Posts Tagged ‘whistleblower’

Rare Case of Patient Whistleblower leads to Successful Settlement

AgeVital agrees to pay $775,000 to settle kickback claims

[*See video below on coverage of the settlement on WFLA channel 8 in Tampa. James Hoyer Attorney Jesse Hoyer is interviewed*]

SARASOTA, FL – The action of one patient who recognized possible fraud against Medicare led to this settlement which returns nearly one million dollars to taxpayers.  Vital Life Institute LLC, known as AgeVital Pharmacy LLC, along with owners Jenny and William Wilkins, have agreed to pay at least $775,000 to resolve claims that they violated the False Claims Act by engaging in an illegal kickback scheme.

“The importance of this settlement goes far beyond the amount recovered. It demonstrates the value and impact of everyday citizens who come forward to expose fraud,” said attorney Jesse Hoyer, local counsel for the whistleblower case. “Medicare, Medicaid and Tricare beneficiaries who carefully review their Explanation of Benefits statements can make a difference.”

The settlement resolves allegations that Sarasota-based AgeVital paid kickbacks to a third-party marketing company to solicit patients for compounded drug prescriptions, regardless of patient need. The marketing company allegedly arranged for prescribers to sign those prescriptions, which were then referred to AgeVital to be filled in exchange for a substantial share of Tricare and Medicare reimbursements.

Details of case

The case was filed in federal court in Tampa in 2015, after Manfred Knopf, a patient in New Jersey who received prescriptions he did not need or want, recognized that Medicare was billed for the products. AgeVital solicited Mr. Knopf to purchase the expensive compounded pharmaceuticals after he suffered a slip and fall accident that required treatment for his injuries.

Despite never agreeing to receive these medications, AgeVital began sending containers of expensive compounding creams to his doorstep. The healthcare prescriber listed on the packages delivered was Dr. Jean Wilson, a provider Knopf had never heard of or been treated by. Medicare paid approximately $37,377 for these medically unnecessary compounded pharmaceuticals sent to Knopf. After recognizing what he believed was fraud, Knopf decided to report his concerns to the government.

With the assistance of attorney David Williams of Kline & Specter, P.C. (along with Jesse Hoyer and Elaine Stromgren of James Hoyer, P.A.), the lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act. The Act allows private citizens who suspect

fraud against the government to bring a lawsuit on behalf of the United States for false claims and to share in any recovery. 

“The False Claims Act gives us a powerful tool with which to expose fraud and recover money on behalf of taxpayers. We thank Mr. Knopf for recognizing the fraud and having the courage to bring it to the Government’s attention,” said attorney Hoyer.

Anti-Kickback Statute

The Anti-Kickback Statute prohibits the knowing and willful payment of compensation to induce the referral of services or items that are paid for by a federal health care program. Individuals and entities can be subject to liability under the False Claims Act for submitting claims to federal health care programs in violation of the Anti-Kickback Statute.

“Kickback schemes undermine public trust in our health care system and lead to unnecessary health care costs at taxpayers’ expense,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division.

“We will not tolerate those who profit at the expense of taxpayers by entering into illegal kickback arrangements,” says U.S. Attorney for the Middle District of Florida Maria Chapa Lopez. “Our office is committed to holding individuals accountable for corporate malfeasance.”

Mr. Williams, Ms. Hoyer and Ms. Stromgren sincerely appreciate the efforts of the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Middle District of Florida, the FBI, the Defense Criminal Investigative Service and the U.S. Department of Health and Human Services Office of Inspector General that contributed to the resolution of this case.

Kline & Specter P.C. is a nationwide personal injury and medical malpractice law firm with offices in Pennsylvania, New Jersey, Delaware, and New York.

James Hoyer, P.A. is a nationwide whistleblower and employment law firm with offices in Florida, Washington D.C., and Michigan.

 

$65 Million Prime Healthcare Whistleblower Settlement

Prime Whistleblower

Whistleblower’s Fearless 7-Year Pursuit of Justice:

Los Angeles, CA- August 3, 2018— The 5th largest for-profit hospital system in the country has agreed to pay $65 million to settle civil charges of healthcare fraud against the government. Prime Healthcare has also agreed to abide by a Corporate Integrity Agreement with strict requirements and oversight to ensure it will follow Medicare rules in the future. Prime, headquartered in Ontario, CA, has 45 hospitals in 14 states. It was a long-fought battle against the healthcare giant lasting nearly a decade, but whistleblower Karin Berntsen is grateful to finally see Prime held accountable.  Read More…

 

CBS Premieres New Whistleblower Program

New CBS program. Premieres on Friday, July 13th, 8pm.

The courageous stories of whistleblowers are about to get some national recognition. CBS is launching a new true-crime series that takes a look at the contributions of whistleblowers in helping to stop fraud against the government. The name of the program is Whistleblower.

CBS says Whistleblower takes a thrilling look into the real-life David vs. Goliath stories of heroic people who put everything on the line in order to expose illegal and often dangerous wrongdoing when major corporations rip off U.S. taxpayers. Hosted by attorney Alex Ferrer, a former judge and police officer, each hour introduces cases in which ordinary people step up to do the extraordinary by risking their careers, their families and even their lives to ensure others are not harmed or killed by unchecked, unethical corporate greed.

The premiere episode will feature cases concerning a pediatric dental chain and a pharmaceutical giant.  It debuts Friday, July 13th at 8 PM on CBS.

 

Mastermind in $24 Million Ed4Mil Military Tuition Scam Sentenced

The mastermind of a $24 million scheme to take advantage of veterans and active duty military will spend 5 years in jail after pleading guilty to conspiracy to commit wire fraud.  Ed4Mil President David Alvey was criminally charged after a whistleblower suit filed by  James Hoyer client Adam Boyce.

Alvey conspired with former Assistant Dean of Caldwell College Lisa DiBisceglie and former Ed4Mil employee Helen Sechrist to trick members of the military into signing up for wildly overpriced online classes that were misrepresented as Caldwell classes. In reality, they were cheap certificate courses offered by an unaccredited school. DiBisceglie and Sechrist also plead guilty.  Click here to read more about Alvey’s sentencing.

adam-boyce-sm

Whistleblower & James Hoyer client Adam Boyce

Boyce first came forward to the government after concerns that Army National Guard members were being subjected to a bait and switch for online certificate courses, that were marked up in cost by 6-times and more when sold to military personnel.

 

Boyce was marketing director for a middleman company called Ed4Mil which recruited soldiers to take the online classes. National Guard members were told the classes were offered by a private school in New Jersey, just outside of  New York City, called Caldwell College, but they were actually provided by another online school called Penn Foster. CBS News reported on the whistleblower complaint when Boyce’s False Claims Act suit was unsealed in 2014.

 

James Hoyer Attorney Speaks at Annual Certified Fraud Examiners Conference

James Hoyer Attorney Clark Bolton (center) speaks on panel at 19th Annual ACFE Fraud conference in Tampa Bay.

James Hoyer Attorney Clark Bolton offered unique insight at the 19th annual Association of Certified Fraud Examiners conference in Tampa Bay. As a former fraud examiner turned whistleblower turned False Claims Act attorney, Clark provided a rare look at what it’s like to be an insider exposing fraud and now an attorney litigating fraud against the government.

Clark first came to James Hoyer as a client a decade ago. He was one of four whistleblowers in the $137.5 million WellCare settlement with the Department of Justice. Click here to learn more about Clark’s experience as a whistleblower in his own words.

Following the WellCare settlement, Clark took a long, hard look at his life and decided to make a career change. After more than two decades as a fraud examiner, he committed to becoming an attorney.  In his senior year of law school, he joined James Hoyer as an investigator, and with his trademark  discipline and determination, graduated cum laude.  All the hard work paid off when Clark passed the Florida Bar Exam in April 2018 and became an Associate with the James Hoyer firm. It was an incredible accomplishment after a roller coaster decade that took him from the whistleblower to the lawyer who now helps whistleblowers seeking justice.

Clark shared his story with members of ACFE and explained how important it is for companies to listen to employees when they come forward to voice their concerns internally.  Too often, however, he said “greed” gets in the way and businesses ignore employee concerns.  That’s where Clark and James Hoyer come in. As one of the premiere Whistleblower/False Claims Act firms in the nation, we listen when employees feel they have nowhere else to turn.

If you have knowledge and evidence of fraud against the government, click here to contact us.