Whistleblower

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 founder of fund manager TFS Capital, said he’s planning to apply for a whistleblower reward after the agency announces its penalty against Credit Suisse.

Credit Suisse may have to pay more than $50 million in fines and disgorgement to the SEC and another $30 million to the New York attorney general over allegations the company misrepresented itself. 

The SEC can award whistleblowers between 10% and 30% of a fine, meaning he could potentially receive a $15 million payday. The dark pool whistleblower said he will submit a claim, provided the SEC suit turns out to be along the lines of the complaints he made.

Dark pools, where supply and demand is kept private and only details of executed trades are made public, make up around one-fifth of trading in the $23 trillion U.S. stock market. Credit Suisse’s Crossfinder platform is the largest alternative trading system in the U.S.

Healthy Markets published a report on September 15, 2015 that concluded, "Dark pools play an important role in our markets. Unfortunately, recent regulatory actions against dark pool operatorshavedemonstratedthatinvestors are justifiedintheir longstanding fears over dark pools’ lack of transparency. Investors and their brokers must revise theirown practices and expectations to better protect themselves from dark pool abuses. By demanding more transparency and lesser conflicts of interest, investors and theirbrokersmayhelpensure dark pools continue to play a constructive role in US capital markets in the years to come."

On September 17, 2015, the 4th U.S. Circuit Court of Appeals issued a decision reviving cases that were originally filed in September of 2011 and then a second filed in January 2013 by a former employee of Norfolk Southern Railway Company (NS).  

In the first lawsuit, the whistleblower claimed that NS suspended him due to his race.  After the district court sided in favor of NS, he filed a second lawsuit. This complaint alleged that NS suspended him for reporting rail safety offenses, in violation of the whistleblower protection provision of the Federal Railroad Safety Act (FRSA). The district court again granted summary judgment in favor of NS, asserting that the whistleblower's second lawsuit was barred by the FRSA's “Election of Remedies” provision, which provides that “[a]n employee may not seek protection under both this section and another provision of law for the same allegedly unlawful act of the railroad carrier.” 49 U.S.C. § 20109(f).

In July 2011, NS suspended the whistleblowing employee without pay for six months. Neither party agreed to the factual basis of the suspension. NS claims it suspended the employee because he drank a beer on duty and then operated a company-owned automobile in violation of company policy. The plaintiff, who is African–American, claims the suspension was motivated both by his race and in retaliation for federal rail safety whistleblowing. 

Less than two months after filing his first lawsuit, Lee filed a complaint with the Occupational Safety and Health Administration (OSHA) under the FRSA's whistleblower provision, 49 U.S.C. § 20109. That provision prohibits railroad carriers from, among other things, discriminating against employees who “refuse to violate or assist in the violation of any Federal law, rule, or regulation relating to railroad safety or security.” Id. § 20109(a)(2). According to Lee, federal law required him to identify—or “bad order”—defective rail cars for repair. NS capped the number of cars he could tag with such orders, however, effectively requiring him to violate federal law. When he refused to comply with the caps, Lee alleges that NS suspended him in July 2011.

First, the district court concluded that, to the extent Lee's claims were based on the collective bargaining agreement, they were preempted by the Railway Labor Act (RLA), 45 U.S.C. § 151 et seq., which requires arbitration of such claims. The court further concluded that NS was not vicariously liable for the individual instances of racial harassment by Lee's co-workers.

Less than a month after the district court granted NS summary judgment in the first lawsuit, Lee filed his FRSA retaliation lawsuit. The allegations in this second lawsuit largely track those in Lee's OSHA complaint. Lee again alleged that he was tasked with tagging defective train cars with “bad orders,” but that NS capped the number of cars he could tag. In doing so, Lee contends NS pressured him to “violate federal rail safety regulations and laws and violate NS's own safety and mechanical department rules.” 

On May 20, 2014, the district court granted summary judgment to NS on Lee's FRSA claims, concluding that Lee's first lawsuit for racial discrimination under Section 1981 constituted an election of remedies under FRSA Section 20109(f) that barred Lee's subsequent FRSA retaliation action. Lee then timely noted this appeal.

A former city employee who claimed she was fired for acting as a whistleblower on official misconduct filed a complaint in April 2011.  Her specific accusations were that the city was in violation of New Jersey's Conscientious Employee Protection Act when it fired her for whistleblowing during her employment. The details of the settlement were not disclosed.

Between 1995 until her dismissal in 2011, the whistleblower served as the city's principal personnel clerk. She was barred from asserting several pieces of evidence if the case went to trial. The barred evidence included her claim the city fired her for cooperating with FBI agents conducting an investigation in 2005 during Operation Bid Rig.

Operation Bid Rig was the state's largest federal corruption sting, targeting dozens of politicians and officials in Monmouth and Ocean counties and elsewhere in the state.

A settlement has been reached in a whistleblower class action lawsuit brought against North Broward Hospital District who is accused of engaging in improper financial relationships with referring physicians.

The whistleblower will receive $12,045,655.51 from the recovery. 

The whistleblower case, filed in 2010, alleged that the hospital district provided compensation to nine employed physicians that exceeded the fair market value of their services.  The United States contended that these agreements violated the Stark Statute and the False Claims Act.  The Stark Statute restricts the financial relationships that hospitals may have with doctors who refer patients to them.

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 a whistleblower class action lawsuit brought against APL Limited who is accused of overcharging and double-billing the Department of Defense. The whistleblower will receive a $5.2 million share of the government's recovery.

The whistleblower case, filed in October 2004, alleged that APL, a wholly-owned American subsidiary of Singapore-based Neptune Orient Lines Limited, knowingly overcharged and double-billed the Department of Defense to transport thousands of containers from ports to inland delivery destinations in Iraq and Afghanistan by inflating its invoices in several ways. For example, APL billed in excess of the rate it paid to plug refrigerated containers holding perishable cargo into a source of electricity at a port in Karachi, Pakistan; billed in excess of the contractual rate to maintain the operation of refrigerated containers at a port in Karachi and at U.S. military bases in Afghanistan; and billed for various non-reimbursable services performed by APL’s subcontractor at a Kuwaiti port.

A settlement has been reached in a whistleblower class action lawsuit brought against The University of Medicine and Dentistry of New Jersey (UMDNJ) who is accused of defrauding Medicaid by submitting duplicate claims for payment.

The whistleblower will receive a $801,000 share of the total federal recovery.

The whistleblwoer case, filed in July 2004, alleged that From 1993 to 2004, UMDNJ’s University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers. By submitting duplicate claims for payment, University Hospital effectively doubled billed the government’s Medicaid program.

A settlement has been reached in a whistleblower class action lawsuit brought against PAE Government Services Inc (PAE) and RM Asia (HK) Limited (RM Asia). They are accused of violating the False Claims Act by taking part in a bid-rigging scheme that resulted in false claims for payment under a U.S. Army contract for services in Afghanistan.

The whislteblower will receive a $261,000 share of the government's recovery.

The whistleblower case, filed in 2011, alleged that former managers of PAE and RM Asia funneled subcontracts paid for by the government to companies owned by the former managers and their relatives by using confidential bid information to ensure that their companies would beat out other, honest competitors.   

In a related criminal investigation, the U.S. Attorney’s Office of the Eastern District of Virginia previously obtained guilty pleas from former PAE program manager Keith Johnson; Johnson’s wife, Angela Gregory Johnson; and RM Asia’s former project manager, John Eisner, and deputy project manager, Jerry Kieffer, for their roles in the scheme.

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. 

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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