Vantage Oncology LLC, an owner and operator of radiation oncology centers, has agreed to pay more than $2.08 million to resolve a whistleblower’s allegations that it over-billed Medicare for radiation oncology services.
The government in this False Claims Act lawsuit accused Vantage of double billing for certain procedures, billing for services without proper supporting documentation, and billing for radiation treatment provided without required doctor supervision.
The whistleblower in this case, a former Vantage employee, will receive $354,450 as his share of the settlement proceeds pursuant to the qui tam provisions of the False Claims Act.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1243.html
Basco Manufacturing Co. (“Basco”) has agreed to pay $1.1 million to resolve a whistleblower’s allegations that it made false customs declarations to avoid paying duties on products imported from China. The products involved were aluminum extrusions, which are used in the manufacture of shower enclosures.
As alleged by the whistleblower, Basco represented to the government that aluminum extrusions were imported from Malaysia, rather than China. By routing the products through Malaysia and misrepresenting their true origin, Basco avoided having to pay antidumping and countervailing duties applicable to Chinese products. The government claimed that Basco knew that the products were simply repackaged in Malaysia and were not substantially transformed to the extent that the country of origin could change from China to Malaysia.
By exposing this scheme through the filing of a False Claims Act lawsuit, the whistleblower is entitled to receive a share of the settlement proceeds. The amount of this share has not been determined.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1221.html
Baptist Health Systems has agreed to pay $3,675,000 to resolve a whistleblower’s allegations that it violated the False Claims Act by failing to disclose insurance coverage applicable to treatment it provided to Medicare beneficiaries.
Under Medicare rules, providers are required to disclose the fact that a patient has other insurance when the provider submits claims to Medicare. In these instances, the claims are processed through the applicable insurance policy, with Medicare sometimes paying for the patient’s deductible or other out of pocket costs. By failing to disclose the existence of applicable insurance coverage, Baptist Health Systems caused the government to overpay Medicare claims from 2003 through 2007.
The whistleblower who exposed this practice through the filing of a False Claims Act lawsuit will receive $661,500 from the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/usao/txw/news/2013/Baptist_Hospital_SA_civil_settlement.html
Nursing home operator Ensign Group, Inc. has agreed to pay $48 million to resolve allegations that it billed Medicare for unnecessary rehabilitation therapy services.
These False Claims Act lawsuits involved billing for services provided at six skilled nursing facilities operated by Ensign in California. According to the whistleblowers’ allegations, Ensign provided medically unnecessary therapy to patients, and billed Medicare for services it had not provided. The government also contended that Ensign improperly incentivized its employees to increase the amount of therapy provided to Medicare patients regardless of the patients’ individual therapy needs.
The whistleblowers who filed these lawsuits, two therapists formerly employed with Ensign, will share in the settlement proceeds pursuant to the qui tam provisions of the False Claims Act. The amount of the whistleblowers’ share has not been announced.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/12-civ-1235.html
FreshPoint, Inc., a Houston-based subsidiary of Sysco Corp., has agreed to pay $4.2 million to resolve a False Claims Act lawsuit relating to the prices it charged the government for fresh fruit and vegetables.
According to the whistleblower’s allegations, FreshPoint improperly inflated its prices to reflect its view of the prevailing market price of the goods at the time of sale. Pursuant to its contracts with the government, FreshPoint was required to supply the produce at cost, plus a pre-established markup as its profit, and was forbidden from making further price adjustments based upon its perception of changes in market prices.
The whistleblower, a former employee of FreshPoint, will receive $798,000 from the settlement proceeds as his award for exposing FreshPoint’s pricing practices by filing a False Claims Act lawsuit.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1233.html
CA, Inc., formerly known as Computer Associates, has agreed to pay $11 million to resolve a False Claims Act lawsuit accusing it of overcharging the government for computer software maintenance services.
According to the whistleblower’s allegations, CA charged its customers for renewal plans immediately, even though they often had months remaining under their current plans. Through this practice, government customers who renewed their maintenance plans were double billed for the months remaining in their existing plans.
This whistleblower case was brought on behalf of the federal government, as well as New York, California, Florida, Hawaii, Illinois, Massachusetts, Nevada, Virginia and the District of Columbia. The federal portion of the settlement amounts to $8 million, and the states will divide the rest based on the number of renewal plans purchased.
For more information on this case, click here: http://www.ag.ny.gov/press-release/ag-schneiderman-announces-11-million-multi-state-settlement-over-fraud-claims-against.
The Department of Justice recently announced that Hospice of the Comforter, Inc. (HOTCI) has agreed to pay $3 million to settle a whistleblower lawsuit filed by one of its former employees.
According the allegations raised in this False Claims Act lawsuit, HOTCI submitted false claims to Medicare for hospice services. These claims violated the Medicare rules which provide for benefits for hospice services rendered to terminally ill patients with less than six months to live. The whistleblower exposed practices that included falsifying medical records to give the appearance that patients were eligible for benefits, admitting patients who did not qualify for the Medicare hospice benefit, and limiting physicians’ ability to assess the patients’ terminal status.
Pursuant to the False Claims Act qui tam provisions, the whistleblower who filed this lawsuit will share in the government’s recovery. The amount of the whistleblower’s share in this case has not been announced.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1179.html
A former employee of Specialty Hospitals of America, LLC will receive $798,000 for filing a False Claims Act lawsuit that exposed billing practices that led to the government overpaying for Medicare reimbursements by $4.2 million.
In connection with its operation of two long-term care facilities, Specialty Hospitals of America, LLC filed cost reports that knowingly contained inaccurate revenue and expense data. Medicare reimbursements based on this bogus data were inflated to the detriment of U.S. taxpayers.
For more information on this case, click here: http://www.justice.gov/usao/dc/news/2013/nov/13-373.html
In one of the largest health care fraud cases in U.S. history, Johnson & Johnson and affiliated companies have agreed to pay over $2.2 billion to resolve allegations of improper prescription drug marketing concerning the drugs Risperdal, Invega and Natrecor. This global settlement covers civil and criminal liability for marketing practices that date back to 1999.
Off-label marketing occurs when a pharmaceutical company promotes a drug for uses beyond those approved as safe and effective by the Food and Drug Administration (FDA). Risperdal, for example, was approved by the FDA to treat schizophrenia, but a Johnson & Johnson subsidiary directed its sales representatives to urge physicians to prescribe Risperdal to treat other symptoms such as anxiety, depression and confusion. These representatives received bonuses for increasing sales for all uses, including those not approved by the FDA.
The government alleged that these marketing practices caused false claims to be submitted to federal health care programs.
The whistleblowers who filed the False Claims Act lawsuits that exposed these fraudulent marketing practices will recover approximately $167.7 million from the federal government’s share of the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-ag-1170.html
The Department of Justice recently announced that Axway, Inc. has agreed to pay $6.2 million to resolve a whistleblower lawsuit alleging that it had failed to properly disclose its pricing policies and practices.
As a participant in the Multiple Award Schedule Program (MAS), Axway, Inc. is required to disclose its pricing policies and practices to the General Services Administration (GSA). In exchange for this disclosure, Axway, Inc. is given the opportunity to gain access to the lucrative federal marketplace and sell to hundreds of government purchasers in one central MAS contract. GSA relies on accurate disclosures in negotiating prices for government purchasers.
The whistleblower in this case, a former employee of a company affiliated with Axway, Inc., revealed to the government that Axway, Inc. failed to disclose accurate pricing information to the government, which resulted in the government paying inflated prices for Axway, Inc.’s software products and related services.
As a reward for exposing to this fraud through the filing of a False Claims Act lawsuit, the whistleblower will receive $1,178,000 from the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/usao/md/news/2013/AxwayInc.AgreesToPay6.2MillionToResolveFalseClaimsActAllegationsRelatedToGSAMultipleAw.html