Healthcare and Pharma Cases

Minnesota-headquartered Sightpath Medical, Inc. and a subsidiary will pay $12 million to resolve False Claims Act allegations raised in a lawsuit filed by whistleblower Kipp Fesenmaier.

The complaint stated that Sightpath and Precision Lens, a company that was targeted by another lawsuit, offered kickbacks to physicians in exchange for their use of their products and services, which include intraocular lenses, ophthalmic surgical equipment, and related services to hospitals. Some of the services and products in question were reimbursed by Medicare and other federal programs.

The alleged kickbacks paid to numerous ophthalmologists included luxury skiing, golfing, and fishing trips, improper consulting agreements. Sightpath, Precision Lens, and some of their executives allegedly used these enticements to induce physicians to use their products and services, which ultimately resulted in the submission of false claims to government programs.

The kickback scheme was exposed at length in a whistleblower lawsuit filed by Kipp Fesenmaier, a former Sightpath executive, in 2013. Fesenmaier, who is now Senior Director of Global Business Solutions at the Mayo Clinic, started working at Sightpath as National Manager in 1994. His last position with the company was VP-GM of Diagnostics, which lasted from January 2006 till December, 2007....

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....

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....

Whistleblower Elma F. Dresser will receive a $545,000 whistleblower award for aiding the United States in reaching a $2.6 million settlement with northern California’s Bay Sleep Clinic, affiliates Qualium Corporation and Amerimed Corporation, and owners and operators, Anooshiravan Mostowfipour and Tara Nader, the Department of Justice announced Wednesday.

The $2.6 million settlement resolves allegations that Bay Sleep Clinic and other defendants violated the False Claims Act by submitting false claims to the Medicare program for diagnostics and medical devices.

Whistleblower Dresser Alleges Non-Licensed Sleep Clinic Staff, Non-Approved Testing Locations, Illegal Kickbacks

Former eight-year Bay Sleep Clinic marketer and sleep technician, Elma F. Dresser, filed the initial whistleblower lawsuit in April 2012, after obtaining inside information of the defendants’ improper Medicare billings....

America’s courageous whistleblowers filed over 700 qui tam suits in fiscal year 2016 and received $519 million in awards for their valuable tips and assistance in fighting various types of fraud.

Since the 2009 Fraud Enforcement and Recovery Act made groundbreaking improvements to the False Claims Act’s whistleblower provisions, the government has recovered close to $24 billion, paying a sizable $4 billion in whistleblower awards.

As legislation tries to catch up with the rampant reports of fraud across a variety of industries, the federal False Claims Act remains the star when it comes to facilitating the exposure of government-defrauding schemes across America....