Health

A settlement has been reached in whistleblower class action lawsuits brought against Adventist Health System who is acccused of maintaining improper compensation arrangements with referring physicians and by miscoding claims.

The whistleblowers’ share of the settlement has not yet been determined. 

The allegations arose from two lawsuits, the first of which was filed in December 2012 and claimed that Adventist submitted false claims to the Medicare and Medicaid programs for services rendered to patients referred by employed physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals to Adventist hospitals.  Additionally, the settlement resolves allegations that Adventist submitted bills to Medicare for its employed physicians’ professional services containing certain improper coding modifiers, and thereby obtained greater reimbursement for these services than entitled.

The United States has intervened in a lawsuit and filed a complaint against H. Ted Cain, Julie Cain, Corporate Management Inc, and Stone County Hospital Inc for submitting false claims to the Medicare program by knowingly charging excessive and ineligible expenses from 2002 to the present.  

The government’s complaint alleges that the Cains as well as the hospital and the management company abused the special Medicare rules for rural hospitals.  In particular, the government contends that they claimed to be serving the hospital in various management and directorship positions but in fact did little of the work for which the hospital paid them and any work they did duplicated work performed by the hospital and the management company staff, which were also paid by the hospital.  The government also contends that Ted Cain improperly claimed the expenses for his personal luxury automobiles on the hospital’s cost reports and his management company wrongfully charged to the hospital work that he did at his other businesses.

A settlement has been reached in a whistleblower class action lawsuit brought against Planned Parenthood Gulf Coast who is accused of getting paid by government programs for items and services were either not medically necessary, not medically indicated or not actually provided.  

Of the $4.3 million settlement, the federal government will receive $3,594,604 and the State of Texas will receive $705,396. The whistleblower will receive $1,247,000.

The whistleblower lawsuit, originally filed in July 2009, alleged that between 2003 and 2009, Planned Parenthood Gulf Coast billed and was paid by government programs, Texas Medicaid, Title XX, and the Women’s Health Program, for certain items and services related to birth control counseling, STD testing and contraceptives when such items and services were either not medically necessary, not medically indicated or not actually provided.  Title XX is funded by the federal government while Texas Medicaid and the Women’s Health Program are funded jointly by the federal government and the State of Texas.

A settlement has been reached in two whistleblower class action lawsuits brought against Kos Pharmaceuticals, a subsidiary of Abbott Laboratories, who is accused of paying illegal kickbacks to doctors, other medical professionals, physician groups and managed care organizations to get them to prescribe or recommend Niaspan and Advicor.

According to the agreement reached with the government, the Delaware-based company will pay more than $38 million to settle civil allegations under the False Claims Act and a $3.36 million criminal fine. The federal share of the civil settlement is $33,705,310 and the state Medicaid share is $4,454,432.The whistleblowers will receive payments totaling more than $6.4 million from the federal share of the civil recovery. 

The first of the two cases was filed in March 2004 and alleged that between January 2002 and June 2006, two doctors proposed that they would endorse the use of Kos products, including Advicor, for the treatment of cholesterol in exchange for a series of payments. During that time, one of the doctors wrote 4,130 prescriptions for Kos products. According to the court documents, some of those prescriptions were paid for by Medicare and Medicaid. From 2002 to 2004, Kos made a series of payments to the two doctors or a third party intermediary in the form of “sponsorship” of continuing medical education classes conducted by the doctors and purported speakers’ fees. 

If you have a similar case please fill out the form below or email mail@whistleonfraud.com or call: 619 - 866 – 6157

OR

If you or someone you know experienced a similar situation or any other wrongdoing within a corporation you should contact mail@whistleonfraud.com or call: 619 - 866 – 6157

A settlement has been reached in a whistleblower class action lawsuit brought against GE Healthcare Inc regarding a company it acquired in 2004, Amersham Health Inc.  Amersham is accused of causing Medicare to make overpayments by providing false or misleading information.

The whistleblower will receive $5.1 million from the government’s recovery.

The whistleblower lawsuit, filed in 2006, alleged that Amersham Health provided false or misleading information to Medicare regarding the number of doses available from vials, causing Medicare to pay for Myoview at artificially inflated rates. Myoview is distributed in multi-dose vials of powder. In a process known as reconstitution, nuclear pharmacies mix the powder with a radioactive agent to prepare individual doses that are injected into patients as part of the cardiac imaging procedures. Certain Medicare payment rates for Myoview were based, in part, on the number of doses available from vials of Myoview.

A settlement has been reached in a criminal lawsuit brought against Maxim Healthcare Services Inc who is accused of defrauding Medicaid programs and the Veterans Affairs program of more than $61 million. 

The settlement requires payment of approximately $130 million to Medicaid programs and the Veterans Affairs program to resolve False Claims Act liability for false home healthcare billings to Medicaid programs and the Veterans Administration under civil agreements relating to this matter. Maxim has agreed to pay a criminal penalty of $20 million. 

The settlement resolves allegations that Maxim billed for services that were not rendered, services that were not properly documented, and services performed by 13 unlicensed offices. Maxim has agreed to pay approximately $70 million to the federal government and approximately $60 million to 42 states.

The whistleblower will receive approximately $15.4 million as his share of the recoveries from the federal government and the states.

The criminal complaint, filed in September 2011, accuses Maxim, a privately-held company based in Columbia, Md., with hundreds of offices throughout the United States, of submitting more than $61 million in fraudulent billings to government health care programs for services not rendered or otherwise not reimbursable. The investigation revealed that the submission of false bills to government health care programs was a common practice at Maxim from 2003 through 2009. During that time period, Maxim received more than $2 billion in reimbursements from government health care programs in 43 states based on billings submitted by Maxim.

If you have a similar case please fill out the form below or email mail@whistleonfraud.com or call: 619 - 866 – 6157

OR

If you or someone you know experienced a similar situation or any other wrongdoing within a corporation you should contact mail@whistleonfraud.com or call: 619 - 866 – 6157

A settlement has been reached in relation to two whistleblower class action lawsuits brought against Columbus Regional Healthcare System (Columbus Regional) and Dr. Andrew Pippas.  They are accused of submitting claims in violation of the Stark Law and submitting claims for payment to federal health care programs that misrepresented the level of services they provided. 

Under the settlement agreement, of the $25.425 million that Columbus Regional and Pippas have agreed to pay to resolve their respective civil claims, they will pay $24,666,040 to the federal government for federal healthcare program losses and $758,960 to the state of Georgia for the state share of its Medicaid losses, plus additional contingent payments not to exceed $10 million, for a maximum settlement amount of $35 million.The whistleblower's recovery amount was not disclosed.

The first of the two lawsuits was filed in May 2012.  The lawsuits alleged that that from May 2006 through May 2013, Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation, and between 2010 and 2012, they submitted claims to federal health care programs for radiation therapy at higher levels than the therapy that was provided.

A settlement has been reached in a whistleblower class action lawsuit brought against Tennessee Orthopaedic Clinics PC and Appalachian Orthopaedic Clinics PC. They are accused of knowingly billing state and federal health care programs for reimported osteoarthritis medications, known as viscosupplements.

Tennessee Orthopaedic Clinics PC will pay $1.3 million, and Appalachian Orthopaedic Clinics PC will pay $550,000. The whistleblower will receive a $323,750 share of the recovery.

The case, filed in February 2012, alleged that the clinics knowingly purchased deeply discounted viscosupplements that were reimported from foreign countries and billed them to state and federal health care programs in order to profit from the reimbursement system, when such reimported viscosupplements were not reimbursable by those programs.  Allegedly, the reimported product included labeling in foreign languages and in English for additional uses not approved in the United States, which demonstrated that the product was reimported.  Moreover, because the product was reimported, the government alleged there was no manufacturer assurance that it had not been tampered with or that it was stored appropriately.   

A settlement has been reached in a whistleblower class action lawsuit brought against Baptist Health, which owns four Jacksonville hospitals, Memorial Hospital, Specialty Hospital, Lake City Medical Center, Orange Park Medical Center, University of Florida Health Jacksonville, and Century Ambulance Service Inc. 

The whistleblower will receive a $1.2 million share of the recovery.

According to the settlement terms, Baptist Health will pay $2.89 million; Memorial Hospital, Specialty Hospital, Lake City Medical Center and Orange Park Medical Center will pay a combined $2.37 million; University of Florida Health Jacksonville will pay $1 million; and Century will pay $1.25 million.

The case, filed in 2011, alleged that the hospitals routinely ordered ambulance transfers via Century that were medically suspect, costing Medicare, Medicaid, Tricare and the Federal Employees Health Benefits Program millions in unnecessary billings. Additionally, the complaint claimed that the hospitals routinely ordered life support ambulance transfers that were medically unnecessary. In association with this alleged healthcare fraud, Century was accused of knowingly up-coding claims from basic to advanced life support. Century was also accused of transporting patients unnecessarily and needlessly driving patients to their own homes as if it were an emergency.

A settlement has been reached in a whistleblower class action lawsuit brought against Jackson-Madison County General Hospital who is accused of overbilling Medicare and Medicaid for certain cardiac procedures.

The whistleblower's portion of the settlement was not disclosed.

The lawsuit, filed in 2007, alleged that Jackson-Madison County General Hospital placed cardiac stents in patients when the procedure was not required, together with other cardiac procedures that were deemed not medically necessary. The hospital, according to allegations stemming from an investigation and a whistleblower healthcare fraud lawsuit, then billed Medicare and Medicaid.