News & Cases

New Jersey-headquartered Celgene Corporation will pay $280 million to settle claims that it cited non-FDA approved uses in its promotion of cancer treatment drugs Thalomid and Revlimid. The biotech giant decided to settle after a judge ruled last December that the case was fit to proceed to trial.

Judge George H. King believed the plaintiff had provided sufficient evidence that Celgene was promoting the drugs for uses the Food and Drug Administration had approved neither Thalomid nor Revlimid for.

As a consequence, the government ended up paying hundreds of thousands of dollars for “off-label” prescriptions.

Not Just Off-Label Marketing but Kickbacks Too?

Both Thalomid and Revlimid are approved for use in cases of myeloma, but Celgene’s promotion went far beyond that in its claims of the drugs’ benefits for cancer patients. Celgene not only pitched the drugs to physicians making claims about off-label uses, but it also allegedly paid kickbacks to ensure the drugs would be abundantly prescribed....

Linde AG-owned Lincare, one of the largest respiratory therapy service providers in the US, will pay $20 million to resolve allegations that it fraudulently billed the government for oxygen and respiratory equipment.

The settlement resolves a whistleblower lawsuit filed by four former employees of the company. Originally filed in 2009 and 2010 as two separate suits by two pairs of Lincare insiders, the filings were consolidated into one in March 2014.

According to the text of the consolidated and amended lawsuit, “Lincare falsely and fraudulently billed the government for services and equipment that were non-reimbursable, were not medically necessary, were never provided, or were provided in direct violation of the applicable standards and regulations governing Lincare’s provision of oxygen equipment and services. As a result of these knowingly false and fraudulent claims, Lincare received payments from the United States of America that were inflated, excessive, unearned, and improper.”...

PAMC Ltd., and Pacific Alliance Medical Center Inc., the owners of Pacific Alliance Medical Center, an acute care hospital just north of downtown Los Angeles, have reached a settlement in a False Claims Act case brought forward by a whistleblower.

The LA hospital operators will pay $42 million to resolve allegations that they violated the Anti-Kickback Statute and the Stark Law, defrauding both Medicare and MediCal (California’s Medicaid).

Whistleblower Paul Chan’s FCA Lawsuit Alleges Kickbacks

The settlement includes a $31.9 million payment to the Federal Government, and a $10 million payment to the State of California. Pacific Alliance’s settlement with the government includes no admission of guilt. Whistleblower Paul Chan is set to receive a reward of $9.2 million for his efforts in uncovering the wrongdoing....

The U.S. Department of Justice (DOJ) has just hit its largest health care fraud enforcement action in history, bringing charges against 412 defendants in 41 federal districts for their purported involvement in $1.3 billion worth of fraud schemes and false billings, the Justice Department announced Thursday.

Charges against the defendants include allegations of illegal kickbacks for beneficiary referrals and billing Medicare, Medicaid and TRICARE for medically unnecessary treatments and/or treatments that facilities never provided.

Over 120 of the defendants also face charges for unlawful prescription narcotic distribution.

DOJ Claims Physicians Illegally Profit from Medically Unnecessary Treatments / Drugs Never Rendered

The record-setting enforcement action targeted medical professionals attempting to profit from Medicare, Medicaid and TRICARE by prescribing medically unnecessary drugs and expensive compounded medications. In many cases, health care facilities billed federal and state government programs for drugs that the facility never even ordered or delivered to patients....

What do whistleblowers and class actions have to do with one another? Until now, very little. That is changing according to a recent announcement by noted whistleblower attorney Brian Mahany. He claims defective Takata airbags have killed 13 people and seriously injured up to 200 others.

Takata pleaded guilty to criminal charges and is now insolvent after being hit with almost $1 billion in fines.

Mahany says that the auto manufacturers share equal blame. This week he announced an investigation of Volkswagen and Audi. He seeks both inside whistleblowers and owners of cars affected by the recalled airbags.

According to records from the National Highway Transportation Safety Administration, approximately 42 million cars have been recalled because of potentially explosive airbags.

Drivers and front seat passengers in high heat and high humidity areas are most at risk of explosions. (If you aren’t sure if your car is on the recall list or is even safe to drive, check the NHTSA Takata Recall Database.)...

Gerald Daneshvar, a 40-year-old physician from the Detroit area has been convicted of conspiracy to commit health care fraud in connection with a scheme to defraud Medicare of $17.1 million, involving unnecessary home doctor visits.
Daneshvar’s jury trial lasted two weeks. He had been charged with two other counts of health care fraud, of which he was acquitted. Based out of West Bloomfield, Michigan, the defendant worked for Lake MI Mobile Doctors between 2012 and 2013.
The...

Tennessee-based TeamHealth Holdings has agreed to pay $60 million plus interest to resolve allegations that IPC Healthcare, a company it recently acquired, is guilty of overbilling Medicare, Medicaid, the Defense Health Agency, and the Federal Employees Health Benefits Program.

North Hollywood, CA-based IPC Healthcare Inc. provides hospitals with physicians and other professionals. Its employees work in more than 1,300 facilities across 28 states. Allegedly, the TeamHealth-controlled company had a practice of “upcoding” when billing government programs. Upcoding refers to billing for more expensive medical services by changing service codes in relevant documentation.

Whistleblower Dr. Bijan Oughatiyan Exposes Alleged Upcoding Scam

The False Claims Act lawsuit against IPC Healthcare was filed by Dr. Bijan Oughatiyan, MD, who worked as a hospitalist (a physician who focuses on hospital services) at IPC between 2003 and 2008. The suit was filed shortly after he left the company, in 2009. The 49-year-old doctor alleges that IPC "trained" and "encouraged" hospitalists in the practice of overbilling....

Florida-based Advanced C4 Solutions, Inc. agreed pay $4.535 million to resolve claims that it violated the federal False Claims Act by knowingly overbilling the government for work performed under an Air Force technology contract at Maryland’s Joint Base Andrews.

Defendants Andrew Bennett and James Shank pleaded guilty to conspiracy to commit wire fraud, according to Department of Justice information.

Feds Say Contractors Charge U.S. For Nonexistent Labor Hours, Ineligible Job Rates

The settlement agreement stems from alleged activities beginning in June 2010, when the U.S. Navy’s Space and Warfare Systems Command (SPAWAR) granted Advanced C4 Solutions a contract titled “DO 27” to perform labor and project management services for an Air Force technology project....

Last year set new records for Foreign Corrupt Practices Act (FCPA) enforcement, with 27 companies paying over $2.48 billion in FCPA settlements. In 2016, the Department of Justice (DOJ) reached four of the largest FCPA settlements in history: Teva Pharmaceuticals Industries ($519 million), Odebrecht and Braskem ($419.8 million), Och-Ziff Capital Management Group ($412 million) and VimpelCom Limited ($397.6 million).
These precedent-setting resolutions speak volumes regarding the...

Troy, Michigan-based United Shore Financial Services LLC (USFS) has agreed to pay the U.S. $48 million to resolve allegations it violated the False Claims Act by underwriting Federal Housing Administration (FHA)-insured mortgage loans that did not meet FHA requirements.

As part of the settlement agreement, United Shore admitted to pressuring underwriters to approve FHA mortgages, using a compensation plan formula tying underwriter compensation to percentage of loans approved and closed, and falsely certifying that direct endorsement underwriters reviewed appraisal reports before USFS approval and FHA-insured mortgage endorsement, the Justice Department announced Wednesday.

U.S. Investigation Finds USFS Approved Hundreds of Ineligible FHA-Insured Loans

Allegations stem from a January 10, 2014-initiated joint investigation into United Shore Financial Services’ underwriting and quality control practices by the U.S. Department of Housing and Urban Development (HUD), HUD’s Office of Inspector General, the Civil Division’s Commercial Litigation Branch and the Western District of Wisconsin and Eastern District of Michigan U.S. Attorneys’ Offices....