attorney, health care fraud defense attorney, litigation against medicare contractors, legal counsel for Medicare and Medicaid audits, The Health Law Firm reviews, reviews of The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

By |2017-01-23T07:25:41+00:00May 15th, 2018|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

By |2017-01-16T07:23:41+00:00May 15th, 2018|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

 

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care programs, by offering gift cards to pharmacy customers that exceeded legal limits. Roundy’s enacted a Script Saver Program that gave all customers “pharmacy club coupons” for pharmacy purchases. When they reached five of those coupons, they could be redeemed for a $10 gift card, the complaint states. At some stores, the number of coupons necessary for a gift card was lowered to three, Kotwica said.

Roundy’s has mounted a defense to these allegations. Despite that defense, the whistle blower maintains the gift cards were more than the legal nominal value allowed. The whistle blower claimed additionally that the “retailer reward exception” failed because the gift cards were tied to the services the government health care programs reimbursed and were meant to induce customers to transfer prescriptions to the store.

The pharmacist and whistle blower in the case, claimed that he heard corporate executives discussing having Medicare and Medicaid recipients excluded from the program because they were concerned their inclusion was illegal, but never acted on that concern. Therefore, Kotwica said that this shows that Roundy’s had the intent to violate the FCA. The whistle blower also claimed that the company retaliated against him for speaking out to the point where he resigned his position as a pharmacist with it.

The case was originally filed in June 2015. Like all federal False Claims Act (FCA) cases, it remained sealed until ordered unsealed by the court. It was unsealed in July 2016 after the U.S., and the states of Illinois, Minnesota and Wisconsin declined to intervene in the case. Click here to read the response in this case.

Fighting Government Fraud and Abuse.

This case was brought under the federal False Claims Act (FCA) or federal “whistle blower law.” This law contains standards for both civil and criminal penalties against those filing false claims for services paid for by the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistle blower) proceeding. This type of action involves a private party filing a lawsuit on behalf of the government against a defendant who allegedly defrauded the government. The “whistle blower” receives a percentage of the money recovered by the government (if any), through any judgment or settlement of the case. Often the amounts awarded to the whistle blower are in the millions of dollars. Whistle blowers are often protected from receiving any potential civil liability or prosecution for their involvement in the matter.

Our firm has been on both sides of both federal and state whistle blower or qui tam cases. We have represented nurses, physicians, pharmacists and other health professionals in bringing such cases. We have also defended physicians, health care providers, medical groups and health facilities in such cases.

We have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government. This means, for example, that of a defendant settles with the government paying back $5 million, the relator or whistle blower can receive up to $1.5 million, plus his attorney’s fees and costs. Usually, the biggest obstacle to bringing any such case is being able to show an actual false claim that was filed.

If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistle blowers to bring these issues to the government’s attention.

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, nurses, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in bringing or defending against False Claims Act, whistle blower or qui tam cases. We also defend health care providers in Medicare and Medicaid investigations, audits and recovery actions. We represent plaintiffs and defendants in complex health care litigation in state or federal courts.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistle blower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented number of doctors and other licensed health professionals as relators in bringing qui tam or whistle blower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistle blower cases.

To contact The Health Law Firm, please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.

Sources:

Kass, Dani. “Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Law360. (December 20, 2016). Web.

“Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Make Me Feed. (December 21, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, whistle blower defense attorney, qui tam defense attorney, legal representation for FCA claims, legal representation for qui tam cases, legal representation for whistle blower defense cases, Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for Medicare and Medicaid fraud investigation, Florida FCA defense attorney, Colorado FCA defense attorney, Kentucky FCA defense attorney, Louisiana FCA defense attorney, District of Columbia FCA defense attorney, Virginia FCA defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, complex health care litigation attorney, legal defense of complex health care business disputes, complex litigation defense counsel

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

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