Archive for 2019

Partner Jesse Hoyer Speaks at American Bar Association Conference


(L to R) Trial Consultant Suann Ingle, Attorney Jesse Hoyer, Jury Consultant Max Bloom

Partner Jesse Hoyer took part in a panel at the American Bar Association’s 2019 False Claims Act and Qui Tam Trial Institute at Fordham University on June 20th.

The False Claims Act mock trial gave attendees a rare look at a whistleblower trial from start to finish, including how jurors come to their verdict. Attorneys were able to observe jury deliberations, via video, and see how jurors responded to themes, evidence and arguments presented during the mock trial.

In addition to attending the mock trial, Jesse Hoyer sat on a panel titled “Bringing Your Trial to Life: Trial Graphics and Jury Consultants.” Joining her on the panel were trial consultant Suann Ingle of Suann Ingle Associates in New York City and jury consultant Max Bloom from Holocene in San Francisco.

“The mock trial was a fascinating exercise to witness, and it was a special honor to present on the panel,” Hoyer said.

 

James Hoyer Investigator Speaks at National Investigative Reporters Conference

IRE Speakers (l to r): Steve Becker, Andy Donahue, Nicole Hong, Angie Moreschi

Every year, the national Investigative Reporters and Editors (IRE) conference brings together many of the best investigative reporters in the United States and abroad. More than 2000 journalists attended IRE 2019 in Houston to learn investigative techniques and develop story ideas. High on the list: stories about fraud.

James Hoyer Investigator and Communications Director Angie Moreschi was invited to speak on a panel about detecting business fraud. For the presentation, she joined Wall Street Journal reporter Nicole Hong, Better Business Bureau International Investigations Specialist Steve Becker, and moderator Andy Donahue, editor of Reveal from the Center for Investigative Reporting.

“These are some of the smartest and best reporters in the world, so it’s always an honor and privilege to speak at the IRE conference. I try to offer useful, practical tips on how to find fraud against the government and ideas to help reporters tell these important stories to public,” Angie said.

The False Claims Act & Whistleblowers

Angie shared important information about how whistleblowers help to expose fraud against the government through the False Claims Act and how they help to recover money for taxpayers.

The False Claims Act is the law that makes it possible for private citizens to file suit on behalf of the government when they become aware of fraud at companies ripping off government agencies or programs.  Through these whistleblower suits, the Department of Justice recovered $2.8 billion, last year alone.

There’s a lot of fraud out there and it takes many forms, from improper patient admissions, over-billing, and up-coding at hospitals;  kickbacks for referrals; selling unnecessary medical equipment; pharmaceutical companies pushing the sale of drugs off-label; defense contractor fraud; and financial aid fraud.

Fastest Growing Types of Fraud

Healthcare fraud is far and away the number one type of fraud against the government, with DOJ estimating some $100 billion lost to healthcare fraud, every year.

One of the fastest growing areas is Durable Medical Equipment fraud. This is where unscrupulous companies often target senior citizens on Medicare and harass them with multiple phone calls everyday, trying to get them to authorize shipments of medical equipment or products. The big problem is many patients don’t need or want the items, but in several cases, the companies ship them anyway, and then fraudulently bill the government.

“It’s something all taxpayers should care about, because we all pay for it,” Angie said.

Presentation by Other Panelists

In addition to Angie’s presentation, Wall Street Journal reporter Nicole Hong talked about some of the biggest fraud cases covered by the paper, this year; and BBB investigator Steve Becker looked at some of the top areas of consumer fraud, including online romance scams, puppy scams, and business email scams.

 

“Fountain of Youth” Doctor Convicted in Healthcare Fraud Scheme

Picture courtesy of Connect Media

A Pittsburgh area cardiologist was found guilty of two counts of healthcare fraud, involving more than $13 million in falsified insurance billing. Dr. Samirkumar Shah submitted the fraudulent claims to Medicare, Medicaid and several private insurance companies and received payments in excess of $3.5 million.

During an eight day trial, evidence was submitted to show that Dr. Shah, 56, offered External Counter Pulsation (ECP) treatments to patients in Pennsylvania, Ohio, New York and Florida for a variety of ailments, including obesity, migraines and erectile dysfunction. He advertised the ECP treatments as “the Fountain of Youth” and claimed they made patients “younger and smarter,” according to the Department of Justice.

ECP involves the use of a specialized bed equipped with pressure cuffs, which exert pressure upon patients’ lower extremities as a means to increase blood flow to the heart.  Insurers only reimburse for ECP treatments for patients who suffer from disabling angina—or chest pain caused by decreased blood flow to the heart—and only when a physician supervised the treatment.

FBI Pittsburgh Special Agent in Charge Robert Jones called healthcare fraud a serious problem that impacts every American. “It takes critical resources from our health care system and increases health care costs for everyone. Dr. Shah’s disregard for safe patient care goes against the medical ethics he was to uphold,” Jones said.

According to the DOJ, evidence showed that Shah instructed his employees to indicate that every patient had disabling angina on billing sheets that were used to support false insurance claims. In some cases, Shah never even met patients and never reviewed ultrasound imagery before approving new patients to begin ECP. In addition to billing for ECP treatments that were not medically necessary and were not provided under direct physician supervision, Shah also double-billed insurers.

Contrary to health insurance requirements, ECP treatments routinely occurred while neither Shah nor any other medical doctor was present at his various locations. On one occasion, a patient experienced an adverse event during his ECP treatment and had to be transported via ambulance to the hospital.

U.S. Attorney Scott Brady said, “Health care fraud threatens the safety and integrity of our entire health care system. Doctors and medical professionals like Dr. Shah who issue false diagnoses, order unnecessary testing and fraudulently bill Medicare and Medicaid in effect steal from the most vulnerable in our community.”

Shah faces a maximum sentence of 10 years in prison, a fine of $250,000, or both.  Click here to read more from the Department of Justice.

 

Endo Pharma Faces Suit for Opioid False Claims

TN Attorney General sues opioid maker Endo Pharmaceuticals (photo courtesy Times News)

Endo Pharmaceuticals, the same company which was at the center of a $193 million settlement with one of James Hoyer’s whistleblower clients, is now facing another major legal battle. The Tennessee Attorney General is suing Endo for making unlawful and false claims about the safety and benefits of its opioid products.

The AG’s office says Endo violated the Tennessee Consumer Protection Act and contributed to a devastating health crisis in Tennessee. Here are details from the news release by Attorney General Herbert Slatery’s office:

Attorney General Herbert H. Slatery III today sued Endo Pharmaceuticals and Endo Health Solutions Inc. (Endo) for making unlawful and false claims about the safety and benefits of its opioid products.

The State’s lawsuit, filed in Knoxville, alleges Endo violated the Tennessee Consumer Protection Act and contributed to a devastating public health crisis in Tennessee.

“Our Office has conducted an extensive investigation into Endo’s unlawful marketing practices which included targeting vulnerable populations like the elderly,” said Tennessee Attorney General Herbert H. Slatery III. “Endo has repeatedly refused to take responsibility for its unconscionable conduct, which is why we are taking this action.”

The allegations in the State’s 180-page complaint detail how Endo deceptively marketed its opioid products as being less addictive and more effective than others on the market. It did this despite evidence to the contrary, including the FDA’s explicit rejection of Endo’s claim that Opana ER was resistant to abuse as well as overwhelming evidence that Opana ER was being abused throughout Tennessee.

The Complaint alleges that Endo also knew the dangers of its opioid products, including increased risks of respiratory depression and death in elderly patients, and failed to clearly disclose those risks while it specifically targeted patients in that age group.

The State also has reason to believe Endo used the recommendations and educational materials of third-party groups like the American Pain Foundation without disclosing that Endo was by far the biggest donor to the Foundation and provided more than half of its total funding. Endo provided significant funding to other third-party groups and subsequently relied on material generated by those groups without disclosing the financial relationship.

The Attorney General requested the complaint be filed under a temporary seal because Endo claims the information produced during the State’s investigation is confidential. The order sealed by the judge allows the seal to expire in 10 days unless Endo acts to extend it.

The Attorney General believes the complaint should be made available to the public in its entirety and efforts to keep it confidential will only prolong and diminish Endo’s accountability for its conduct.

 

Generic Drug Price Fixing


Connecticut Attorney General William Tong interviewed on 60 Minutes

If you ever wondered why the price of generic drugs is getting so expensive, 60 Minutes gave us an inside look at the problem on its Sunday broadcast. The CBS program profiled the on-going battle of Connecticut Attorney General William Tong to hold big pharma accountable.

Connecticut and more than 40 other states filed a sweeping lawsuit accusing the biggest generic drug makers of engaging in an “industry-wide conspiracy” to fix the prices of generic drugs. They allege there is a massive, systematic scheme to bilk consumers and the government out of billions of dollars.

Based on evidence like text messages, emails, phone records, and documents, the prosecutors say sudden, dramatic, price spikes can be tied to drug makers colluding to profiteer, not a shortage of drugs. In a word “greed.”

The price hikes have affected 100’s of different, everyday prescriptions, driving up the costs for health insurance, Medicare and Medicaid. With 90-percent of all prescriptions filled with generic drugs, the impact on everyday American lives has been overwhelming.

Drug makers deny any wrong-doing and insist they will fight the lawsuits vigorously. Click here to watch the 60 Minutes report.

 

California legislators looking to expand False Claims Act to tax fraud

California Assembly Bill 1270 was introduced on February 21, 2019. If it becomes law, it would amend the state’s False Claims Act to remove the bar against tax-related false claims.

Read More…
 

Former CEO of Hospital Chain to Pay $3.46 Million to Resolve False Billing and Kickback Allegations

Gary D. Newsome, former CEO of Health Management Associates LLC (HMA),  a hospital chain that was headquartered in Naples, Florida, has agreed to pay the United States $3.46 million to settle allegations that he caused HMA to knowingly submit false claims to government health care programs by admitting patients who could have been treated on a less costly, outpatient basis, the Department of Justice announced. The settlement also resolves allegations that Newsome caused HMA to pay remuneration to Emergency Department (ED) physicians in return for referrals.  

“Those who bill federal health care programs for unnecessary hospital stays will be held accountable for wasting federal dollars,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Patients deserve the unfettered, independent judgment of their health care professionals. We will pursue those who cause hospitals to offer financial incentives to physicians in return for improper patient referrals that undermine the integrity of our health care system.”

“A physician’s health care decisions should be driven by what is in the patient’s best interest, not by what helps line a provider’s pockets,” said Barbara Bowens, the Acting U.S. Attorney for South Carolina for purposes of this case. “The U.S. Attorney’s Office will not tolerate false claims based on unnecessary hospital admissions, which drive up health care costs and can harm patients.”

“Providers are expected to closely follow rules and bill properly. Further, in this case, the government contended that Newsome directed illegal payments for referrals,” said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services. “Taxpayer money wasted is money stolen from vital government health programs.”

Read the entire press release from the Department of Justice by clicking here.

 

Pharmaceutical Company To Pay $17.5M To Resolve Allegations Of Kickbacks

US WorldMeds LLC founder and CEO Breckenridge Jones
US WORLDMEDS LLC

The Justice Department announced today that US WorldMeds LLC (USWM) has agreed to pay $17.5 million to resolve allegations that it violated the False Claims Act, 31 U.S.C. §§ 3729 et seq., by paying kickbacks to patients and physicians to improperly induce prescriptions of its drugs, Apokyn® and Myobloc®. USWM is a pharmaceutical manufacturer headquartered in Louisville, Kentucky. 

“The Department of Justice is committed to ensuring that physicians’ and patients’ selection of medications is not influenced by improper financial considerations,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “The nation’s health care programs and taxpayers deserve health care companies that play by the rules, including the Anti-Kickback Statute.”

When a Medicare beneficiary obtains a prescription drug covered by Medicare Part D, the beneficiary may be required to make a partial payment, which may take the form of a copayment, coinsurance, or a deductible (collectively “copays”). Congress included copay requirements in the Medicare program, in part, to encourage market forces to serve as a check on health care costs, including the prices that pharmaceutical manufacturers can demand for their drugs. Under the Anti-Kickback Statute, a pharmaceutical company is prohibited from offering, directly or indirectly, any remuneration — which includes paying patients’ copay obligations — to induce Medicare patients to purchase the company’s drugs. 

Read the entire press release from the Department of Justice by clicking here.

 

Supreme Court Deals Worker Rights Another Blow

The fight for worker rights took another blow today.  The Supreme Court ruled employees at a California company could not band together in an effort to get compensation from their employer for a breach of their data.  The 5-4 decision put yet another limitation on the ability to use class arbitration and class actions against bigger, more powerful opponents.

Attorney Dave Scher, head of the James Hoyer Employment Law Division, says the decision is disappointing but “really not surprising, given the conservative shift on the Court.”  Recent rulings have chipped away at employee rights and, unfortunately, this will make it even more difficult for employees to tackle joint grievances in the workplace.

“It impacts any issue where employees band together to fight unfair circumstances in their workplace—not paying overtime, underpaying tips, break times, not getting benefits they’re entitled to—things like that,” Scher explained.

Forcing Individual Arbitration

The ruling helps allow companies to ban class action lawsuits and class arbitration proceedings to address disputes; instead, forcing employees to bring their cases on an individual basis.  It essentially creates a divide and conquer scenario for companies to take away the “strength in numbers” individuals can get by working together.

Attorney Dave Scher

“It allows corporations to take advantage of low-income employees and prevents them from being held accountable for improper practices,” Scher said.  “They do what they want, because they know there’s really nothing these employees can do about it.”

It’s cost prohibitive in most cases for employees to bring individual cases for claims that don’t amount to large sums, even if the collective damage to all employees is large.  Class actions and class arbitrations are supposed to help even the playing field for employees and consumers by spreading out the costs, but that gets harder now with this ruling.

“Companies can afford to fight, but an individual with a $1,000 or $5,000 claim can’t afford it.  They can’t pay a lawyer to help them, and the way it’s now structured, many lawyers can’t afford to bring the case, because they won’t recoup their costs.”

According to the Economic Policy Institute, nearly 54-percent of non-union, private sector employers require mandatory arbitration clauses and 65-percent of large companies with more than 1,000 employees have them.  These arbitration agreements require workers to give up their rights to have disputes settled in a court of law. They are often a take-it-or-leave-it deal, where if you don’t sign, you don’t get the job. Unfortunately, many don’t even realize the rights they are giving up and that it puts them at a significant disadvantage should a dispute arise.

What can you do about it?

Some employment attorneys are developing a head-on approach to tackle “class” bans by filing large numbers of arbitration cases, one by one.

“Creative employment lawyers are saying—‘Fine, instead of having a class, I’ll find a thousand workers who fit into this category, and I’ll represent each of them. And I’ll bring a separate arbitration claim for each of them, and you’re going to have to pay for the cost of each of those arbitrations.’ And that is having some degree of effect,” Scher explained.

In other words, in the world of unintended consequences, class bans could end up backfiring on some employers.

“Essentially employers are coming back and saying, ‘Well, wait a minute, that’s completely inefficient. It’s all the same issue’—which is the whole point of having a class action,” Scher explained. “So ultimately, we can put them all together in a class or you can oppose class actions. Which do you want? You’re making me do this.”

If you find yourself facing an unfair workplace issue, click here to contact attorney Dave Scher for an evaluation.

 

Attorney Jesse Hoyer Fights Fraud, carrying on firm legacy

James Hoyer law firm Shareholder & Partner Jesse Hoyer

Attorney Jesse Hoyer is a partner and shareholder of the James Hoyer law firm. She carries on the legacy of her parents, former prosecutors who founded the firm. Watch the video below to learn more about her.

Attorney Jesse Hoyer explains how she helps clients.

Jesse’s main area of practice is False Claims Act – Whistleblower litigation, which is essentially fighting fraud against the government. Her area of specialty is education fraud, specifically cases involving for-profit colleges that abuse government financial aid funding. She also handles cases involving healthcare, big pharma, and defense contractor fraud, among others.

If you are a potential whistleblower with information that your company is improperly billing the U.S. government, you can request a confidential evaluation here: http://www.jameshoyer.com/contact-us/

**Be sure to let us know that you learned more about Jesse and the firm by watching this video.