Serenity Hospice and Pallative Care Guilty of Hospice-Medicare Fraud

According to the Phoenix Sun, a Phoenix hospice provider will pay $2.2 Million to the federal government for falsely billing Medicare for hospice care. 

Under the agreed terms, the founder and former president Ruth Siegel agreed to be excluded from Medicare, Medicaid and other federal health programs for 5 years. She will also, personally pay $1 Million of the $2.2 Million settlement

This lawsuit was filed by a former employee Cheryl Sifford, under the false claims act. Serenity still denied the allegations, but said it was more cost effective to settle rather than fight it.

 

Here's how the system works, Medicare pays for medical care to manage symptoms and provide relief to those with a life expectancy of less than 6 months and who have decided not to seek any further treatment, but rather prepare for death. The rate Medicare pays for this service is over 4 times the rate that should have been paid for the actual services they received. Thus boosting profits for the facility.

 

Sifford claimed in a civil lawsuit filed, that Serenity flagged patients who were referred by CareMore to ensure they were admitted as hospice patients. In addition she was also instructed to take CareMore's staff to dinner, concerts and limousine rides.

Siegel has not admitted guilt, but has insisted that this settlement is the quickest and most cost effective settlement.

The whistleblower, Cheryl Sifford will collect $440,000 for her help in this case.

If you know of any such thing taking place where you work we encourage you to contact Jim VanderLinden immediately. http://www.vanderlindenlaw.com/

Adventist Health Systems To Pay Out $118.7 Million

Three former employees of a North Carolina hospital were the first to expose an alleged scheme by Adventist Health System to pay doctors excessive compensation to lock in their patient referrals to Adventist-owned hospitals, clinics and other outpatient services in Florida, North Carolina, Tennessee and Texas.

The US Justice Department announced today that Adventist will pay a total of $118.7 million to the federal government and four states to settle a whistleblower (qui tam) lawsuit filed in December 2012 by those former employees. The settlement agreement also covers a separate qui tam lawsuit filed in 2013 that made the same allegations as some of those made earlier in Phillips & Cohen's qui tam lawsuit.

The Adventist settlement is the largest healthcare fraud settlement ever made involving physician referrals to hospitals. It is nearly twice the previous largest settlement involving hospital kickback allegations, which was North Broward Hospital District's recent $69.5 million settlement.

It was alleged Adventist's hospitals paid doctors outrageous sums and offered overly generous benefits and lax billing oversight as part of a corporate strategy to capture and control physician referrals for inpatient and outpatient services near its hospitals. Federal law prohibits hospitals from paying doctors directly or indirectly for referrals so that doctors make recommendations for care based on what's best for the patient – not what's best for the doctor's bank account.

A substantial portion of the settlement amount is based on allegations involving Florida Hospital Medical Group, an Adventist-owned physician practice in Florida whose doctors worked at several Adventist hospitals and dozens of Adventist-owned outpatient clinics. Those hospitals include Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital Celebration Health, Florida Hospital Kissimmee, Florida Hospital Orlando, Florida Hospital Waterman (Tavares, Fla.), Florida Hospital for Children (Orlando, Fla.) and Winter Park Memorial Hospital.

The three whistleblowers were longtime employees at Adventist's Park Ridge Health in Hendersonville, NC, where they became aware of the alleged system-wide kickback scheme. Michael Payne was a risk manager and Melissa Church was the executive director of physician services at Park Ridge. Gloria Pryor was a compliance officer for physician offices at Park Ridge.

Kmart Guilty of False Claims Act Violation

KMART Corp. (Kmart), a discount department store chain that operates approximately 780 in-store pharmacies, has paid the United States $1.4 million to resolve allegations that it violated the False Claims Act by using drug manufacturer coupons and gasoline discounts as improper Medicare beneficiary inducements, the Justice Department announced today. 

 

The settlement resolves allegations that Kmart violated the False Claims Act by providing illegal benefits to beneficiaries of the Medicare program.  The government alleged that from June 2011 to June 2014, Kmart knowingly and improperly influenced the decisions of Medicare beneficiaries to bring their prescriptions to Kmart pharmacies by permitting the Medicare beneficiaries to use drug manufacturer coupons to reduce or eliminate prescription co-pays that they otherwise would be obligated to pay.  Federal law prohibits a person from offering beneficiaries of certain federal health programs, such as Medicare, remuneration that is intended to influence the beneficiary’s choice of provider.  The government alleged that Kmart’s conduct caused the Medicare beneficiaries to seek expensive, brand name drugs in lieu of cheaper generic drugs, which caused the government’s costs to increase without any medical benefit to the beneficiary.  The government also alleged that Kmart improperly encouraged Medicare beneficiaries to bring their prescriptions to Kmart pharmacies by offering them varying levels of discounts on the purchase of gasoline at participating gas stations based on the number of prescriptions that they filled at Kmart pharmacies.

 

The settlement resolves allegations in a lawsuit filed by Joshua Leighr, a former Kmart pharmacist, under the qui tam, or whistleblower provisions of the False Claims Act.  The act authorizes private parties, such as Mr. Leighr, to sue for fraud on behalf of the United States and to share in any recovery.  Mr. Leighr will receive approximately $248,500 of the settlement.   

 

Update on Trinity Industries

A Texas federal judge tripled a $175 million False Claims Act verdict against Trinity Industries Inc. on June 9 and assessed more than $138 million in penalties. This comes after a jury verdict in October finding that the company defrauded the U.S. government by selling it defective guardrails. U.S. District Judge Rodney Gilstrap entered final judgment of $663.4 million against Trinity, including a $199 million to whistleblower Joshua Harman. Since the U.S. did not participate in the trial and left the defense solely to the whistleblower, he was awarded the 30 percent commission along with more than $16 million in attorneys’ fees, $2.3 million in expenses and $177,830 in taxable costs, for a total award of $218 million. The government was awarded $464.4 million.

We’ve been perplexed by the government’s position from day one in this case. We pursued this case without any help from the government. In fact, we pursued this case in the face of the government’s hostility.

The judgment stems from an October verdict finding Trinity liable for changing the design of the guardrails without getting approval from the U.S. Federal Highway Administration (FHWA), then misrepresenting them as the earlier, approved version even though they were more dangerous. Harman filed his original False Claims Act (FCA) complaint in 2012, alleging that Trinity falsely claimed its modified ET-Plus guardrail was properly crash-tested.

Trinity contended that the government cannot be defrauded because it was fully aware of the facts at the time the representations in question were made. But Harman argued that Trinity intentionally withheld information about the modifications from the government. Trinity says the FHWA has confirmed that the ET-Plus is fully compliant with federal safety regulations, and has always been eligible for reimbursement under the federal aid highway program. It’s certain that, after post-judgement motions, Trinity will appeal to the Fifth Circuit.

Agents from the U.S. Department of Transportation Inspector General’s office and from the FBI’s Boston office have opened a criminal investigation into Trinity and its relationship with the FHWA, according to Bloomberg and ABC News. The original ET-Plus was designed to absorb and dissipate a collision’s impact by flattening the guardrail and pushing it out into a ribbon that is deflected away from the collision, reducing the impact force felt inside a crashing vehicle.

The FHWA approved that device in 2000. But Harman claimed the company changed that design sometime between 2002 and 2005 and that the new design locks up, folds over and protrudes into the crashing vehicle. He says Trinity never disclosed those changes to the FHWA, nor did it test the units according to FHWA protocols. The FHWA partially approved the guardrails after a 2005 crash test, but it’s unclear whether Trinity used the new ET-Plus for the test.

 

Whistleblower Saves Medicare Millions!

- Thanks to a brave whistleblower the Justice Department said Tuesday that it is stepping into a long-running lawsuit against one of the nation's largest nursing-home chains, accusing it of systematic Medicare overbilling and sometimes putting frail, dying patients through arduous rehab schedules just to increase revenue.

The department is taking control of a whistleblower lawsuit in U.S. District Court in Alexandria against Toledo, Ohio-based HCR ManorCare after a yearslong investigation. The initial accusations against the company were filed by a northern Virginia occupational therapist in 2009.

The lawsuit alleges that ManorCare routinely pressured administrators of its nursing homes, assisted living and rehab facilities to meet financial targets by billing for unnecessary care.

ManorCare, which also operates under the Heartland and Arden Courts brands, denied wrongdoing and said the dispute revolves around providing care that exceeds government expectations.

"The government bases its allegations on retrospective analyses performed by a few alleged experts who have never cared for, spoken with or even seen the patients in question. Instead, these alleged experts second-guess the hands-on clinical judgment of tens of thousands of experienced, licensed, caring and compassionate doctors, nurses and therapists who actually provided care to our patients," the company said in a statement issued Tuesday. It declined to comment further.

But Jeffrey Downey, attorney for the original whistleblower, occupational therapist Christine Ribik, said the government's investigation of ManorCare was exhaustive and "uncovered an astonishing amount of really bad facts."

The lawsuit alleges that ManorCare routinely pushed the vast majority of its patients into Medicare's highest tier of rehabilitation services, whether they needed it or not. That allowed the company to increase the amounts it billed.

For instance, in 2006, ManorCare billed Medicare at the top reimbursement rate for 39 percent of its patients. That number more than doubled to 80 percent by 2009, according to the lawsuit.

The lawsuit describes an 85-year-old patient at a ManorCare facility in Palm Harbor, Florida, whose medical records called for hospice care only, instead being put through 100 days of therapy even though a therapist described him as "medically fragile." He was put into hospice care only at the end of the 100 days, which marked the length of time that Medicare would cover his therapy treatments.

"We strive for a system whereby health care providers provide reasonable and necessary services without overbilling Medicare for unreasonable and unnecessary services," said Dana Boente, U.S. Attorney for the Eastern District of Virginia, where the case has been brought.

The lawsuit does not specify the amount that investigators believe Medicare was overbilled, but says Medicare paid more than $6 billion to ManorCare's 281 skilled nursing facilities from January 2006 to May 2012.

ManorCare operates skilled nursing facilities in 30 states. It was purchased in 2007 by The Carlyle Group for $6.3 billion.

The lawsuit was initially filed under the False Claims Act, which allows private citizens to bring lawsuits on behalf of the United States when they have knowledge that the government is being defrauded. The U.S. can then investigate and decide whether it wants to take over the case. Whistleblowers whose cases are taken over by the government are entitled to collect anywhere from to 15 to 25 percent of any money recovered. The percentage increases slightly if they win a case without the government's help.

Whistleblower Awards Nearing $50 Million

Washington D.C., March 2, 2015 — 
                    
The Securities and Exchange Commission today announced a whistleblower award payout between $475,000 and $575,000 to a former company officer who reported original, high-quality information about a securities fraud that resulted in an SEC enforcement action with sanctions exceeding $1 million.

Officers, directors, trustees, or partners who learn about a fraud through another employee reporting the misconduct generally aren’t eligible for an award under the SEC’s whistleblower program.  However, there is an exception to this exclusion that makes an officer eligible if he or she reports the information to the SEC more than 120 days after other responsible compliance personnel possessed the information and failed to adequately address the issue.  This is the first SEC whistleblower award to an officer under these circumstances. 

“Corporate officers have front-row seats overseeing the activities of their companies, and this particular officer should be commended for stepping up to report a securities law violation when it became apparent that the company’s internal compliance system was not functioning well enough to address it,” said Andrew Ceresney, Director of the SEC’s Division of Enforcement. 

The SEC has now awarded 15 whistleblowers since its whistleblower program began more than three years ago.  Payouts have totaled nearly $50 million out of an investor protection fund established by Congress.  The fund is financed entirely through monetary sanctions paid to the SEC by securities law violators, and no money is taken or withheld from harmed investors to pay whistleblower awards.

Whistleblower awards can range from 10 percent to 30 percent of the money collected in a case.  By law, the SEC protects the confidentiality of whistleblowers and does not disclose information that might directly or indirectly reveal a whistleblower’s identity.

“Receiving information and cooperation from company insiders is particularly useful in the early detection of securities fraud, and we will continue to leverage whistleblower information to help combat securities law violations and better protect investors and the marketplace,” said Sean McKessy, Chief of the SEC’s Office of the Whistleblower.  “Meanwhile, companies must have rigorous internal compliance programs that adequately address and remedy potential violations voiced by their employees as well as by their officers, directors, or other individuals.”

Whistleblower Case Reassigned Due To Judge Lynn Hughes Procrastination

 Houston federal judge who has been accused of unfairly stalling a federal whistle-blower lawsuit for years has been removed from the case by the 5th U.S. Circuit Court of Appeals for ignoring its instructions.

In a rare move, a three-judge panel determined that the case should be assigned to a jurist other than U.S. District Judge Lynn Hughes.

The appeals court concluded that Hughes would have "substantial difficulty in setting aside his previously-expressed views" and that "reassignment would be advisable to preserve the appearance of justice, given the long delays, repeated errors, and cursory reasoning in the district court's opinions to date."

The case was originally filed in 2006 in an Oklahoma federal court by two government auditors who accused Shell Exploration of fraud under the False Claims Act, which allows individuals to sue on behalf of the government. If successful, plaintiffs receive a bounty or a share of any money returned to federal coffers.

The workers, who were employed by the Minerals Management Service - an Interior Department agency - claimed that they discovered unauthorized deductions related to Shell's operation of offshore drilling platforms that bilked the United States out of at least $19 million in royalties from 2001 to 2005. (The government declined to join the lawsuit.)

The case was transferred to Houston in 2007 and landed on Hughes' docket.

In 2011, the district court granted summary judgment to Shell on the grounds that the False Claims Act prohibited the auditors from bringing the suit on the government's behalf as whistle-blowers and that the claim already had been revealed publicly.

The 5th Circuit reversed that decision in 2012 and remanded the case for a redetermination by Hughes.

Instead of complying with the court's order, Hughes granted Shell's 2013 request for a second summary judgment. In that opinion, the district court judge did not clarify why the original summary judgment was thrown out by the appeals court.

The plaintiffs again challenged the decision. This week, the 5th Circuit determined that Hughes should not preside over the case.

"We reverse the district court's judgment, remand this action, and direct the Chief Judge of the Southern District of Texas to reassign the case to a different district judge," 5th Circuit Judge W. Eugene Davis wrote for a panel of three jurists including Judges Jacques L. Wiener Jr. and Catharina Haynes.

The Feb. 23 opinion further stated that Hughes "disregarded" the higher court's mandate on remand and concluded that his treatment of the case "might reasonably cause an objective observer to question [the judge's] impartiality."

When reached in his chambers Friday, Hughes declined to comment.

Whistblower Being Wronged For Doing Right!

    
Thomas Drake became a symbol of the dangers whistleblowers

face when they help journalists and Congress investigate

wrongdoing at intelligence agencies. He claims he was subjected to

a decade of retaliation by the National Security Agency that

culminated in his being charged with espionage.

But when the Pentagon Inspector General’s Office opened an

inquiry into the former senior NSA official’s allegations of

retaliation in 2012, it looked at only two of the 10 years detailed in

his account, according to a recently released Pentagon summary of

the probe, before finding no evidence of retaliation. That finding

ended Drake’s four-year effort to return to government service.

Whistleblower advocates say Drake’s experience, spelled out in a

document McClatchy obtained this month through the Freedom of I

information Act, underscores the problem that intelligence and

defense workers face in bringing malfeasance to the surface. The

agencies that are supposed to crack down on retaliation are not up

to the task, especially when the alleged wrongdoing involves

classified information, they charge.

“This report epitomizes the utter lack of protection for national

security whistleblowers,” said Jesselyn Radack, Drake’s attorney.

“This is a pathetic, anemic excuse for an investigation.”

Although investigators appear to have rejected Drake’s claims

almost a year ago, the Pentagon Inspector General’s Office did not

publicly disclose its findings and hadn’t shared them even with

Drake’s attorneys. McClatchy gave the attorneys a copy of the

report.


The news of the rejection comes as McClatchy has learned that the

same officials who are supposed to be helping whistleblowers such

as Drake claim that they themselves have been forced to blow the

whistle on their own office.

Multiple former and current officials from the Pentagon Inspector

General’s Office have alleged to the Office of Special Counsel, the

independent government agency that investigates whistleblower

claims, that they’ve been retaliated against for objecting to how

cases are handled. Drake’s case is one of several singled out for

criticism.
  “It illustrates the bleak landscape faced by whistleblowers and IG  investigators,” said one of the several people who described the  accusations but asked to remain anonymous because of the  sensitivity of the matter. “The numerous allegations of reprisal and  misconduct directed against senior IG officials call into question  the efficacy of the whistleblower mission. If true, one can make the  case that the office of inspector general has failed.”

Read more here: http://www.charlotteobserver.com/2015/02/23/5534356/rejection-of-nsa-whistleblowers.html#storylink=cpy

Whistleblower Advocate Attorney General Eric Holder



U.S. Attorney General Eric Holder on Wednesday called for Congress to take steps to help prosecutors build criminal cases against senior Wall Street executives, saying companies often insulated their leaders from responsibility for misconduct.

Holder made some of his most extensive comments yet on improving the prosecution of white-collar crime. He called on Congress to boost rewards for Wall Street whistleblowers and fund more FBI agents with forensic accounting expertise.

It has reached multibillion-dollar settlements with institutions including JPMorgan Chase & Co, Bank of America Corp and Citigroup Inc, for misrepresenting risks of shoddy mortgage bonds sold before the crisis. But no individuals have faced related charges.

"When it comes to financial fraud, the department recognizes the value of bringing enforcement actions against individuals, as opposed to simply the companies that employ them," Holder said. But he said prosecutors could not always prove that operations knew about a particular scheme. He said blurred lines of authority often make it hard to name the person responsible for individual business decisions.

Holder suggested lawmakers consider a rule in the Sarbanes-Oxley Act of 2002 that requires a single executive to sign accounting forms and bear liability for misrepresentations, and examine whether it could be applied to other areas of corporate wrongdoing.

"We need not tolerate a system that permits top executives to enjoy all of the rewards of excessively risky activity while bearing none of the responsibility," he said, before an audience that included Manhattan U.S. Attorney Preet Bharara and U.S. District Judge Jed Rakoff.

COOPERATORS

Also on Wednesday, another top Justice Department official said prosecutors have put individuals at the center of probes into corporate misconduct.

"If you want full cooperation credit, make your extensive efforts to secure evidence of individual culpability the first thing you talk about when you walk in the door to make your presentation," Marshall Miller, the No. 2 official in the Criminal Division told an audience of lawyers who conduct corporate investigations
.
Reuters reported last week that prosecutors in cases of foreign bribery and other white-collar crimes have used more investigative tools such as body wires and search warrants and also improved relationships with counterparts overseas to build stronger cases against individuals.
Since the financial crisis, prosecutors have stepped up efforts to pursue bankers, traders and others in finance for other types of fraud including insider trading and manipulation of interest rate benchmarks and foreign exchange rates.

Holder confirmed that the department had obtained undercover cooperators as part of its probe into the manipulation of foreign exchange rates, and expected to bring charges against individuals in financial fraud cases in the "coming months."

But the law caps rewards for potential whistleblowers in cases that do not involve fraud against government programs and hurts the ability of prosecutors to get Wall Street executives to cooperate, Holder said in his speech. "We should seek to better equip investigators to obtain this often elusive evidence," Holder said.

In one recent case in which a federal judge ordered Bank of America to pay $1.27 billion for fraud at its Countrywide unit, a whistleblower who served as the government's star witness is entitled to $1.6 million. Holder described that amount as a "paltry sum" for an industry in which the collective bonus pool stood above $26 billion last year and median executive pay was $15 million.

In addition to cooperators, Holder said prosecuting white-collar crime also requires FBI agents sophisticated enough to know what questions to ask and what to look for when those witnesses do come forward. He called on Congress to consider more resources for the FBI to sustain efforts to investigate financial crime.

Whistleblower Special Meeting for Your Rights!

 

BREAKING NEWS

 

Whistleblower Special Meeting

Tomorrow, Tuesday September 9^th at 2:00 pm ET, the House Oversight Government Reform Committee’s Federal Workforce, US Postal Service and Census Subcommittee will  hold the following hearing, “Examining the Administration’s Treatment of Whistleblowers”. It will explore whistleblower retaliation since passage of the Whistleblower Protection Enhancement Act.

 

 

Witnesses have not yet been publicly announced, but GAP legal director Tom Devine, Federal Air Marshal whistleblower Robert MacLean, and VA whistleblower Dr. Van Boven will be testifying, among others.

 

The hearing is open to the public and will be held at 2154 Rayburn House Office Building.

 



 

Whistleblower Settlements Summary 2014

There were a number of settlements and verdicts around the country in whistleblower cases in August. This is an area of litigation that is expanding rapidly.



COMMUNITY HEALTH SYSTEMS TO PAY $98 MILLION IN SETTLEMENT

The nation’s largest operator of acute care hospitals, Community Health Systems, Inc., has agreed to pay $98 million to settle claims that the company billed government health care programs for inpatient services that should have been billed as significantly less expensive outpatient or observation services. CHS was said to have engaged in a corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and TRICARE beneficiaries older than 65. The government further claimed that the inpatient admissions were not medically necessary and should have been provided in a less costly outpatient or observation setting.

The settlement resolves lawsuits filed by several whistleblowers under the qui tam provisions of the False Claims Act. Since January 2009, the Justice Department has recovered more than $20.2 billion through False Claims Act cases.


MCKESSON TO PAY $18 MILLION TO END CDC DRUG SHIPMENT CLAIMS

Pharmaceutical distributor McKesson Corp. will pay $18 million to settle whistleblower claims that it improperly set temperature monitors outside contractual limits when shipping vaccines for the Centers for Disease Control and Prevention . The U.S. Department of Justice announced the settlement on August 8. San Francisco-based McKesson signed a contract with the CDC in 2007 requiring it to set electronic devices in shipping containers to detect whether temperatures strayed outside a slim range just above freezing. The False Claims Act suit, filed by a former financial director, alleged the company instead set the monitors for a much wider range that would have allowed vaccines to freeze or reach room temperature without alerting personnel.

The CDC said the monitors were a backup system and that the vaccines were properly packed in insulated containers and transported at the right temperatures. McKesson maintained that the temperature monitors complied with the contract. The relator in the lawsuit, Terrell Fox, alleged that from April to November, McKesson shipped vaccines from manufacturers to health care providers and set monitors to go off only if the vaccines were colder than -1 degree Celsius and warmer than 25 degrees.
It was alleged that the vaccines were supposed to stay refrigerated and never freeze and that the correct range should have been from 2 to 8 degrees Celsius. Fox said that McKesson violated the contract and knowingly submitted false claims in an attempt to avoid liability for replacing potentially ruined vaccines. The vaccines shipped by McKesson were intended for children. 

VASCULAR SOLUTIONS SETTLES FALSE CLAIMS ACT CASE

Vascular Solutions (VSI) will pay $520,000 to resolve allegations that it caused false claims to be submitted to federal health programs by marketing a medical device for the ablation (or sealing) of perforator veins without U.S. Food and Drug Administration (FDA) approval and despite the failure of its own clinical trial. VSI, a medical device company based in Minneapolis, Minn., markets and sells medical devices that treat varicose veins by sealing the veins with laser energy – endovenous laser ablation. Their products include consoles, which generate the laser energy, and accessory kits.
In 2010, DeSalle Bui, a former Vascular Solutions salesperson, sued the company. The U.S. Attorney’s Office in Texas subsequently intervened in the case. The lawsuit accused VSI of “off-label promotion” of its Vari-Lase products, saying the company marketed the product for the treatment of perforator veins despite the fact that it wasn’t approved for such uses. The lawsuit alleged that the improper promotion of the product, as well as kickbacks that VSI paid to physicians, caused the government to lose roughly $20 million, as health care providers submitted claims to government programs such as Medicare.


JURY AWARDS $730,000 IN WHISTLEBLOWER LAWSUIT

A jury has returned a $730,000 verdict in favor of a whistleblower who reported on an unethical pain management study on prison inmates by researchers at the University of California, Davis. Janet Keyzer, a former UC Davis administrative nurse, claimed in a lawsuit that her career was ruined when she raised questions about whether the research project on physically and mentally disabled inmates at San Quentin Prison had obtained consent from its subjects. The Superior Court jury’s verdict was in favor of the 59-year-old Keyzer. She had worked for the university’s Center for Healthcare Policy and Research for more than nine years at the time of her termination in 2007.

Whistleblower-Rules To Live By

 

WARNING: If you believe your employer or individuals at your work place are committing federal fraud, DO NOT communicate with us from your company e-mail, computers, fax, phone or any communication device.

If you have information about fraud taking place in your workplace, we can help you resolve the problem without risking your job, your health, or your family. There may also be a substantial cash reward for reporting the fraud, sometimes in the millions of dollars. But we can’t help you if you get fired for calling us or emailing us from your workplace.

Because we cannot guarantee that your employer is not monitoring your communications, we recommend contacting us from your home telephone or computer. We can help you if you are worried about what will happen because you did the right thing and reported potential fraud, but there is no need to take unnecessary risks.

So please, be safe and use your home computer or telephone to talk with us. We’re here to help.

Who Is Jim VanderLinden? What Does He Stand For?

Jim VanderLinden featured on Minnesota Public Radio

 

The problem of Medicaid fraud has been in the news a lot lately in Minnesota. These small victories have only scratched the surface, as many cases of large-scale Medicaid fraud have – as of yet – continued without consequence. Minnesota Public Radio’s Mark Olson recently interviewed our own Jim VanderLinden for a report on the fight against Medicaid fraud.

St. Louis Park attorney James Vander Linden represents whistleblowers, company insiders filing claims for money recovered from employers suspected of stealing funds. He has spent years trying to recover Medicaid and Medicare dollars, and he doesn’t think the government has enough muscle to go after the big time health care fraud perpetrators.

“The real problem,” he says, “is corporate America.”

A team of lawyers including James G. VanderLinden, seated, and Robert P. Christensen, Brian Wojtalewicz and Neil P. Thompson took on Big Pharma and won. (Staff photo: Bill Klotz)

Once again, a team of Minnesota lawyers has taken on Big Pharma and won.
Neil P. Thompson, Robert P. Christensen, Brian Wojtalewicz and James G. VanderLinden recently settled a qui tam case against the pharmacy chain CVS for $17.5 million.  The whistleblower/relator, pharmacist Stephani LeFlore of Minnesota, alleged that CVS designed a billing software program that consistently overcharged Medicaid for prescription drugs.
LeFlore and her attorneys will receive $2,595,460 under the state and federal False Claims Acts, and are also entitled to receive attorney fees from CVS.  The reward is 16 percent of the settlement, a little bit more than the national average of 15.6 percent.  The amount of the attorney fee is still under negotiation.
The four lawyers also sued Walgreens in 2005 for using a billing system that cheated Medicaid. That case settled in 2008 for $9.9 million with the whistleblowers – Thompson, who is a pharmacist as well as a lawyer, and another man – receiving $1.44 million plus fees.
In the CVS case, the fraud arose in connection with customers who were on Medicaid and also had private health insurance coverage.  In the 10 states involved in the lawsuit – California, Massachusetts, Michigan, Minnesota, Florida, Indiana, Alabama, Nevada, New Hampshire and Rhode Island – CVS was supposed to charge the insurance companies a certain amount for prescriptions, with a limited co-pay charged to the customers. This limited co-pay was assigned to Medicaid.
But LeFlore, who is a pharmacist at CVS, alleged that CVS consistently overcharged Medicaid for the co-pays. She claimed that overcharges occurred on hundreds of thousands of prescription sales for over five years. To support her claims, she first gathered data from CVS’s computers, Christensen said.
LeFlore was told by her attorneys to look to see how much CVS had billed Medicaid, and then contact the state and the insurance companies to see how much CVS was entitled to.
Because the same attorneys had handled the Walgreens case, it was easier to know what to look for, Thompson said.
“She … had a tip as to what to look for, because of the previous cases,” he noted.
Once LeFlore had collected the information, she and her attorneys could run the numbers and see a pattern, Wojtalewicz said.
Before filing their case, LeFlore’s attorneys wanted to make sure they were bringing good information to the table.

“We wanted to have some of the juice before we got to the government to build up our credibility, to prove our case,” Christensen said. “Not only do we have to sell it to ourselves, we have to sell it to the government lawyers and then it has to get sold to the defendant.”
Typically, a relator files a complaint under seal. This allows the government, if it decides to intervene, to investigate though its own channels before informing the object of the investigation.  If the investigation reveals a basis for going forward, a judge partially lifts the seal and advises the defendant of the case. Then the parties may negotiate a settlement, keeping in mind that the law allows for treble damages and a penalty of $5,500 to $11,000 for each claim falsely filed, VanderLinden said.
As the case develops, the relator’s attorneys may find themselves in conflict with the government over their share.
“We often end up negotiating with the government,” Wojtalewicz said.
He said that many private lawyers who work with qui tam cases become frustrated because the federal attorneys are “smothered” in False Claim Act matters.  “We think they cherry-pick.  They take the biggest and most easily proven, and you can’t blame them.”
In this case, the government almost backed away because they didn’t think there were enough damages to make it worth pursing. But LeFlore’s lawyers persisted and the government eventually came around.
Qui tam cases are frustrating for the relator, noted Thompson, because he or she is generally still employed by the defendant.
“One of the important take-aways for lawyers … is to emphasize that the whistleblower should get advice early before he or she reports inside the company,” Wojtalewicz said.  Otherwise, “you’re painting a big target on your back.”
Venue is an important issue in qui tam cases. In the LeFlore case, one of the first strategic decisions the team made was to sue in federal court in Wisconsin, which is in the Seventh Circuit. “Eighth Circuit opinions on false claims really are oriented to the corporations, not the whistleblower,” Wojtalewicz explained.

Whistleblowers-Doing The Right Thing and Being Rewarded!



The U.S. Department of Justice announced settlements with several healthcare companies accused of fraud — including a massive $150 million deal with Amedisys Inc. in which the government resolved seven lawsuits with the giant homecare provider, leading to more than $26 million in payouts to whistleblowers and a jackpot for U.S. taxpayers.

The largest whistleblower reward, more than $15 million, went to April Brown, an Alabama nurse and single mother who was fired by Amedisys after she questioned its Medicare billing practices.
The False Claims Act penalizes fraud against the U.S. government, including programs such as Medicare. Its qui tam provision allows whistleblowers to sue on behalf of the government, and to get up to 30% of recovered funds as a reward.

• In the Amedisys cases, the Justice Department was able to prove the homecare company had misrepresented patients’ conditions in order to inflate Medicare payments — and also had violated the law by paying doctors for referring business to Amedisys. The company denied wrongdoing. Ms.Brown filed the original FCA complaint against Amedisys in 2012, and was followed by six other whistleblowers with similar qui tam claims, who will split about $11 million between them.
• In another case a Florida healthcare provider agreed to pay taxpayers $2.5 million to settle claims that two neurologists in its network misdiagnosed patients with various neurological disorders, including multiple sclerosis, causing Baptist Health to bill government insurance programs for medically unnecessary services. The FCA lawsuit was filed originally by Verchetta Wells, a former Baptist Health employee who will receive $424,155 for her role as a whistleblower in the case, according to the Justice Department.
• In U.S. ex rel. Simmons v. Health Management Associates, Inc., an Oklahoma hospital group agreed to pay more than $1.4 million to settle charges that, among other things, it billed the state’s Medicaid program for unnecessary surgical procedures performed on children — and for other procedures that were never performed. The FCA case was filed originally by Sandra Simmons, a former manager for the group who was fired after raising concerns about the practices; she will receive $159,750 for acting as a whistleblower, the Justice Department said.

Ranbaxy Pays $2.3 Million To Settle Unsafe Medication Lawsuit!



The Oregon Department of Justice has also settled a case with Ranbaxy Laboratories Ltd. and two affiliated American companies. Pursuant to the settlement, $2.3 million will be paid to the state. It was discovered that Ranbaxy sold generic prescription drugs in Oregon that were not safe for consumers. A whistleblower case in federal court revealed that the company had been shipping substandard generic drugs to the United States, some of which were distributed in Oregon. While that case settled for $500 million, the money allocated to Oregon’s Medicaid program did not cover the full cost of drugs purchased from Ranbaxy.


The Ranbaxy-manufactured drugs in question include amoxicillin, a widely prescribed antibiotic; clavulanate potassium, used in combination with antibiotics to treat drug-resistant bacteria; and sotret, an acne medication. Medications manufactured by Ranbaxy have been subject to safety concerns outside of Oregon.

LB & B claims to be minority owned to qualify for grant money!

Funny what some people will do for money isn't it.

This information taken directly from the LB & B Website

Success
            Our success is a combination of customer satisfaction, employee satisfaction, high productivity and efficient operations.

 Ethics and Integrity
            Our integrity and ethics will never be compromised. Each and every employee must be challenged, recognized and involved.

It's amazing the lengths people will go to get free money. This company thought it would be a good idea to claim that it was owned by someone who was socially and economically disadvantaged in order to qualify for a Section 8(a) program. They also used this status to qualify for SBA's Mentor Protégé program. They were eventually brought to justice on both counts. The first was headed by former employees and the latter was prosecuted by the Federal government.

The question I have is how many other free money sources did they oust before people caught on to what they were doing and also how many other fraudulent companies are adhering to the same type of false funding options. This is very frustrating to the common person who not only supports and donates to these false causes, but also to the other legitimate company's that lost out on financial assistance.

How do you feel about this company? Do you know of any such false organizations? If so please contact our office today. James Vander Linden  (612) 339-6841,or email   jim@vanderlindenlaw.com.