Social Issues

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 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.

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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.

A settlement has been reached in a whistleblower class action lawsuit brought against Pediatric Services of America Healthcare, Pediatric Services of America, Inc., Pediatric Healthcare, Inc., Pediatric Home Nursing Services (collectively, “PSA”), and Portfolio Logic, LLC. They are accused of failing to disclose and return overpayments that it received from federal health care programs and submitting false claims to federal health care programs.

The whistleblowers will receive a $1,121,729 share of the recovery.

The case, filed in 2011, alleged that PSA knowingly (1) failed to disclose and return overpayments that it received from federal health care programs such as Medicare and Medicaid, (2) submitted claims under the Georgia Pediatric Program for home nursing care without documenting the requisite monthly supervisory visits by a registered nurse, and (3) submitted claims to federal health care programs that overstated the length of time their staff had provided services, which resulted in PSA being overpaid.

A settlement has been reached in a whistleblower class action lawsuit brought against Abbott Laboratories Inc., B. Braun Medical Inc. and Roxane Laboratories Inc. n/k/a Boehringer Ingelheim Roxane Inc. They are accused of that engaging in a scheme to report false and inflated prices for numerous pharmaceutical products.

The whistleblowers will receive approximately $88.4 million.

This whistleblower case stemmed from numerous cases filed against these pharmaceutical companies, one case goes all the way back to 1997.  The United States allged that Abbott, Roxane and Braun created artificially inflated spreads to market, promote and sell the drugs to existing and potential customers.  Because payment from the Medicare and Medicaid programs was based on the false inflated prices, the government alleged that the defendants caused false claims to be submitted to federal healthcare programs, and as a result, the government paid millions of claims for far greater amounts than it would have if Abbott, B. Braun and Roxane had reported truthful prices. 

The difference between the resulting inflated government payments and the actual price paid by healthcare providers for a drug is referred to as the “spread.”  The larger the spread on a drug, the larger the profit for the health care provider or pharmacist who gets reimbursed by the government.

A settlement has been reached in a whistleblower class action lawsuit brought against Dey Inc, Dey Pharma LP (formerly known as Dey, LP) and Dey LP Inc.  They are accused of  engaging in a scheme to report false and inflated prices for numerous pharmaceutical products.

The whistleblowers will receive a share of approximately $67.2 million.

The initial whistleblower complaint against Dey Inc was filed in the Southern District of Florida on August 13, 1997. Eventually the United States interevened in August 2006.  The United States alleged that Dey reported false prices for the following drugs: Albuterol Sulfate, Albuterol MDI, Cromolyn Sodium and Ipratropium Bromide. The difference between the resulting inflated government payments and the actual price paid by health care providers for a drug is referred to as the “spread.”  The larger the spread on a drug, the larger the profit for the health care provider or pharmacist who is reimbursed by the government.  The government alleges that Dey created artificially inflated spreads to market, promote and sell the drugs to existing and potential customers.  Because payment from the Medicare and Medicaid programs was based on the false inflated prices, the government alleged that Dey caused false and fraudulent claims to be submitted to federal health care programs and, as a result, the government paid millions of claims for far greater amounts than it would have if Dey had reported truthful prices.