As we noted in our Top 10 False Claims Act Recoveries post, it was another big year of recoveries under the False Claims Act. ��As usual, the majority of recoveries occurred in cases involving healthcare fraud.

As the Department of Justice (DOJ) just reported in its annual roundup of False Claims Act successes, of the $2.9 billion the government and whistleblowers recovered this past fiscal year (ending September 30), more than $1.67 billion (58%) came from matters involving healthcare fraud. ��Since 1986, when the False Claims Act was amended to add stronger incentives and protections for whistleblowers, the aggregate percentage of cases involving healthcare fraud is even higher — 70% (or $54 billion of the roughly $78 billion in total recoveries over this period).

Unsurprisingly, four of this past year’s Top-10 healthcare fraud recoveries involved violations of the Anti-Kickback Statute, which prevents making or receiving any form of consideration to induce patient referrals.�� Going after healthcare kickbacks has been a perennial DOJ enforcement priority.�� So has taking action against health care providers, pharmaceutical companies and pharmacies that contributed to and exacerbated the opioid crisis.�� Two of the Top-10 listings involved opioid-related fraud.

Rounding out the Top-10 listing are cases involving Medicare Advantage (Risk Adjustment) fraud, another hotbed for DOJ enforcement, and a variety of classic healthcare fraud cases involving overbilling Medicare or billing Medicare for services not provided.�� Not included in the listing is the $150 million jury verdict last June against Johnson & Johnson subsidiary Janssen Products for illegally promoting and marketing its HIV/AIDS drugs Prezista and Intelence. ��The decision is on appeal and if upheld could result in total damages ultimately exceeding $1 billion.

As expected, all but three of the Top-10 recoveries were originated by whistleblowers under the qui tam provisions of the False Claims Act.�� This percentage of whistleblower-led recoveries is consistent with the dominant role whistleblowers have played since 1986 in enforcing the False Claims Act.�� Of the $78 billion the government has recovered over this period, roughly $55 billion (71%) has come from matters originated by whistleblowers. ��Whistleblowers received roughly $9.5 billion in awards during this period.

Finally, 91�Թ���is especially pleased to note that two of this past year’s Top-10 cases were originated by whistleblowers the firm represented — Independent Health (No. 6) and DaVita (No. 9).

With all that said, here is our Top-10 listing of False Claims Act healthcare recoveries in 2024 (by calendar year).

No. 1: Endo Health ($476M).�� On February 29, Endo Health Solutions, which is in bankruptcy, agreed to pay roughly $476 million to settle DOJ charges of violating the False Claims Act and the Federal Food, Drug and Cosmetic Act through its sales and marketing of the opioid drug Opana.�� Specifically, the company allegedly used a marketing scheme that targeted healthcare providers the company knew were “pill mill” prescribing Opana for non-medically accepted indications.�� In addition to the civil settlement, the company was hit with a criminal fine of roughly $1 billion and an additional $450 million in criminal forfeiture, representing the second-largest set of criminal penalties ever levied against a pharmaceutical company.

No. 2: Teva ($450M).�� On October 10, New Jersey-based Teva Pharmaceuticals agreed to pay $450 million to settle DOJ charges of violating the False Claims Act and Anti-Kickback Statute by (i) paying Medicare patient copays for its multiple sclerosis drug Copaxone to steer patients to the drug while raising its price, and (ii) conspiring with other generic drug makers to fix prices for certain generic drugs, including its widely-used cholesterol drug pravastatin.

No. 3: Rite Aid ($410M).�� On July 10, Rite Aid Corporation and 10 subsidiaries and affiliates to pay $7.5 million and up to roughly $402 million in unsecured claims in Rite Aid’s bankruptcy to settle DOJ and whistleblower charges of violating the False Claims Act and Controlled Substances Act by dispensing hundreds of thousands of prescriptions for controlled substances — including highly addictive oxycodone and fentanyl — that lacked a legitimate medical purpose and/or were not issued in the usual course of professional practice.�� The allegations originated in a whistleblower lawsuit filed by Rite Aid pharmacy employees Andrew White, Mark Rosenberg and Ann Wegelin, who collectively will receive a whistleblower award of 17% of the government’s total False Claims Act recovery.

No. 4: Rite Aid ($121M).�� On July 10, Rite Aid Corporation and certain subsidiaries to pay $101 million and up to $20 million in unsecured claims in Rite Aid’s bankruptcy to settle DOJ and whistleblower charges of failing to properly report to Medicare drug rebates it received from manufacturers, characterizing them instead as bona fide service fees.�� The allegations originated in a whistleblower lawsuit filed by former Rite Aid subsidiary employee��Glenn Rzeszutko who will receive an undisclosed whistleblower award from the proceeds of the government’s recovery.

No. 5: Walgreens ($107M).�� On September 13, Illinois-based Walgreens agreed to pay roughly $107 million to settle DOJ and whistleblower charges of violating the False Claims Act by billing Medicare/Medicaid for prescriptions it processed but that patients never picked up.�� The allegations originated in a whistleblower lawsuit filed by former Walgreens pharmacy manager Steven Turck who received a whistleblower award of roughly $15 million from the proceeds of the settlement.

No. 6: Independent Health ($98M).�� On December 29, Buffalo-based Independent Health agreed to pay up to $98 million to settle DOJ and whistleblower charges of violating the False Claims Act by submitting invalid diagnosis codes to increase the payments the company received from Medicare for its Medicare Advantage Plan enrollees. ��The allegations originated in a whistleblower lawsuit filed by Teresa Ross, a former employee of Group Health Cooperative (now Kaiser). ��91�Թ���represented Ms. Ross who will receive a whistleblower award of at least $8.2 million from the proceeds of the settlement.

No. 7: Oak Street ($60M).�� On September 18, Chicago-based Oak Street Health to pay $60 million to settle DOJ and whistleblower charges of violating the False Claims Act and Anti-Kickback statute by paying kickbacks to third-party insurance agents in exchange for recruiting seniors enrolled in or eligible for Medicare Advantage to Oak Street Health’s primary care clinics.�� The allegations originated in a whistleblower lawsuit filed by Joseph Stinson who received a whistleblower award of $9.9 million from the proceeds of the government’s recovery.

No. 8: QOL Medical ($47M).�� On November 15, Florida-based pharmaceutical company QOL Medical and its CEO Frederick Cooper agreed to pay $47 million to resolve DOJ and whistleblower charges they violated the False Claims Act and Anti-Kickback Statute by providing patients free breath testing services to induce them to purchase QOL’s drug Sucraid.�� The allegations originated in a whistleblower lawsuit filed by former QOL employees Elizabeth Allen, Lauren Canlas, Donald Johnson and Stacey Adams, who collectively received a whistleblower award of roughly $8 million from the proceeds of the government’s recovery.

No. 9: DaVita ($34.5M).�� On July 18, Denver-based DaVita Inc. agreed to pay roughly $34.5 million to settle DOJ and whistleblower charges of violating the False Claims Act and Anti-Kickback Statute by (i) paying kickbacks to a competitor for referrals to DaVita’s former pharmacy services subsidiary DaVita Rx, and (ii) paying kickbacks to nephrologists and vascular physicians for patient referrals to DaVita dialysis centers.�� The allegations originated in a whistleblower lawsuit filed by former Chief Operating Officer of DaVita Kidney Care Dennis Kogod.�� 91�Թ���represented Mr. Kogod, who received a whistleblower award of roughly $6.4 million from the proceeds of the government’s recovery.

No. 10: Silver Lake ($30.6M).�� On January 16, New Jersey-based Silver Lake Hospital and certain hospital investors agreed to pay $30.6 million to settle DOJ charges of violating the False Claims Act and Federal Debt Collection Procedures Act by claiming excessive cost outlier payments from Medicare for fraudulent money transfers by the hospital to investors. ��With respect to the cost outlier overpayments, which are designed to supplement Medicare payments for unusually high costs of care, the government alleged Silver Lake improperly distorted the cost outlier payment system by rapidly increasing its charges well in excess of any increase in its costs.

If you would like more information on any of these settlements or would like to learn more about what it means to be a whistleblower under the False Claims Act, please do not hesitate to contact us.�� We will connect you with an experienced member of our whistleblower team for a free and confidential consult.

Read Top 10 False Claims Act Recoveries in Healthcare for 2024 at constantinecannon.com

Athira Pharma Inc., a Bothwell, Washington-based, clinical stage bio-pharmaceutical company, will pay $4,068,698 to allegations that it violated the False Claims Act. It failed to report claims of research misconduct to the National Institutes of Health (NIH) and Department of Health and Human Services (HHS) Office of Research Integrity when filling out grant applications and grant award progress reports.

From January 1, 2016, to June 20, 2021, it was alleged that Athira failed to report allegations regarding its former CEO, Leen Kawas, for falsification and manipulation of scientific images in her doctoral dissertation, and in published research papers that were referenced in grant applications submitted to NIH, including in a 2019 NIH-funded grant.

Athira violated its regulatory obligations to disclose allegations to NIH in Research Progress Performance Reports, grant applications, and to the HHS Office of Research Integrity in Small Business Organization Statements, Institutional Assurances, or Annual Reports on Possible Research Misconduct.

Federally funded research is crucial to all Americans who desire accurate and reliable medical research to make advancements in science that impact our families and friends. Here, grant research for Alzheimer’s and Parkinson’s disease was implicated. Special Agent in Charge Steven J. Ryan of the HHS Office of Inspector General (OIG) commented: “The failure of Athira to properly disclose allegations of falsified and manipulated scientific images by its former CEO to the NIH undermines public trust in taxpayer-funded research.”

This civil settlement resolves claims brought by courageous whistleblower Andrew P. Mallon Ph.D.��under the qui tam provisions of the False Claims Act, in which a person can file an action on behalf of the United States and receive a sizeable portion of the recovery. With this settlement, Mallon will receive $203,434. To its credit, in this case, Athira did also notify NIH after the full board of directors learned of the research misconduct.

Whistleblowers are one of our first lines of defense to ensure the proper stewardship of grant funds, Brook Hargrave, an Auditor in the Division of Program Integrity at NIH.

If you think you might have information relating to potential fraud against the government, please contact��Constantine Cannon.��We will connect you with an experienced member of our whistleblower��team��for a free and confidential consult.

Read Scientific Research Misconduct: Athira Pharma Inc. Will Pay $4M to Settle False Claims Act Allegations at constantinecannon.com

On December 29, 2024, the government that Buffalo, New York’s Independent Health Association and Independent Health Corporation (collectively known as Independent Health) have agreed to pay up to $98 million to settle allegations that they violated the False Claims Act by submitting, or causing the submission of, invalid diagnosis codes to Medicare for Medicare Advantage Plan enrollees. 91�Թ���represented the brave whistleblower who came forward to uncover this scheme.

Under Medicare Advantage, beneficiaries can enroll in private managed care plans (“MA Plans”), which receive fixed payments from Medicare to provide covered benefits. These payments are adjusted based on the beneficiary’s health status. Beneficiaries with more complex or expensive diagnoses receive higher “risk adjustment” scores which result in increased payments to the MA Plan to cover expected health care costs.

Independent Health manages MA plans for beneficiaries living in western New York. The government alleges that Independent Health developed a wholly owned subsidiary called DxID LLC to dig deep when searching medical records and asking physicians for information to support extra diagnoses that could result in higher risk scores. DxID completed these services for Independent Health and other MA Plans.

In a previous complaint, the United States alleged that Independent Health, with assistance from DxID, and its founder / chief executive, Betsy Gaffney, submitted fraudulent diagnoses to CMS, not supported by the beneficiaries’ medical records, to inflate Medicare’s payments to Independent Health from 2011 to 2017.

The December 2024 settlement amount is based on Independent Health’s ability to pay. As listed in the��, Independent Health is guaranteed to pay $34,500,000 and will make contingent payments of up to $63,500,000 for itself and DxID. DxID halted its operations in 2021. Gaffney will independently pay $2,000,000.

Deputy Assistant Attorney General Michael Granston of the Justice Department’s Civil Division stated: “The government expects those who participate in Medicare Advantage to provide accurate information to ensure that proper payments are made for the care received by enrolled beneficiaries…Today’s result sends a clear message to the Medicare Advantage community that the United States will take appropriate action against those who knowingly submit inflated claims for reimbursement.”

This case is captioned United States ex rel. Ross v. Independent Health Association et al., No. 12-CV-0299(S) (WDNY). The civil settlement includes a resolution of claims brought under the��qui tam��or whistleblower provisions of the False Claims Act by Teresa Ross, a former employee of Group Health Cooperative, now Kaiser Foundation Health Plan of Washington (Kaiser). Under the��qui tam��provisions, a private party can file an action on behalf of the United States and receive a portion of the recovery. The Act allows the government to intervene in such lawsuits, as seen with this case.

Ross will receive at least $8,212,500 from the settlement announced on December 20, 2024. Ross also alleged that Kaiser used DxID to discover additional diagnoses to pad Medicare submissions for risk adjustments. The United States previously��settled��those claims with Kaiser.

The government counts on whistleblowers like Ross to recover billions of dollars lost to healthcare fraud each year.

If you would like to learn more information on��the��False Claims Act, what it means to be a whistleblower, or believe you have a case, please��contact��us.��We will connect you with an experienced member of our��whistleblower team.

Read Independent Health to Pay $98M to Resolve Medicare Advantage Fraud Allegations at constantinecannon.com

While many of us are enjoying the slowdown typically accompanying the holiday season, the Department of Justice (DOJ) has been hard at work with a flood of False Claims Act successes to usher in the New Year.�� In the last two weeks alone, DOJ has secured roughly a dozen such settlements, returning roughly $165 million to the government’s coffers.

The False Claims Act is the government’s primary fraud-fighting tool through which the government annually recovers billions of dollars of ill-gotten gains. ��It was enacted during the Civil War to go after war profiteers trying to defraud the Union Army with lame mules, empty munitions, and the like.

While the statute reaches virtually any type of fraud against the government, most of the False Claims Act cases DOJ brings involve healthcare fraud, and more specifically, fraud against Medicare/Medicaid and the other government healthcare programs.�� Indeed, all but three of DOJ’s most recent spate of settlements involve healthcare fraud.�� And notably, four of them involved violations of the Anti-Kickback Statute, a perennial DOJ enforcement priority, which prohibits paying or receiving any form of consideration to induce patient referrals.

Here is a breakdown of these recent settlements:

• December 26 — SoCal Medical Center ($10M). Southern California Medical Center (SCMC), Universal Diagnostic Laboratories, and their owners agreed to pay $10 million to settle DOJ and whistleblower charges of violating the False Claims Act, Anti-Kickback Statute, and Stark Law by paying kickbacks and making self-referrals. ��According to the government, the defendants (i) paid marketers to refer Medicare/Medi-Cal patients to SCMC clinics, (ii) paid third-party clinics through above-market rent payments, complimentary and discounted services to clinic staff, and write-offs of balances owed by patients and clinic staff in exchange for referring Medicare/Medi-Cal patients to UDL for lab tests, and (iii) referred Medicare/Medi-Cal patients from SCMC clinics to UDL for lab tests.

• December 23 — MMM Holdings ($15M). The Puerto Rico-based healthcare provider agreed to pay roughly $15.2 million to DOJ charges of violating the False Claims Act and Anti-Kickback Statute through gift card incentive program.�� According to the government, MMM distributed gift cards to administrative assistants of providers to facilitate the enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan.

• December 23 — Food City ($8.5M). The Virginia-based grocery store chain agreed to pay roughly $8.5 million to DOJ and whistleblower charges of violating the False Claims Act by dispensing through its pharmacies opioids and other controlled substances covered by Medicare/Medicaid that were medically unnecessary and/or without a valid prescription.

• December 23 — Inform Diagnostics ($2.9M). The Texas-based clinical laboratory agreed to pay $2.9 million to DOJ charges of violating the False Claims Act and Anti-Kickback Statute through its purchased test arrangements (PTAs) with several physician practice customers. ��According to the government, Inform Diagnostics used these PTA agreements to induce its physician customers to refer their patients for certain diagnostic services Inform Diagnostics billed to Medicare.

• December 23 — BTW Solutions ($1.5M). The Arkansas-based drug wholesaler for physicians treating workers’ compensation patients agreed to pay $1.5 million to DOJ and whistleblower charges of violating the False Claims Act and Anti-Kickback Statute for improperly billing the Department of Labor’s Workers’ Compensation Programs for certain pain creams.�� According to the government, BTW induced the sale of its pain creams to physicians by offering them at or near cost, billing the government on behalf of the physicians at an exorbitant markup and then splitting the reimbursement with the physicians.

• December 20 — Independent Health ($98M). The Buffalo-based healthcare provider agreed to pay up to $98 million to DOJ and whistleblower charges of violating the False Claims Act by billing Medicare based on invalid diagnosis codes for its Medicare Advantage Plan patients.�� According to the government, Independent Health created a wholly owned subsidiary (called DxID) to retrospectively search medical records to support additional diagnoses to generate higher risk scores, with the ultimate goal of inflating Medicare’s payments to Independent Health.

• December 20 — Cardiology 91�Թ��� ($17.8M). Sixteen separate cardiology practices across 12 states agreed to pay roughly $17.8 million to settle DOJ and whistleblower charges of violating the False Claims Act by overbilling Medicare for diagnostic radiopharmaceuticals used to treat certain cancers and diseases. ��According to the government, the settling cardiology practices regularly reported inflated acquisition costs to Medicare to increase their reimbursement payments.

• December 20 — Rapid Health ($8.2M). The Los Angeles-based pharmacy agreed to pay roughly $8.2 million to DOJ charges of violating the False Claims Act by billing Medicare for Covid-19 tests never provided.�� According to the government, Rapid Health’s processing procedures caused the company to bill Medicare for Covid tests without shipping them to the beneficiary and Rapid Health was aware of the issues but continued to bill Medicare anyway.

• December 19 — Chemonics International ($3.1M). The Washington, DC based international development firm agreed to pay roughly $3.1 million to DOJ charges of violating the False Claims Act by submitting fraudulent claims for payment to the U.S. Agency for International Development (USAID). ��According to the government, Chemonics (i) acted recklessly in failing to detect fraudulent charges by its subcontractor, Zenith Carex, for certain delivery services in Nigeria, and (ii) passed those inflated charges on to USAID under its Global Health Supply Chain-Procurement and Supply Chain Management contract. ��The government claimed Chemonics allowed these overcharges for more than two years because of inadequate financial controls, monitoring, and employee training and support.

• December 18 — Lafayette RE Management ($680K). The New York City based private asset manager agreed to pay $680,000 to DOJ and whistleblower charges of violating the False Claims Act by securing improper loans under the COVID-19 Paycheck Protection Program (PPP).�� According to the government, the company improperly obtained a PPP loan by falsely certifying it was economically necessary due to the uncertainty caused by the pandemic.

• December 16 — Revision Military ($426K). The Vermont-based manufacturer of protective eyewear systems agreed to pay $426,000 to DOJ charges of violating the False Claims Act by selling eyewear products it falsely represented were wholly sourced in the United States.�� The Berry Amendment requires textile components in products sold to the military be sourced from the United States.�� According to the government, however, the company used a non-domestic source of carrying pouches, cases, and/or straps for certain eyewear systems it sold to the military.

Also notable is that whistleblowers initiated roughly half these actions under the qui tam provisions of the False Claims Act, which allow private parties to bring False Claims Act lawsuits on behalf of the government and share in any government recovery.�� Over the past thirty years, whistleblowers have been responsible for originating a majority of False Claims Act cases and have received billions of dollars in whistleblower rewards.

So if you think you might have information relating to potential fraud against the government, please do not hesitate to contact us.�� We will connect you with an experienced member of the 91�Թ���whistleblower team for a free and confidential consult.

Read DOJ Ends 2024 with a Flood of False Claims Act Successes at constantinecannon.com

On December 26, the DOJ that medical clinics, a lab, and the owners will pay $10 million to settle allegations that they submitted false claims to Medicare and California’s Medicaid program, Medi-Cal, in violation of the Anti-Kickback Statute (AKS) and Stark Law (Physician Self-Referral Law).

The defendants include Southern California Medical Center (SCMC), R & B Medical Group Inc., doing business as Universal Diagnostic Laboratories (UDL), Mohammad Rasekhi M.D., (the founder and chief medical officer of SCMC and the co-owner of UDL), and Sheila Busheri (the chief executive officer of SCMC and the co-owner and chief executive officer of UDL). The federally qualified health center, SCMC, operates six clinics in Southern California. UDL is a reference and esoteric lab in Southern California.

According to the government, defendants paid kickbacks to marketers to refer Medicare and Medi-Cal beneficiaries to SCMC clinics in violation of the Anti-Kickback Statute (AKS). They also offered kickbacks to third-party clinics through above-market rent payments, free or discounted services for clinic staff, and forgiveness of balances owed by patients and clinic staff in exchange for referring Medicare and Medi-Cal beneficiaries to UDL for laboratory tests. In addition, defendants referred Medicare and Medi-Cal beneficiaries from SCMC clinics to UDL for laboratory tests, in violation of the Stark Law’s prohibitions on self-referrals.

The AKS prohibits individuals involved in federal health care programs from knowingly and willfully offering or paying any form of remuneration in exchange for referring a patient to, or arranging for the provision of, items or services reimbursed by a federal health care program. Similarly, the Stark Law bars physicians from referring patients for “designated health services,” including “clinical laboratory services,” covered by Medicare or Medicaid to entities with which the physician or their immediate family has a financial relationship, unless a specific exception applies. Payment under federal healthcare programs must comply with the AKS and Stark Law.

Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division said: “Kickback and self-referral schemes risk impairing the judgment of healthcare providers and diminish the reliability of the care that they render. This resolution upholds the department’s commitment to ensuring that Medicare and Medicaid beneficiaries receive care that is untainted by the providers’ financial interest.”

The $10M settlement resolves claims brought under the��qui tam��or whistleblower provisions of the False Claims Act by Ferzad Abdi, Julia Butler, Jameese Smit and Karla Solis. These individuals were former employees or managers of SCMC and UDL. Qui tam��provisions permit a private party (a “relator”) to file an action on behalf of the United States and receive a portion of the recovery. The relators’��qui tam��case is captioned��United States ex rel. Abdi v. Rasekhi, No. 18-cv-03966 (CDCA). Alongside this announcement, the relators separately settled with the defendants for $5 million to resolve additional allegations in their��qui tam��complaint. The relators’ portion of the two settlements has not been announced.

If you would like to learn more about��health care fraud,��the��False Claims Act,��or��what it means to be a whistleblower, please��contact��us.��We will connect you with an experienced member of our��whistleblower team.

Read California Clinics, Lab, and Their Owners Pay $10M to Resolve False Claims, Kickback, and Stark Law Allegations at constantinecannon.com

On December 20, 2024, the government that 16 cardiology practices and physicians across 12 states will pay a total of $17,761,564 to settle claims that they overbilled Medicare for diagnostic radiopharmaceuticals and thereby violated the False Claims Act (FCA).

Diagnostic are “radioactive drugs that healthcare providers use for special imaging tests and for treating certain types of cancer,” per the Cleveland Clinic. ��These cases concern diagnostic radiopharmaceuticals used in cardiac stress tests.�� In certain states, Medicare Part B reimburses providers for diagnostic radiopharmaceuticals based on the provider’s cost to acquire the drugs. ��In these partially intervened FCA cases, which were initiated by two whistleblowers who are doctors, the government that the defendant cardiology practices “regularly reported inflated acquisition costs to Medicare for these drugs.”

Like so many FCA cases, the particular facts of the cases – here, involving the acquisition of and reimbursement for diagnostic radiopharmaceuticals for use in cardiac stress tests – are complicated, but the core allegations boil down to a common pattern of inflating costs and overbilling Medicare.�� In many instances, the key to successfully bringing an FCA case is fitting unique, sometimes complicated facts to a tried-and-true theory of FCA liability.

Principal Deputy Assistant Attorney General Brian M. Boynton, the head of the DOJ Civil Division, said: “The financial stability of federal healthcare programs depends upon providers complying with applicable billing rules. We are committed to ensuring that Medicare funds are expended appropriately and to pursuing those who knowingly fail to do so.”

Matthew M. Graves, the U.S. Attorney for the District of Columbia, applauded the whistleblowers who came forward in this case: “91�Թ��� and providers who overcharge the government and fail to return overpayments compromise our healthcare programs. When people see the wrong and report it, we have the tool we need to put a stop to this type of irresponsible conduct.”

These FCA cases were initiated by two whistleblowers. ��The qui tam or whistleblower provisions of the FCA allow private parties to initiate a lawsuit on behalf of the United States and receive a share of the recovery. ��In these cases, the whistleblowers will receive over $2.7 million from the settlements.

Below is a list of settling medical practices and associated physicians that have agreed to pay the listed amounts:

• Western Kentucky Heart & Lung Associates PSC and Mohammed Kazimuddin ($6,750,000)
• Heart Clinic of Paris P.A. and Arjumand Hashmi ($2,600,000)
• Scranton Cardiovascular Physician Services LLC ($2,369,111)
• Shannon Clinic ($996,856)
• Edward W. Leahey M.D. Professional Association and Edward Leahey ($894,679)
• Metropolitan Cardiovascular Consultants LLC and Ayim Djamson ($846,888)
• Cardiology Center of New Jersey LLC, Mario Criscito, Frank Iacovone, and Sameer Kaul ($740,000)
• Clovis Cardiology Associates LLC and Mahamadu Fuseini ($600,000)
• Family Medical Specialty Clinic PLLC, Melecio Abordo, and June Abadilla ($409,594)
• James R. Higgins M.D. Inc. and James Higgins ($395,537)
• TrustCare Health LLC ($279,407)
• Taj Medical Inc. ($240,000)
• White River Diagnostic Clinic PLC, Margaret Kuykendall, and Seth Barnes ($234,490)
• Veinguard Heart & Vascular Center P.C. and Fareeha Khan ($195,000)
• Boulder Medical Center PC ($160,000)
• Wellspring Cardiac Care P.A. ($50,000).

If you would like to learn more about��health care fraud,��the��False Claims Act,��or��what it means to be a whistleblower, please��contact��us.��We will connect you with an experienced member of our��whistleblower team.

Read 16 Cardiology 91�Թ��� Across 12 States Pay $17.7M to Settle False Claims Act Allegations at constantinecannon.com

On December 12, the DOJ that California’s Oroville Hospital will pay $10,250,000 to the United States and the State of California to resolve allegations that it submitted false claims to Medicare and Medicaid for medically unnecessary inpatient hospital admissions, a kickback and physician self-referral scheme, and the use of incorrect diagnosis codes to maximize reimbursements.��Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.

According to the government, Oroville Hospital admitted patients and billed Medicare and Medicaid for more expensive inpatient hospital stays when inpatient care was not medically necessary and less costly options, such as observation status or outpatient care, would have been appropriate.

The government also alleged that Oroville Hospital illegally incentivized inpatient admissions by paying kickbacks disguised as bonuses to doctors who worked full time at the hospital and were able to use their influence to determine whether patients were admitted. Oroville Hospital’s “bonuses” were based on the volume or value of admissions by these physicians.

The Hospital also allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS). This resulted in the Hospital’s receipt of excessive reimbursements to which it was not entitled.

U.S. Attorney Phillip A. Talbert for the Eastern District of California said, “Hospitals engaging in kickback schemes betray the trust placed in them by their communities and distort care decisions that should be untainted by illegal kickbacks. This settlement demonstrates my office’s commitment to preserving the integrity of public healthcare programs and ensuring that the well-being of patients remains paramount.”

Oroville Hospital entered into a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General. Under the CIA, Oroville is required to implement a risk assessment and internal review process designed to identify and address evolving compliance risks, among other conditions. Additionally, the CIA requires an independent review organization to annually assess the medical necessity and appropriateness of claims billed to Medicare.

The settlement resolves claims under the��qui tam��or whistleblower provisions of the False Claims Act by Cecilia Guardiola. These provisions allow a private party to file an action on behalf of the United States and receive a portion of any recovery. The��qui tam��case is captioned��United States ex rel. Cecilia Guardiola v. Oroville Hosp., Case No. 2:20-CV-1558 (EDCA). Guardiola will receive approximately $1.7 million from the federal settlement amount.

Cases like these rely on the public to report any suspected fraud. If you would like to learn more about��health care fraud,��the��False Claims Act,��or��what it means to be a whistleblower, please contact��us.��We will connect you with an experienced member of our��whistleblower team.

Read Fraud alert! California Hospital Pays $10.25M to Resolve Whistleblower Suit Alleging Medically Unnecessary Inpatient Admissions and Kickbacks at constantinecannon.com

Gen Digital Inc. (formerly Symantec Corp.) knowingly overcharged the General Services Administration. Now the company is required to pay a hefty judgment after a decade of False Claims Act litigation.

Located in Tempe, Arizona, Gen Digital Inc. $55.1 million. The company is required to shell out $16.1 million in damages and $36.8 million in civil penalties, in addition to post-judgment interest and costs.

Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division said: “The department will hold accountable contractors that knowingly overcharge the United States to enrich themselves. The years spent litigating this case and taking it to trial demonstrate the department’s steadfast commitment to protecting taxpayer funds.”

After a four-week bench trial in February and March 2022, the trial court found Symantec liable for making knowing false claims to the United States. It misrepresented its commercial sales practices during the negotiation and subsequent performance of a General Services Administration (GSA) contract. The court determined that Symantec made false statements to GSA during contract negotiations in 2006 and early-2007. The company continued to falsely certify during the contract’s performance through September 30, 2012, that its disclosures of commercial sales practices were complete, accurate, and current. The false disclosures caused GSA to accept and continue to pay higher prices than it would have if it knew about Symantec’s real commercial pricing practices.

The court also determined that Symantec repeatedly violated the Price Reduction Clause, a standard term in Multiple Award Schedule contracts. This clause requires the contractor to maintain GSA’s price position relative to a specified customer or customer category, as agreed upon during contract negotiations. These violations resulted in the United States being denied discounts that it was entitled to.

GSA Deputy Inspector General Robert C. Erickson said, “The United States deserves fair prices and accurate information from GSA contractors. This outcome is the result of hard work and dedication by a cross-functional team from the U.S. Department of Justice, GSA and GSA Office of Inspector General.”

Gen Digital Inc.’s payment concludes the lawsuit filed under the qui tam or whistleblower provision of the False Claims Act, which allows private parties to file suit on behalf of the United States for false claims and receive a portion of the government’s recovery. The Act permits the United States to intervene and take responsibility for litigating these cases. The qui tam case is captioned��United States ex rel. Morsell v. Symantec Corp.,��Civ. A. No.��12-0800 (DDC), and was brought by Lori Morsell, who administered the contract at issue for Symantec. Morsell’s share of the recovery has not been determined yet.

If you have any information about��government contract fraud��or if you would like to learn more about the��False Claims Act��or��what it means to be a whistleblower, please don’t hesitate to��contact��us.�� We will connect you with an experienced member of our��whistleblower team.

Read Gen Digital Pays $55.1M False Claims Act Judgment for Intentional Overcharges to General Services Administration After Government Wins at Trial at constantinecannon.com

Dell Technologies, Inc. and Dell Federal Systems L.P. (“Dell”), based in Austin, Texas, have to pay $2.3 million to settle allegations of violating the False Claims Act. The allegations stem from claims that Dell submitted, and caused the submission of, non-competitive bids to the U.S. Army, resulting in overcharges under the Army Desktop and Mobile Computing 3 (ADMC-3) contract. In addition, Iron Bow Technologies LLC (Iron Bow), headquartered in Herndon, Virginia, has agreed to pay $2.05 million for its involvement in the scheme.

The settlements resolve that from May 2020 to April 2024, Dell operated a deal registration program that provided Iron Bow with preferential pricing to sell specific Dell computer hardware products to the Army in response to solicitations under the ADMC-3 contract. According to the U.S. government, Dell also submitted its own direct bids to the Army for the same solicitations, knowing that the prices would be higher than Iron Bow’s, thus giving the false impression of competition. The United States further alleged that Dell’s practice of submitting higher direct bids influenced the Army’s source selection process, ultimately allowing Iron Bow to overcharge the Army for specific Dell products.

Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division highlighted the importance of competition in government contracts, : “The United States relies on competition to get the best value and price for the American taxpayers. This settlement demonstrates the department’s commitment to hold accountable those who overcharge the government through collusion or other unlawful conduct.”

U.S. Attorney Prim F. Escalona for the Northern District of Alabama said, “Fraud in the government contracting process costs taxpayers untold dollars each year. We will continue to work with our federal law enforcement partners to investigate and pursue those who commit government contracting fraud.”

The Dell settlement also resolves a lawsuit filed under the whistleblower provisions of the False Claims Act, which allows private individuals to sue on behalf of the government if they believe a defendant has submitted false claims for government funds, and to receive a portion of any resulting recovery.

In this case, the settlement provides whistleblower Brent Lillard, an executive of another IT reseller, with a reward of $345,000 as his share of Dell’s recovery. The qui tam case is titled United States ex rel. Lillard v. Dell Technologies Inc., No. 5:20-CV-1613-HNJ (NDAL).

If you have any information about government contract fraud or if you would like to learn more about the False Claims Act or what it means to be a whistleblower, please don’t hesitate to��contact��us.�� We will connect you with an experienced member of our��whistleblower team.

Read Deception Tied with a Bow: Dell and Iron Bow Settle for $4.3M Over False Claims Act Allegations in Army Bidding Scheme at constantinecannon.com