Category Archives: Whistleblower

South Carolina Ambulance Company to Pay U.S $800,000 to Resolve False Claims Allegations

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Monday, February 25, 2013
Williston Rescue Squad Inc. has agreed to pay the United States $800,000 to resolve allegations that it violated the False Claims Act by making false claims for payment to Medicare for ambulance transports, the Justice Department announced today.  Williston, based in Williston, S.C., provides ambulance transport services in the southwestern part of South Carolina.

 

Medicare is a federally-funded health care program that is intended to provide basic medical insurance to people over the age of 65.  Medicare reimburses providers only for non-emergency ambulance transports if the patient transported is bed-confined or has a medical condition that requires ambulance transportation.  The settlement resolves allegations that Williston billed Medicare for routine, non-emergency ambulance transports that were not medically necessary and that Williston created false documents to make the transports appear to meet the Medicare requirements.

“Billing Medicare for unnecessary ambulance transports contributes to the soaring costs of health care,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division.  “The Department of Justice is committed to pursuing companies that waste limited Medicare funds.”

 

“Medicare fraud is stealing, and it is crippling America’s health care system.  We have doubled the number of attorneys working these cases in South Carolina.  Take notice, if you are bilking the Medicare system designed to support our elders, we are working to find you.  For the honest service providers, which is a greater majority of the community, you can report fraud at  1-800-MEDICARE,” said William N. Nettles, U.S. Attorney for the District of South Carolina.

 

The settlement resolves a lawsuit filed by Sandra McKee under the qui tam, or whistleblower provisions, of the False Claims Act.  McKee is a clinical social worker at a facility that regularly received patients transported by Williston’s ambulances.  Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery.  Ms. McKee will receive $160,000 as her share of the government’s recovery.

 

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover nearly $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion.

 

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

 

The United States’ investigation was conducted by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division, and the U.S. Department of Health and Human Services, Office of the Inspector General.  The claims settled by this agreement are allegations only; there has been no determination of liability.

 

The False Claims Act suit was filed in the U.S. District Court for the District of South Carolina and is captioned United States ex rel. McKee v. Williston Rescue Squad, Inc., No.  11-CV-00186 (D.S.C.).

Florida Physician to Pay $26.1 Million to Resolve False Claims Allegations

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Steven J. Wasserman, M.D., a dermatologist practicing in Venice, Fla., has agreed to pay $26.1 million to resolve allegations that he violated the False Claims Act by accepting illegal kickbacks from a pathology laboratory and by billing the Medicare program for medically unnecessary services, the Justice Department announced today.   The settlement is the largest ever with an individual under the False Claims Act in the Middle District of Florida and one of the largest with an individual under the False Claims Act in U.S. history.

The government alleged that, in or around 1997, Dr. Wasserman entered into an illegal kickback arrangement with Tampa Pathology Laboratory (TPL), a clinical laboratory in Tampa, Fla., and Dr. José SuarezHoyos, a pathologist and the owner of TPL, in an effort to increase the lab’s referral business.   Under that agreement, Dr. Wasserman allegedly sent biopsy specimens for Medicare beneficiaries to TPL for testing and diagnosis.   In return, TPL allegedly provided Dr. Wasserman a diagnosis on a pathology report that included a signature line for Dr. Wasserman to make it appear to Medicare that he had performed the diagnostic work that TPL had performed.   The government alleged that Dr. Wasserman then billed the Medicare program for TPL’s work, passing it off as his own, for which he received more than $6 million in Medicare payments.   In addition, the government asserted that, in furtherance of his agreement with TPL, Dr. Wasserman substantially increased the number of skin biopsies he performed on Medicare patients, thus increasing the referral business for TPL.

The government further alleged that, in addition to his involvement in the alleged kickback scheme, Dr. Wasserman also performed thousands of unnecessary skin surgeries known as adjacent tissue transfers on Medicare beneficiaries.   Adjacent tissue transfers are complicated and often time-consuming procedures physicians sometimes use to close a defect resulting from the removal of a growth on a patient’s skin.   The governmentalleged that Dr. Wasserman performed many of these procedures in order to obtain the reimbursement for them, and not because they were medically necessary.

“Doctors who take illegal kickbacks and perform unnecessary procedures not only put their own financial self-interest over their duty to their patients, they raise the cost of health care for all of us as patients and as taxpayers,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division of the Department of Justice. “The Department of Justice will not tolerate those who abuse the public health care programs to which we all contribute and on which we all depend.”

“This settlement represents a watershed achievement in our district’s civil healthcare fraud enforcement program,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida.  “Schemes of this magnitude require extraordinary remedies, and we are proud to have reached such an outstanding resolution for the taxpayers and their health programs.”

The allegations resolved by today’s settlement were initiated by a lawsuit originally filed in the District Court for the Middle District of Florida by Alan Freedman, M.D., a pathologist who formerly worked at TPL.   Dr. Freedman filed the lawsuit under the qui tam, or whistleblower provisions of the False Claims Act.   Under the False Claims Act, a private party may file suit on behalf of the United States for false claims and share in any recovery.   The United States has the right to intervene in the action, which it did in this case, filing its own complaint in October 2010.   Dr. Freedman will receive $4,046,000 of today’s settlement.

The United States previously settled with TPL and Dr. SuarezHoyos for $950,000 to resolve the allegations asserted against them in the same lawsuit.

“Anyone cheating patients and taxpayers should expect to pay a high price,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services.  “Besides paying more than $26 million, Dr. Wasserman is excluded from treating patients and being paid under Medicare, Medicaid and all other federal health care programs.”

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion.

Principal Deputy Assistant Attorney General Delery and U.S. Attorney O’Neill thanked the joint investigation team, which includes special agents with the Department of Health and Human Services-OIG and the FBI, for their efforts in the investigation of this matter.

The claims settled by this agreement are allegations only; there has been no determination of liability.

Guest Columnist Al Scott, CFE: Emerging Health Care Fraud: China tackles emerging health care fraud (Part 2 of 2)

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In part 2 of 2 parts, Guest Columnist Al Scott, CFE, principal for NSD Bio Group LLC in Philadelphia, Pa., describes Chinese emerging enforcement approaches.

Jan-Feb ’13 Fraud Magazine Rx for Fraud column – Emerging Health Care Fraud in China (part 2 of 2)

In part 1 of 2 parts, Al described lesser-known but emerging health care frauds, including schemes involving fraudulent treatments, cures and devices, and crimes involving the manufacture, sale or distribution of unapproved FDA-regulated products.

Nov-Dec ’12 Fraud Magazine Rx for Fraud column – Emerging Health Care Fraud

 

The opinions expressed in this column aren’t necessarily those of GeyerGorey LLP.  Special thanks to Fraud Magazine for authorizing us to republish Al’s work— ed.

 

British Contractor Agrees to Plead Guilty to Wire Fraud Conspiracy Related to Iraq Reconstruction Efforts

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FOR IMMEDIATE RELEASE
Monday, December 10, 2012
British Contractor Agrees to Plead Guilty to Wire Fraud Conspiracy Related to Iraq Reconstruction Efforts

WASHINGTON – British contractor APTx Vehicle Systems Limited agreed today to plead guilty to conspiracy to defraud the United States, the Coalition Provisional Authority that governed Iraq from April 2003 to June 2004, the government of Iraq and JP Morgan Chase Bank.  A civil settlement agreement resolving a related action filed under the False Claims Act was also announced today.

APTx was charged with one count of wire fraud conspiracy in a criminal information filed today in U.S. District Court in Massachusetts.  As part of the plea agreement filed with the information, APTx agreed to pay a criminal fine of $1 million.

The charges and resolutions were announced today by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, Principal Deputy Assistant Attorney General Stuart F. Delery of the Justice Department’s Civil Division and U.S. Attorney for the District of Massachusetts Carmen M. Ortiz.

According to the criminal information, APTx engaged in a fraudulent scheme involving an August 2004 contract valued at over $8.4 million for the procurement of 51 vehicles for the Iraqi Police Authority.  The contract was initially awarded to a different, “prime” contractor, which in turn subcontracted the procurement to APTx for over $5.7 million.  Payment under the contract was by letters of credit issued by JP Morgan Bank.

The criminal information further charges that in May and June 2005, APTx submitted shipping documents to JP Morgan to draw down on the letters of credit, which falsely and fraudulently asserted that all 51 vehicles were produced and ready to ship to Iraq.   In fact, as APTx knew, none of the vehicles had been built, none of the vehicles were legally owned or held by APTx and none of the vehicles were in the process of transport to Iraq.  The fraudulent shipping documents also listed a company as the freight carrier that APTx knew was not a shipping company and named a fictitious company as the freight forwarder.

In a related civil settlement agreement, APTx, along with Alchemie Grp Ltd., a United Kingdom corporation, and Haslen Back, the director and shareholder of Alchemie, agreed to pay $2 million to the United States to resolve claims originated by Ian Rycroft, an individual retained by the prime contractor to oversee transportation of the vehicles, under the qui tam, or whistleblower, provisions of the False Claims Act in the District of Massachusetts.  The False Claims Act authorizes private whistleblowers to bring suit for false claims submitted to the United States and to share in any recovery.  Rycroft’s estate will receive $540,000 as its share of the settlement amount.

Benjamin Kafka, a representative for APTx in the United States, was charged on April 13, 2009, with one count of misprision of a felony in connection with his role in the wire fraud conspiracy.  According to court documents, Kafka allegedly allowed APTx to use his corporate name and identity as the freight carrier and freight forwarder on the fraudulent shipping documents presented to JP Morgan.

The criminal case is being prosecuted by Director of Procurement Fraud Catherine Votaw and Trial Attorney William H. Bowne III of the Criminal Division’s Fraud Section, and by Assistant U.S. Attorneys Eugenia M. Carris and Jeffrey Cohen of the District of Massachusetts.  The civil case is being handled by Trial Attorney Diana Younts of the Civil Division, and by Assistant U.S. Attorney Christine Wichers of the District of Massachusetts.  The investigation was conducted by the Special Inspector General for Iraq Reconstruction, the Defense Criminal Investigative Service Boston Resident Agency and U.S. Immigration and Customs Enforcement Homeland Security Investigations in Washington, D.C.

South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton to Pay U.S. $1.286 Million to Resolve False Claims Act Allegations

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FOR IMMEDIATE RELEASE
Tuesday, November 20, 2012
South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton to Pay U.S. $1.286 Million to Resolve False Claims Act Allegations

Harmony Care Hospice Inc. (Harmony) and Harmony owner and chief executive officer Daniel J. Burton have agreed to pay the United States $1,286,999.32 to settle allegations that the South Carolina-based company submitted false claims to Medicare for patients under care at its hospice facilities, the Justice Department announced today.

 

Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less. The United States alleged that Harmony and Burton knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. Under today’s agreement, Burton is individually liable for $200,000 of the settlement amount.

 

“Billing Medicare for unnecessary or inappropriate end-of-life care contributes to the soaring costs of health care for everyone. Today’s settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Civil Division.
Today’s settlement with Harmony and Burton resolves a lawsuit filed by former Harmony employees Mona Singletary and Lynda Fulton under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, private citizens can bring suit for false claims on behalf of the United States and share in any recovery. Together, Singletary and Fulton will receive $244,529.87 as their share of the government’s recovery.

 

As part of the settlement, Harmony and Burton will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaint.

 

“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The company and its owner have agreed to Federal monitoring and reporting requirements designed to avoid such problems in the future.”

 

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.9 billion.

 

The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability.

 

The qui tam case is captioned United States ex rel. Singletary, et al. v. Harmony Care Hospice, Inc., et al., Case No. 2:10-cv-01404-PMD (D.S.C.).

Group of Owned and Affiliated Florida Hospitals Agree to Pay US $10.1 Million to Resolve False Claims Act Allegations

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FOR IMMEDIATE RELEASE
Tuesday, November 20, 2012
Group of Owned and Affiliated Florida Hospitals Agree to Pay US $10.1 Million to Resolve False Claims Act Allegations

Morton Plant Mease Health Care Inc. and its affiliated hospitals (Morton Plant) have agreed to pay $10,169,114 to the federal government to resolve allegations that they violated the False Claims Act by submitting false claims for services rendered to Medicare patients, the Justice Department announced today. Morton Plant owns and operates, or is affiliated with, Morton Plant Hospital, St. Joseph’s Hospital, Morton Plant North Bay Hospital, St. Anthony’s Hospital, Mease Countryside Hospital and Mease Dunedin Hospital. These hospitals are part of the BayCare Health System in Florida’s Pinellas, Hillsborough and Pasco counties.

 

The settlement announced today resolves allegations that, between July 1, 2006 and July 31, 2008, Morton Plant improperly billed for certain interventional cardiac and vascular procedures as inpatient care when those services should have been billed as less costly outpatient care or as observational status.

 

“Overbilling the government for routine procedures wastes valuable resources that could be used to care for other patients,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Justice Department’s Civil Division. “At a time when we are trying to reduce public spending, it is especially important to ensure that hospitals do not overcharge the government by improperly inflating their billing.”

 

“We hold medical providers to a high standard in our district, and we will not hesitate to hold them to account when we find evidence of serious misconduct,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida. “This settlement should send a strong message that health care fraud enforcement is a growing priority in our office.”

 

Today’s settlement resolves a qui tam, or whistleblower, lawsuit filed by Randi Ferrare, a former director of Health Management Services at Morton Plant Hospital. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and

share in any recovery. Ms. Ferrare will receive over $1.8 million as her share of the government’s recovery.

 

“When hospitals attempt to boost profits with improper inpatient admissions, they squander scarce dollars from Medicare and Medicaid,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “Our corporate integrity agreements hold providers accountable for preventing such abuse of government health care programs.”

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion

 

The United States’ investigation was conducted by the U.S. Attorney’s Office for the Middle District of Florida, the Civil Division of the Department of Justice, the FBI and the Department of Health and Human Services, Office of Inspector General.

 

The claims settled by this agreement are allegations only; there has been no determination of liability.

 

The case is docketed as United States ex rel. Randi Ferrare v. Morton Plant Mease Health Care, Inc., No. 08:cv:01689-T-266MSS (M.D. Fl.).

Chicago Psychiatrist Allegedly Submitted At Least 190,000 False Claims to Medicare and Medicaid; Lawsuit Alleges Kickbacks to Prescribe Antipsychotic Medication for Nursing Home Patients

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press release NDIL

US Government Intervenes in Whistleblower Lawsuit Against Fluor Companies

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FOR IMMEDIATE RELEASE
Thursday, November 8, 2012
US Government Intervenes in False Claims Lawsuit Against Fluor Companies
Texas-based Company Allegedly Used Federal Funds for Lobbying Activities

The government has intervened in a lawsuit against Fluor Hanford Inc. and its parent company, Fluor Corporation (collectively Fluor), in the U.S. District Court for the Eastern District of Washington, the Justice Department announced today.   Fluor Hanford, Inc. is a subsidiary of Fluor Corporation, a Texas-based corporation that provides a wide variety of services to government and private customers.   The False Claims Act lawsuit was originally filed by whistleblower Loydene Rambo, a former employee of Fluor.

 

Between 1999 and 2008, Fluor had a prime contract with the Department of Energy (DOE) to provide a wide variety of security, maintenance and operational services at the DOE’s Hanford Nuclear Site in southeastern Washington State.   As part of its contract, Fluor was responsible for managing and operating the Hazardous Materials Management and Emergency Response (HAMMER) Center, a federally-funded facility established to train Hanford site workers as well as first responders and law enforcement personnel.

The whistleblower complaint alleges that, as a condition of receiving its DOE contract, Fluor was required to certify that it would not use federal funds for lobbying activities.   The complaint further alleges that between 2005 and 2008, Fluor ignored these restrictions and used DOE funding to lobby Congress and executive branch officials for more funding for HAMMER.   The complaint alleges that Fluor, and two lobbying firms hired by Fluor and paid using DOE funds, Secure Horizons LLC and Congressional Strategies LLC, lobbied members of Congress and executive branch agencies to include additional funds for HAMMER in agency appropriations.  The United States intervened in the lawsuit with respect to Fluor, but declined to intervene with respect to additional defendants, including Secure Horizons LLC and Congressional Strategies LLC.

“The taxpayer money Congress allocated for this program was for training federal emergency response personnel and first responders, not to lobby Congress and others for more funding,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice.   “When public funds are misused, as alleged in this case, the Justice Department will work to restore them to the Treasury.”

“The allegations set forth in the whistleblower complaint are troubling and very serious,”

said Michael C. Ormsby, U.S. Attorney for the Eastern District of Washington. “My Office will continue to work with the Justice Department to ensure a just resolution of these alleged violations of federal law.”

Ms. Rambo’s lawsuit was filed under the False Claims Act, which authorizes private parties to sue on behalf of the United States and share in any recovery.   The act authorizes the United States to intervene in such a suit and take over the responsibility for litigating it.   The United States has informed the court that it intends to file its own complaint in the action.

The case is being handled by the Civil Division of the Department of Justice and the U.S. Attorney’s Office for the Eastern District of Washington, with the assistance of the Department of Energy Office of Inspector General.

Ms. Rambo’s lawsuit is captioned U.S. ex rel. Rambo v. Fluor Hanford, et al., cv-11-5037.   The claims asserted in this case are allegations only, and there has been no determination of liability.

Indictments Returned in Hammond Federal Court (USAO-NDIN)

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HAMMOND, IN—The United States Attorney’s Office announced that the following Indictments were returned on November 8, 2012:

  • Hoosier EMS Roy Dunn, 59, and Kahley Vergon-Mayotte, 27, both of Winimac, Indiana; and Anthony Bitterling, 39, of Monticello, Indiana, were charged in an indictment with conspiracy to commit health care fraud. These charges were filed as the result of an investigation by the Federal Bureau of Investigation, the United States Department of Health and Human Services, and the Indiana Medicaid Fraud Control Unit. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.
  • Edwin Tollinchi-Rodriguez, 27, of East Chicago, Indiana, was charged in an indictment with aggravated sexual abuse. This case resulted from an investigation by members of the Indiana Internet Crimes Against Children Task Force, including the Federal Bureau of Investigation; the East Chicago Police Department; and the Lansing, Illinois Police Department. This case has been assigned to and will be prosecuted by Assistant United States Attorney Jill Koster.
  • Kevin Paul Brewster, 40, of Portage, Indiana, was charged in an indictment with four counts of production of child pornography, one count of receipt of child pornography, and one count of possession of child pornography. This case resulted from an investigation by members of the Indiana Internet Crimes Against Children Task Force, including the Federal Bureau of Investigation and the Portage Police Department. This case has been assigned to and will be prosecuted by Assistant United States Attorney Jill Koster.
  • Austin Nwaka, dba Service Above Self, of Canby, Indiana, and Phyllis Lark, dba Absolute Care, of Hammond, Indiana, were charged in an indictment with health care fraud. Lark was also charged with making false statements to a federal agent. These charges were filed as the result of an investigation by the Federal Bureau of Investigation and the Indiana Medicaid Fraud Control Unit. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.
  • Daron Moten, 23, of Gary, Indiana, was charged in an indictment with possession of a firearm by a convicted felon. These charges were filed as the result of an investigation by the by the Bureau of Alcohol, Tobacco, Firearms, and Explosives and the Gary Police Department. This case has been assigned to and will be prosecuted by Special Assistant United States Attorney Armando Salinas, Jr.
  • Michael J. Plake, 47, of Lafayette, Indiana, and Paul Cardwell, 46, formerly of Monticello, Indiana, were charged in an indictment with conspiracy to commit mail fraud. These charges were filed as the result of an investigation by the Federal Bureau of Investigation. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.

The United States Attorney’s Office emphasized that an indictment is merely an allegation and that all persons charged are presumed innocent until and unless proven guilty in court.

If convicted in court, any specific sentence to be imposed will be determined by the judge after a consideration of federal sentencing statutes and the Federal Sentencing Guidelines.