Archive for August, 2014

Zahid Imran, a Louisiana Psychiatrist Sentenced to More Than Seven Years in Prison for His Role in $258 M Medicare Fraud

A Louisiana psychiatrist was sentenced in federal court in Baton Rouge, Louisiana, today to serve 86 months in prison for his role in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric services.   He was further ordered to pay $43.5 million in restitution and to forfeit all proceeds from the fraudulent scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney J. Walter Green of the Middle District of Louisiana, Special Agent in Charge Mike Fields of the Dallas Region of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division and Louisiana State Attorney General James D. “Buddy” Caldwell made the announcement.   Chief U.S. District Court Judge Brian A. Jackson of the Middle District of Louisiana imposed the sentence.

According to documents filed in the case, Zahid Imran, M.D., 56, of Baton Rouge, served as the medical director of Shifa Community Mental Health Center of Baton Rouge, and co-owned Serenity Center of Baton Rouge and Shifa Community Mental Health Center of Texas.   As part of the scheme, Imran admitted mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certified the patients’ appropriateness for the program in an effort to continue to bill Medicare for services.   To support the fraudulent Medicare billing, Imran and others falsified patient treatment records to reflect services on dates when no such services were provided.   Imran pleaded guilty on May 13, 2014, to conspiracy to commit health care fraud.

Read rest of story here

 

James Hoyer Cases Among Largest False Claims Settlements of 2014

peggy-ryan-endo-150sq

Peggy Ryan

A James Hoyer case tops the list of the 10 largest False Claims, Stark Law, and Anti-Kickback settlements of 2014, as compiled by Becker’s Hospital Review.  Endo Pharmaceuticals $193-million settlement with the federal government for off-label marketing of its Lidoderm pain patch comes in at number one.  James Hoyer client Peggy Ryan is the whistleblower who first exposed the massive fraud.

Coming in at number four on the list is another James Hoyer case in which we served as co-counsel, the $85 million Halifax Hospital settlement.

Becker’s reports this year is on track to be a record-breaking one for government recoveries in the healthcare industry. These two James Hoyer cases and several others settled this year have contributed substantially to the return of taxpayer dollars.  The False Claims Act allows private citizens to bring civil actions on behalf of the federal government to recover money when fraud is suspected.

Here are the top four settlement recoveries so far in 2014, as compiled by Becker’s Hospital Review:

1. (James Hoyer Case) Endo Health Solutions — a pharmaceutical company — and its subsidiary, Endo Pharmaceuticals, agreed to pay $192.7 million to resolve criminal and civil claims stemming from Endo’s marketing of Liboderm for uses not approved by the Food and Drug Administration. The settlement included a deferred prosecution agreement and forfeiture totaling $20.8 million and $171.9 million to be paid to the federal government, the states and the District of Columbia.

2. Baton Rouge, La.-based Amedisys, one of the country’s largest providers of home health services, and its affiliates agreed to pay $150 million to resolve allegations brought under the False Claims Act, Stark Law and the Anti-Kickback Statute. The lawsuit filed against Amedisys was brought under the qui tam, or whistle-blower, provision of the False Claims Act by former employees of the company. The lawsuit alleged Amedisys submitted improper claims to Medicare for reimbursement from 2008 to 2010 for therapy and nursing services that were medically unnecessary or provided to patients who were not homebound. The lawsuit also alleged the company engaged in improper financial relationships with referring physicians.

3. Cincinnati, Ohio-based Omnicare — the nation’s largest provider of pharmaceuticals and pharmacy services to nursing homes — agreed to pay $124.24 million to settle allegations that it violated the False Claims and Anti-Kickback Statute. The government alleged Omnicare offered improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid beneficiaries. The government also alleged the improper relationship resulted in Omnicare and the facilities submitting fraudulent claims for reimbursement to Medicare and Medicaid.

4. (James Hoyer Case) Daytona, Fla.-based Halifax Hospital Medical Center and Halifax Staffing agreed to pay $85 million to resolve allegations they violated the False Claims Act and the Stark Law. The government alleged Halifax knowingly violated the Stark Law by executing contracts with six medical oncologists that included an incentive bonus that improperly included the value of prescription drugs and tests the oncologists ordered and Halifax billed to Medicare. The government also alleged Halifax knowingly violated the Stark Law by paying three neurosurgeons more than fair market value for their work, and the hospital admitted patients who did not need to be admitted, then billed Medicare for their care.

Click her to read the entire list.

 

 

ABC Interviews James Hoyer Partner About For-Profit Colleges

Jesse Hoyer - Partner

Jesse Hoyer – Partner

ABC Action News in Tampa continued its multi-year  investigation of for-profit colleges with another powerful report on this troubled industry.  This time the report focused on Everest University, which is closing down or selling off it’s campuses and online programs around the country.  The action comes after a Department of Education investigation revealed serious problems, including falsified job placement and attendance numbers and inflated grades.

ABC’s I-Team reporter Adam Walser interviewed James Hoyer partner Jesse Hoyer about the for profit college industry and the latest problems at Everest.  “This is a school that’s getting over a billion dollars a year in federal funding and the government is getting no return on its investment, ” said  Hoyer.

 

 

Click here to watch another I-Team story on the debt racked up by Everest students.

 

 

 

 

 

 

 

IRS expands whistleblower awards

Senator Chuck Grassley

The IRS recently expanded awards given to relators under the IRS whistleblower program; thereby encouraging more taxpayers to come forward to report wrongdoing. The online version of the regulations are available here.

Read More…

 

McKesson Corp. to Pay $18 Million to Resolve False Claims Allegations Related to Shipping Services Provided Under C.D.C. Vaccine Distribution Contract

McKesson Corporation has agreed to pay $18 million to resolve allegations that it improperly set temperature monitors used in shipping vaccines under its contract with the Centers for Disease Control and Prevention (CDC), the Justice Department announced today.  McKesson is a pharmaceutical distributor with corporate headquarters in San Francisco.

“Companies must comply with the requirements they agree to when they contract with the government to provide products that protect the public,” said Assistant Attorney General Stuart F. Delery for the Justice Department’s Civil Division.  “If a contractor does not adhere to the terms it negotiated, its conduct not only hurts taxpayers but also could jeopardize the integrity of products, like vaccines, that Americans count on to be safe.”

The government alleged that McKesson failed to comply with the shipping and handling requirements of its vaccine distribution contract with the CDC.  Under the contract, McKesson provided distribution services, receiving vaccines purchased by the government from manufacturers and then distributing the vaccines to health care providers.  The government alleged that the contract required McKesson to ensure that during shipping, the vaccines were maintained at proper temperatures by, among other things, including electronic temperature monitors set to detect when the air temperature in the box reached two degrees Celsius and below or eight degrees Celsius and above.  The government alleged that, from approximately April 2007 to November 2007, McKesson failed to set the monitors to the appropriate range, and as a result, knowingly submitted false claims to the CDC for shipping and handling services that did not satisfy its contractual obligations.

Read rest of story here

 

 

Tracey Cota and Gary Lang, Co-Owners of Atlanta-Based Medical Clinic Pleaded Guilty to Illegal Pay-for-Patient Conspiracy

A CEO of an Atlanta-area hospital and the co-owner and chief operating officer of an Atlanta-based medical clinic chain pleaded guilty in connection with the payment of illegal kickbacks to clinics in exchange for Medicaid patient referrals to hospitals in the Atlanta area and on Hilton Head Island, South Carolina.

Principal Deputy Assistant Attorney General Marshall L. Miller of the Justice Department’s Criminal Division, U.S. Attorney Sally Quillian Yates of the Northern District of Georgia, Special Agent in Charge Derrick Jackson of the Atlanta Region of the Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Director in Charge J. Britt Johnson of the FBI’s Atlanta Field Office made the announcement.   The guilty pleas were entered by U.S. District Judge Amy Totenberg of the Northern District of Georgia.

“These medical executives enriched themselves by using uninsured pregnant women and newborn babies as commodities, whose health care could be bought and sold for kickbacks and bribes,” said Principal Deputy Assistant Attorney General Miller.   “Unlawful payments for patient referrals can lead to increased Medicaid costs, corrupt medical decision-making, overutilization of medical services, and unfair competition – and most importantly, insufficient or inadequate care for patients.   The Justice Department is committed to investigating and prosecuting those who illegally pay for patients.”

Read rest of story here

 

 

Do I Really Need a False Claims Act Attorney? Pro Se Relators and the Pitfalls of Trying to Do it Alone

You’ve suspected fraud at your workplace. You’ve gathered evidence that confirm your suspicions. You’ve researched the False Claims Act (“FCA”). You think you qualify to be a whistleblower and now you’re ready to file a qui tam complaint.

In fact, you’re so prepared that you’re thinking maybe you don’t even need an attorney. After all, you can file an FCA case by yourself just like any other lawsuit, right?

Wrong.

To protect the Government, courts have adopted a straightforward rule that an FCA relator may not bring a case pro seStoner v. Santa Clara County Office of Educ., 502 F.3d 1116, 1126-28 (9th Cir.2007); Timson v. Sampson, 518 F.3d 870, 873-874 (11th Cir.2008); U.S. ex rel. Lu v. Ou, 368 F.3d 773, 775-76 (7th Cir.2004).  Every court to address the issue has ruled the same, thus representing one of the few issues surrounding the FCA where there is no split among the circuits.

Although it is certainly advisable to consult with an attorney to bring complex cases, it is every person’s right to represent his or her own interests in most legal proceedings. Indeed, acting pro se is a right entitled to individuals by United States statutes. 28 U.S.C. § 1654 (“In all courts of the United States, the parties may plead and conduct their own cases personally or by counsel….”) ..

The key to this right, however, is that a person must be representing “his or her own interests,” not the interest of any others.  Stoner, 502 F.3d at 1126.  The relator in an FCA case does not bring a case based on his or her own interests, but on behalf of the United States of America.  From the time a case is filed until the time it is resolved, whether or not the Government intervenes, the case belongs to the United States as the real party in interest.  U.S. ex rel. Milam v. University of Texas M.C. Anderson Cancer Center, 961 F.2d 46, 50 (4th Cir.1992).

Because the interests of the United States are at issue, the stakes are incomparably high and therefore the rules are different.  An inexperienced or untrained relator, even with the best intentions, may make a misstep which compromises the Government’s ability to obtain a recovery.  Stoner, 502 F.3d at 1126 (“[T]he United States ‘is bound by the relator’s action’ for purposes of res judicata and collateral estoppel.”)  Because of the incredibly complex rules of the False Claims Act, one simple procedural mistake or pleading deficiency can doom a case.  As such, the law requires relators to engage experienced FCA attorneys to avoid such pitfalls.

So, as a practical matter, if you’ve gotten this far in your investigation of a suspected fraud and you’re prepared to take the courageous step of becoming a whistleblower, then do it right.  Find a law firm with a proven record of success under the False Claims Act to help you bring your case on behalf of the United States.

To contact James Hoyer about a suspected FCA violation, please contact us here or call us toll-free at 1-800-651-2502.

 

Hospital System Pays $98 Million to Settle Whistleblower Suit on Improper Emergency Room Admissions

The Justice Department announced that Community Health Systems Inc. (CHS), the nation’s largest operator of acute care hospitals, has agreed to pay $98.15 million to resolve multiple lawsuits alleging that the company knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services.  The settlement also resolves allegations that one of the company’s affiliated hospitals, Laredo Medical Center (LMC), improperly billed the Medicare program for certain inpatient procedures and for services rendered to patients referred in violation of the Physician Self-Referral Law, commonly known as the Stark Law.  CHS is based in Franklin, Tennessee, and has 206 affiliated hospitals in 29 states.

“Charging the government for higher cost inpatient services that patients do not need wastes the country’s health care resources,” said Assistant Attorney General Stuart F. Delery for the Justice Department’s Civil Division.  “In addition, providing physicians with financial incentives to refer patients compromises medical judgment and risks depriving patients of the most appropriate health care available.  This department will continue its work to stop this type of abuse of the nation’s health care resources and to ensure patients receive the most appropriate care.”

Click here to read more from the Department of Justice.