According to the lawsuit, DCA violated the Act by submitting false claims to the Medicare program for the use of Epogen, an intravenous medication that is used to treat anemia afflicting patients with end-stage renal disease.  DCA allegedly billed Medicare for more Epogen than medical personnel actually administered to dialysis patients.  The complaint brought against DCA represents the government’s ongoing battle against health care fraud.

The whistleblower in this case, Laura Davis, took advantage of provisions of the False Claims Act that allow private citizens with knowledge of fraud to bring civil actions on behalf of the U.S. government and, consequently, receive a percentage of the settlement.  Working as a nurse in one of DCA’s facilities, Ms. Davis gained direct and independent knowledge of fraudulent practices.  She will receive $1,314,000 from the settlement agreement as a reward for disclosing DCA’s allegedly fraudulent practices to the Government.

For more information on health care fraud visit our website at www.fraudfighters.net.

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Brachytherapy seeds are a form of radiation therapy.  According to the complaint filed in 2006, Bard allegedly paid illegal kickbacks in numerous forms to both physicians and other customers who used the seeds to perform treatment for prostate cancer.  Specifically, Bard was accused of paying illegal kickbacks in the form of grants, guaranteed minimum rebates, conference fees, marketing assistance, and free medical equipment.  According to the allegations, Bard caused false claims to be submitted to Medicare when hospitals ultimately submitted bills for treatments ordered as a result of a kickback scheme.

The whistleblower in this case, Julie Darity, was a former contracts administration officer for Bard’s Georgia office.  Ms. Darity worked for Bard for 18 years and initially tried to report the kickbacks to her supervisors to no avail.  She then decided to file her qui-tam lawsuit.  Ms. Darity will receive $10,134,600 as her portion of the settlement.

For more information on health care fraud visit our website at http://www.fraudfighters.net/.

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As part of the civil charges brought against Ranbaxy, the company was accused of submitting false claims to federal and state health care programs for drugs manufactured at two of its facilities in Paonta Sahib and Dewas, India.  Ranbaxy allegedly manufactured, distributed and sold drugs whose formulations or specifications did not comply with the FDA-approved manufacturing requirements.  These Ranbaxy drugs, that allegedly were not up-to-par and should not have been sold in the United States, were then sold to federal and state health care patients.  As a result, Ranbaxy was accused of submitting false claims to numerous government agencies including the FDA, Medicaid, Medicare, TRICARE, the Federal Employees Health Benefits Program, the Department of Veterans Affairs, and USAID.

The criminal settlement also relates to the poor oversight and inadequate testing and maintenance of drugs manufactured at the Paonta Sahib and Dewas facilities.  Under the federal Food, Drug, and Cosmetic Act (“FDCA”), a company cannot introduce into interstate commerce any drug that has been adulterated.  Because the Paonta Sahib and Dewas facilities did not comply with various federal regulations and requirements, the drugs manufactured there did not comply with the FDCA.

The whistleblower in this case was Mr. Dinesh S. Thakur.  Mr. Thakur was a former Ranbaxy Director and Global Head, Research Information & Portfolio Manager.  When Mr. Thakur initially learned of the fraud, he tried reporting his findings to company management who failed to take any corrective action.  As a result, Mr. Thakur left Ranbaxy in 2005 and began to develop his case to report to the government.  Mr. Thakur’s information and help with the investigation allowed the government to reach this amazing settlement.  Mr. Thakur will receive 21% of the federal and participating states’ civil settlement, approximately $48.6 million.

The attorneys at Tycko & Zavareei applaud Mr. Thakur’s bravery and persistence.  And all whistleblowers should be encouraged by the substantial reward he received as a result of his efforts.

If you are aware of a company committing fraud, you need to take action like Mr. Thakur in order to stop it.  For more information on bringing your qui-tam lawsuit, contact the attorneys at Tycko & Zavareei today.

The post Department of Justice Announces Largest Ever Drug Safety Settlement with a Generic Drug Manufacturer—$500 Million appeared first on Tycko & Zavareei LLP.

Adventist Health operates hospitals and clinics in California, Hawaii, Oregon, and Washington.  According to their website, the company operates 19 hospitals and over 150 clinics and outpatient centers.  They employ over 21,000 employees, 4,500 medical staff physicians, and 3,000 volunteers.  White Memorial Medical Center, one of Adventist Health’s affiliates, is a teaching hospital in Los Angeles, California.

According to the lawsuit filed against the companies in 2008, Adventist Health was improperly compensating physicians for patient referrals to White Memorial by transferring medical and non-medical supplies and other inventory to the physicians at less than fair market value.  White Memorial was also accused of paying referring physicians at a rate above fair market value for teaching services at the family practice residency program.

The Anti-Kickback Act bans offering, paying, soliciting, or receiving kickbacks of any kind in order to encourage referrals of an item or service covered by federally funded programs.  The Stark Statute bans hospitals from submitting claims to federally funded programs for patient referrals by physicians with improper financial relationships with that hospital.  The allegations brought against Adventist Health and White Memorial violate both these laws which were designed to ensure impartiality in physician referrals and services.

The whistleblowers in this case were Dr. Hector Luque and Dr. Alejandro Gonzalez.  Between 1995 – 1999, Drs. Luque and Gonzalez were members and then partners of White Memorial.  From 1999 to at least 2008 when the complaint was initially filed, they continued to treat patients at White Memorial.  Drs. Luque and Gonzalez will collectively receive $2,839,219 as their portion of the government’s recovery in this settlement.

For more information on Anti-Kickback qui-tam suits and for a free consultation regarding your potential case, contact the experienced attorneys at Tycko & Zavareei LLP today.

The post Adventist Health and White Memorial Medical Center Agree to Settle Anti-Kickback Case for $14.1 Million appeared first on Tycko & Zavareei LLP.

In 2012, the largest health care fraud settlement in U.S. history, as well as the largest payment ever by a drug company, was announced. Pharmaceutical giant GlaxoSmithKline agreed to a $3 billion settlement to resolve both criminal and civil allegations surrounding its promotion of prescription drugs, its failure to report safety data about some of its drugs, and its false drug reporting practices. The numerous whistleblowers in this case could receive anywhere between 15% and 25% of the recovery.

For more information about this settlement, read our blog post.

2.  Abbott – $1.5 billion

In May of 2012, the Department of Justice also announced the second largest payment it will have ever received from a drug company. Abbott Laboratories Inc. agreed to pay $1.5 billion in order to resolve criminal and civil allegations surrounding the company’s off-label marketing of Depakote. The four whistleblowers who brought the civil cases against Abbott will receive an $84 million share of the settlements.

3.  Bank of America/Countrywide - $1 billion

Bank of America agreed to a $1 billion settlement with the government. This is the largest ever False Claims Act settlement relating to mortgage fraud. Bank of America, Countrywide Financial Corporation, and other Countrywide subsidiaries had been under investigation since 2009 and were accused of mortgage origination and underwriting fraud. The whistleblower in this case was Kyle Lagow, an employee of one of Countrywide’s contractors.

For more information about this settlement, read our blog post.

4.  Pfizer – $491 million

Pfizer announced a $491 million charge to settle a case initially filed against Wyeth (a drug company acquired by Pfizer in 2009). Wyeth was accused of paying kickbacks and using off-label marketing for its organ transplant rejection drug, Rapamune. The two whistleblowers in this case were former Wyeth salespeople.

5.  Actavis – $202 million

Actavis Group Hf, one of the world’s largest pharmaceutical manufacturers and distributors, agreed to pay $202.6 million to settle allegations in numerous False Claims Act lawsuits that the company reported inflated prices of its drugs, causing the US and four state governments to overpay. Whistleblower Ven-A-Care of the Florida Keys Inc. received $15.6 million as its relators’ share of the settlements.

6.  McKesson – $190 million

The Department of Justice announced a settlement it reached with McKesson Corporation, a large drug wholesaler, for over $190 million to resolve accusations that the company inflated pricing information for numerous prescription drugs it sold, resulting in Medicaid overpaying for those drugs. McKesson allegedly reported inflated pricing data to First DataBank, a publisher of drug prices that are used by most state Medicaid programs, causing the average wholesale price for these drugs to be significantly higher than they should have been.

For more information about this settlement, read our blog post.

7.  Citigroup – $158 million

Citigroup agreed to pay over $158 million to settle claims that the company’s mortgage unit knowingly and actively approved federally backed home loans for unqualified applicants, and then falsified information regarding these loans to the government. Sherry Hunt was a quality assurance manager in the company’s Missouri office. She received $31 million from the settlement as her reward under the False Claims Act for blowing the whistle on the company.

For more information about this settlement, read our blog post.

8.  Johnson & Johnson – $158 million

One week after the case went to trial in Texas, Johnson & Johnson agreed to a $158 million settlement to resolve False Claims Act allegations that the company engaged in off-label marketing of　Risperdal, an antipsychotic. The off-label marketing involved attempts to sell the drug for uses in children and young adults, even though such uses had not been FDA approved. This is one of many settlements that the company has reached with various state and federal government agencies surrounding the marketing of Risperdal. Allen Jones, the whistleblower in this case, was a Pennsylvania state investigator who uncovered the fraud.

9. IRS Whistleblower – $104 million

In September of 2012, the IRS announced the largest ever whistleblower payment made by the agency. In return for information on his former employer UBS (one of the largest banks in Switzerland), Bradley Birkenfeld was awarded a $104 million service award. Because of the information Mr. Birkenfeld provided to the IRS Whistleblower office, the government recovered over $5.7 billion.

For more information about this settlement, read our blog post.

10. First SEC Whistleblower Award – $50,000

This year, the U.S. Securities and Exchange Commission made its first whistleblower award under the Dodd-Frank program. The program was established in 2011 to incentivize whistleblowers to disclose securities fraud and other violations of securities laws to the SEC. The details of the case are still under seal, but the whistleblower was awarded $50,000, and the court ordered over $1 million in sanctions against the defendants. While not a significant amount, the award has historical significance as the first made under the SEC’s whistleblower program.

For more information about this settlement, read our blog post.

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The Working Group is headed by five co-chairs: Assistant Attorney General for the DOJ’s Criminal Division Lanny Breuer; Acting Assistant Attorney General for the DOJ’s Civil Division Stuart Delery; U.S. Attorney for the District of Colorado John Walsh; Director of the U.S. Securities and Exchange Commission Robert Khuzami; and New York State Attorney General Eric Schneiderman. The primary focus of the Working Group is investigating potential false or misleading statements by market participants in the creation, pooling, and sale of RMBS. The Working Group uses a variety of tools to identify and investigate RMBS offerings likely affected by fraud, such as analyzing private RMBS litigation throughout the country; utilizing risk-based analytics; and convening meetings among investigators, analysts, RMBS market experts, and corporate insiders. Indeed, the Working Group has signaled that it is particularly interested in information about RMBS fraud from corporate insiders due to the difficulty in identifying misconduct in the RMBS market. It has also indicated that it will pursue fraud even if it occurred several years ago. Under the statutes of limitations that apply to the most commonly-used federal laws, regulators likely can reach back to prosecute wrongdoing that occurred a decade ago.

The Working Group commenced its first legal action October 2, 2012, when New York Attorney General Eric Schneiderman, in his role as co-chair of the group, filed a Martin Act lawsuit against JP Morgan Chase Bank for allegedly making false representations and omissions to promote the sale of RMBS to investors. The Martin Act affords the New York Attorney General broad powers in investigating and prosecuting securities fraud. According to the lawsuit, JP Morgan misrepresented the level of care that it used to evaluate the quality of mortgage loans packaged into RMBS before the collapse of Bear Stearns in 2008, resulting in approximately $22.5 billion in losses to RMBS investors to date. Included among those investors are the Government Sponsored Entities Fannie Mae and Freddie Mac, which purchased RMBS from JP Morgan.

Since October 2012, the Working Group has spearheaded three additional enforcement actions, including a lawsuit against Credit Suisse Securities for making fraudulent statements in connection with the promotion and sale of RMBS. Like the lawsuit against JP Morgan, the action was a Martin Act complaint filed by New York Attorney General Eric Schneiderman alleging that Credit Suisse deceived investors regarding the quality of the mortgage loans packaged into the RMBS it sold to investors. The lawsuit also asserts that RMBS sponsored and underwritten by Credit Suisse in 2006 and 2007 have suffered approximately $11.2 billion in losses. Fannie Mae and Freddie Mac were again identified as victims of the fraud.

The Working Group has shown that it intends to take an aggressive approach toward investigating and prosecuting fraud in connection with the sale of RMBS by commencing a number of actions in the few months since its inception. This aggressive approach, coupled with the fact that much of the misconduct it appears to be pursuing occurred many years ago, suggests that we can expect a lot more activity from the Working Group in 2013.

People with non-public information concerning fraud by lenders or underwriters in connection with the packaging and sale of RMBS can bring such information to the attention of the Working Group in a variety of ways. The members of the Working Group enforce three different laws that create an avenue for whistleblowers to provide information to the Government regarding fraud in connection with the sale of RMBS: the False Claims Act; the Dodd-Frank Wall Street Reform and Consumer Protection Act; and the Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA). Broadly speaking, each of these laws effectively targets fraud in different sectors of the market for RMBS. For instance, the False Claims Act prohibits false statements to the Government in connection with the packaging and sale of RMBS. The Dodd-Frank Act, by contrast, applies to RMBS offerings that violate federal securities laws. And FIAFEA renders unlawful fraud in the packaging and sale of RMBS to banks and other federally insured financial institutes.

All three of these laws allow whistleblowers to recover substantial awards if the information provided by the whistleblower results in a successful recovery of funds by the Government. Furthermore, a whistleblower is not limited to pursuing a case under just one of these laws. In fact, given the nature of RMBS fraud and the overlapping jurisdiction of the Working Group membership, it may make sense for a whistleblower to proceed under more than one, or all three, of these laws.

The post The Residential Mortgage-Backed Securities Working Group: What Is It? What Does It Do? What Has It Done? appeared first on Tycko & Zavareei LLP.

Whistleblower Nyle Hooper sued his former employer, Lockheed, under the False Claims Act, accusing the company of, among other things, knowingly underbidding for a contract concerning the United States Air Force’s Range Standardization and Automation (“RSA”) IIA program. The RSA IIA program was intended to “automate, standardize, and modernize software and hardware used to support our nation’s space launch operations.” The RSA IIA program contract was a “cost reimbursement, plus award fee” contract, and the Air Force issued a RFP for bids on the contract. Three companies, including Lockheed, submitted bids. Lockheed’s best and final offer was $432.7 million, but it was not the lowest bid. However, after analyzing all three bids, the Air Force determined that Lockheed’s proposal provided the “best overall value” to the government and awarded it the contract. The government made this decision despite findings by independent consultants that Lockheed “employed realistic methods” in making its cost estimates but “overstated [the] potential for cost savings” and understated the total risk associated with the project.

Hooper, a Senior Research Operations Engineer and, later, a Senior Project Engineer, was assigned to work on the RSA IIA program but did not work on the proposal for the project. However, another Lockheed insider who did work on the proposal testified that “employees were instructed to lower their estimates without regard to actual costs” and that the calculations used to compute the final bid were “bad, bad guesses,” but not false. He also testified that he was instructed to lower the estimated costs “even though the change in cost was not based on any engineering judgment.” When he resisted, he was ignored, and Lockheed subsequently lowered the cost estimates significantly. Taking into account this evidence, the Ninth Circuit held that there was “a genuine issue as to whether Lockheed had actual knowledge, deliberately ignored the truth, or acted in reckless disregard of the truth when it submitted its allegedly false bid for the RSA IIA contract[.]”

On the key issue of whether underbids were “false claims” under the Act, the Ninth Circuit relied upon similar decisions in the First and Fourth Circuits that were based on a “fraud in the inducement” theory. Specifically, under that theory, “FCA liability may attach where there is fraud surrounding the efforts to obtain the contract or benefit status, or the payments thereunder.” Citing the Fourth Circuit’s earlier decision in U.S. ex rel. Harrison v. Westinghouse Savannah River Co., the Ninth Circuit rejected Lockheed’s argument that its cost estimates were merely predictions or opinions because “an opinion or estimate carries with it an implied assertion, not only that the speaker knows no facts which would preclude such an opinion, but that he does know facts which justify it.”

The Ninth Circuit’s opinion is an important milestone in combatting fraud by government contractors. Per Hooper, government contractors must think past the short-term goal of winning the contract by any means necessary, including by knowingly submitting underbids. Hooper reinforces the principle that the government contracting process should be transparent, fair, and honest and that government contractors who do not abide by those standards may be held accountable for their actions, including through qui tam cases brought under the False Claims Act by company whistleblowers.

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As late as 1980, no privately-run prisons existed in the United States. Today, over 100,000 prisoners are held in such facilities and privately-run immigration detention facilities, the latter largely located in Florida and along the southern border with Mexico. Contracts for operation of detention centers uniformly require private companies to maintain minimum detainee treatment standards outlined in federal and state regulations. For example, in the immigration detention context, Immigration and Customs Enforcement (“ICE”) maintains “Detention Standards” that require, inter alia, adequate food, medical care (including mental health and dental care), recreation opportunities, sanitation, clothing, and personal hygiene items. Of course, all Constitutional requirements are also in effect at privately run but publicly funded detention centers. To the extent companies mistreat prisoners or detainees, provide substandard medical care, or even provide substandard food (or not enough of it), those companies may be defrauding Federal, state or local governments.

Unfortunately, numerous studies and news reports indicate that these abuses may not be uncommon. The two largest and most influential prison companies in the United States are the GEO Group (formerly part of Wackenhut) and Corrections Corporation of America (“CCA”). Numerous complaints against both have been made public in recent years. GEO, which contracts with 13 states, the Federal Bureau of Prison, the U.S. Marshals Service, and ICE, has been the subject of governmental enforcement action at least once. In March, 2012, the U.S. Department of Justice (“DOJ”) announced, after a comprehensive investigation, that a Mississippi facility run by GEO had systematically violated the constitutional rights of detained youths. According to DOJ, evidence revealed “systematic, egregious and dangerous practices” at the facility. GEO immediately withdrew from its contract. While no civil litigation has been publicly disclosed, it is likely that such violations breached the contract GEO had with the State of Mississippi.

CCA has had trouble too. In 2005 the Florida Attorney General’s Medicaid Fraud Control Unit issued a report outlining wrongdoing committed by CCA at facilities it ran in Citrus and Bay Counties, Florida. According to the report, CCA submitted claims to the State of Florida Medicaid program–even though the terms of CCA’s contract required CCA itself to pay detainees’ medical costs, and even though Medicaid is not available as a payment source for outpatient medical services provided to inmates in Florida. The state alleged that CCA employees had instructed outside providers, “both verbally and in writing, to bill Medicaid for inmate care before submitting a bill to CCA.” CCA agreed to a $300,000 settlement with the state to settle litigation under the Florida False Claims Act.

Even at non-privatized prisons and detention centers, many functions essential to the facility’s operation may be privatized. Over the past decade, Federal, state, and local governments have turned to private companies in an effort to cut the cost of feeding, housing, transporting, and treating detainees. This, too, creates an opportunity for fraud. For example, a whistleblower brought a qui tam case under New Jersey’s false claims statute, alleging that from 1996 through 2005, a company called AllCare, which furnished dental services to inmates of New Jersey’s prisons, submitted false claims for payment. State ex rel. Hayling v. Corr. Med. Services, Inc., 28 A.3d 1246, 1249 (N.J. App. Div. 2011). While that case was dismissed due to a statute of limitations obstacle, it may be indicative of similar misconduct at other facilities. In another example, a 2012 class action lawsuit on behalf of female prisoners incarcerated in a Virginia prison alleged that a health services contractor at the prison, Armor Correctional Health Services Inc., had failed to provide constitutionally adequate medical care. The lawsuit described health care conditions so inadequate that the plaintiffs had suffered prolonged physical pain and the risk of premature death. The allegations, if true, could also amount to contractual violations and fraud against the state of Virginia.

In the prison food services realm, the most prominent company contracting with prisons and detention facilities is Philadelphia-based Aramark Correctional Services. Aramark provides food and commissary services at over 600 detention facilities nationwide, and, according to its website, serves over 1,000,000 meals a day. Complaints from prisoners at Aramark facilities regarding food quality have abounded in recent years. Aramark was accused of billing the Florida Department of Corrections for meals that were never prepared or eaten and failing to pass on the cost savings for serving less expensive food items to inmates, according to an analysis conducted by Florida’s inspector general. Aramark announced under pressure in September 2008 that it was withdrawing from its contract with the Florida Department of Corrections. Even before the contract’s termination, Aramark had been fined over $241,000 in 2008 alone for foodservice contract violations, including insufficient staffing.

In sum, the improper operation of privately-run prisons and detention centers by contractors, and the provision of substandard services at both private and public prisons, can endanger detainees and may defraud Federal, state and local governments. The federal False Claims Act and state whistleblower statutes are important tools in the fight against substandard detainee treatment and misuse of taxpayer funds. Individuals with knowledge for this type of misconduct-including current or former employees of the contractors-could bring qui tam whistleblower lawsuits, which would expose and stop the wrongdoing. By so doing, these whistleblowers also could receive the substantial monetary awards available under federal and state statutes.

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Two lesser-known federal statutes provide the possibility of hefty awards for any whistleblower that discloses information to the Government leading to a conviction for pollution of U.S. waters: the Act to Prevent Pollution from Ships (“APPS”) and the Rivers and Harbors Act of 1899. Together, these statutes cover a broad range of conduct, not just related to the illegal dumping of oil, but to the release of any pollutant into the air or U.S. waters. Under what is commonly referred to as these statutes’ “bounty provisions,” whistleblowers can receive up to 50% of any fine levied as a result of a conviction. Although the APPS leaves the court with discretion as to the exact award amount, the Rivers and Harbors Act explicitly mandates that a whistleblower must receive 50% of any fine unless the conviction results from a multicount indictment.

A whistleblower’s potential recovery under these statutes can thus be significantly greater than that provided for by the False Claims Act, under which awards range from between 15-30% of any recovery by the Government depending on a variety of factors. With the availability of fines as high as $25,000 per day for violations of the APPS and Rivers and Harbors Act, whistleblower awards can also quickly reach the million dollar mark. In addition, unlike the APPS and many other environmental statutes, which often require willful or knowing violations, the Rivers and Harbors Act is a strict liability criminal statute. Although the Government is responsible for prosecuting a violation of either statute, whistleblowers are entitled to retain counsel to protect their right to an award, both by participating in legal proceedings, including the examination of witnesses, as well as by taking various actions to collect the whistleblower’s award.

The most oft-invoked section of the Rivers and Harbor Act is known as the Refuse Act, 33 U.S.C. § 407, which imposes misdemeanor criminal liability for the discharge of “refuse” into U.S. navigable waters or on their banks without a permit. Reasoning that “[m]ore comprehensive language would be difficult to select,” the Supreme Court has interpreted the term “refuse” to include “all foreign substances and pollutants apart from those ‘flowing from streets and sewers and passing therefrom in a liquid state’ into the watercourse.” See U.S. v. Standard Oil Co., 384 U.S. 224 (1996). The Exxon Valdez case resulted in a plea of guilty to violations of the Refuse Act. Other sections of the Rivers and Harbors Act that also trigger its bounty provision prohibit the obstruction of marine transportation in U.S. waterways by, for example, sinking or unlawfully anchoring a ship, floating loose timbers, or impairing U.S. marine improvements, such as jetties, bulkheads, wharfs, and piers. 33 U.S.C. §§ 408, 409, 414, 415.

The APPS imposes class D felony liability on any person who knowingly violates the MARPOL Protocol (the International Convention for the Prevention of Pollution from Ships), Annex IV to the Antarctic Protocol, or the APPS and its implementing regulations. MARPOL regulates all forms of pollution from ships, including emissions into the air. While courts have held that the pollution of international waters (as opposed to U.S. waters) is not within the jurisdiction of the United States, the APPS can nevertheless be used to deter such conduct by prosecuting intentional failures to maintain accurate oil record books. In February of 2011, for example, a seaman docked in the port of Baltimore turned over hundreds of cell phone photographs to the U.S. Coast Guard showing that his employer illegally dumped oil by hooking up a hose, known as a “magic pipe,” to bypass required oil distillation equipment and had then falsified records to conceal this misconduct. The employer ultimately pleaded guilty and agreed to pay approximately $1 million in fines, half of which was paid to the whistleblower.

By some accounts, 10-15% of the worldwide commercial shipping fleet is estimated to illegally dump using these “magic pipes,” which one Department of Justice attorney who frequently prosecutes these cases has called “an epidemic.” Since the bounty provision was added to the APPS in 1987, a growing number of these cases have been prosecuted across the country in port cities like Baltimore. Whistleblowers under the APPS and the Refuse Act have included not only seamen, but also cruise ship passengers and other individuals who had cause to believe a violation of either statute had occurred.

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In order for hospice care to be reimbursed by Medicare, patients are required to have a life expectancy of, at most, six months.  Medicare patients admitted to hospices do not receive treatments to cure their diseases; instead, they receive treatment to provide comfort and relief from the symptoms of a terminal illness.

The qui tam lawsuit, filed against the companies in 2010, accused the defendants of submitting false claims to Medicare for patients who did not need to be admitted to the Hospice of Arizona.  Additionally, they were accused of submitting false claims by overbilling Medicare for some of the hospice’s services.

Ellen Momeyer, the whistleblower in this action, was a former Hospice of Arizona employee.  Pursuant to the whistleblower provisions of the False Claims Act, whistleblowers or relators can receive up to 30% of a settlement.  In this case, Momeyer will receive $1.8 million (approximately 15%) as her relator’s share of the settlement.

Medicare fraud is a serious and rampant problem that requires the help of courageous whistleblowers to root it out.  For more information on Medicare fraud and filing a potential whistleblower action, contact the attorneys at Tycko & Zavareei today.

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