FORMER DOJ SENIOR COUNSEL FOR HEALTH CARE FRAUD, NOW REPRESENTING WHISTLEBLOWERS
- Former Senior Counsel for Health Care Fraud at the U.S. Department of Justice (DOJ)
- Member of Taxpayers Against Fraud https://www.taf.org/
- Represented Whistleblowers at another prominent whistleblower firm
- Former Member of DOJ-appointed Independent Corporate Compliance Monitor and Auditor for Volkswagen under its Plea Agreement and Consent Decree with DOJ, helped VW to establish a first-time Office of Compliance and Whistleblower (WB) System and to evaluate complaints filed through the new WB System
- Enforced these laws at the Justice Department:
- The False Claims Act/The Whistleblower Law
- The Stark Law—prohibiting financial rewards for physician-self referrals
- The federal Anti-Kickback Law—prohibiting financial rewards for referrals
- Deep health care fraud expertise:
- All federal health care programs (Medicare, Medicaid, TRICARE, FEHB)
- Analyzing complex health care data sets, including Medicare and Medicaid payment data and trends, to identify potentially fraudulent practices
- Enforced anti-fraud laws and represent whistleblowers across industries: pharmaceutical manufacturers, health care providers, hospitals, physicians, physician groups, laboratories, managed care, pharmacies, hospice and nursing home providers, financial institutions, government suppliers, small businesses, automotive, small businesses, and defense contractors.
- Investigations involving parallel criminal proceedings
- Investigations involving compliance and whistleblower programs of health care organizations, including those subjected to Corporate Integrity Agreements and oversight by Independent Review Organizations, as required by the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG)
- Prior to joining the Justice Department, worked in private practice at two international law firms. Handled complex commercial litigation and administrative trials.
- Handled pro bono matters, including the successful defense of an individual seeking asylum and acting as guardian ad litem on behalf of three children.
Representative matters involved violations of the False Claims Act, the Anti-Kickback Statute and Stark Law and all federal health care programs (Medicare, Medicaid, TRICARE, FEHB):
- A $300 million False Claims Act settlement, a 5 year Corporate Integrity Agreement, and a criminal guilty plea to obstruction of justice and other charges by a drug company that allegedly illegally marketed several drugs (Selective Serotonin Reuptake Inhibitor drugs or SSRI) with serious side effects that it knew were not approved by the FDA to treat depression in children and adolescents; used high pressure sales tactics with physicians to get them to prescribe these drugs and paid the doctors cash and other kickbacks disguised as grants or consulting fees, expensive meals and lavish entertainment.
- A $45 million payment, a 5 year Corporate Integrity Agreement, and a criminal guilty plea by a pharmaceutical manufacturer involving off-label marketing of a steroid drug with dangerous side effects.
- A $38 million settlement alleging that a drug company paid kickbacks to physicians to induce them to write drug prescriptions for patients who had heart conditions, fibromyalgia, or dementia.
- A $35 million settlement and a guilty plea by a drug company that allegedly misled patients and physicians about the intended uses of a drug designed to treat patients with a rare disorder that negatively impacted their cholesterol levels.
- As lead trial counsel on a several-month health care fraud trial in 2015, one of the most complex False Claims Act trials in recent history.
- A $26 million settlement involving a Medicare Managed Care contractor that failed to provide required screening, assessment and case management for adults, and children with special health care needs and submitted false data to a cash-strapped state Medicaid program to avoid penalties.
- A nearly $20 million settlement involving an oncology provider for alleged fraudulent billing for medically unnecessary urine tests involving bladder cancer and for paying doctors bonuses to order these tests.
- A $12 million settlement in just under 9 months—from the filing of the case to settlement—involving a physician and a cancer center that allegedly billed for radiation oncology services that were not medically necessary for the patient, were not properly supervised by doctors, or were upcoded—a practice in which the provider bills for procedures that are paid at a higher rate when, in fact, those procedures were not actually performed.
- An $8 million dollar settlement involving a radiology center that allegedly gave patients an intravenous chemical called contrast dye during MRI scans without proper physician supervision and paid doctors kickbacks for referring patients for medical procedures.
- A $7 million dollar settlement involving a hospital that allegedly submitted Medicare claims for fraudulent oncology services.
- A resolution with a physician and his practice group involving a precedent-setting period of exclusion from participating in the federal health care programs for allegedly performing unnecessary, highly invasive peripheral artery procedures on patients.
- Numerous settlements involving hospice companies that allegedly certified patients as terminally ill, thereby preventing them from receiving curative care, and fraudulently submitted inflated Medicare claims on behalf of other patients. The cases resulted in trial, criminal indictments of an executive and other hospice employees, and millions of dollars in recoveries.
- Millions of dollars in settlements in cases involving providers, including a large medical center, for alleged fraudulent administration of intensity modulated radiation therapy (IMRT)—a sophisticated radiation treatment for specific types of cancer where extreme precision is required to spare patients’ surrounding organs or healthy tissue.
- A settlement involving a defense contractor for charging unallowable costs on an army contract related to identity intelligence analysis support services.
- Millions of dollars in settlements in cases relating to alleged fraud in the contracting process involving the General Services Administration (GSA) and the U.S. Small Business Administration (SBA), which undermined the integrity of the government procurement process.