Healthcare Fraud

A settlement has been reached in a whistleblower class action lawsuit brought against EndoGastric Solutions Inc who is accused of misleading health care providers about how to bill federal health care programs for a procedure using a device manufactured by the company and by paying kickbacks.

As part of the settlement, the whistleblower will receive $945,000.

The lawsuit was filed in June 2012.  The government's case included alleagations that EndoGastric Solutions knowingly caused health care providers to bill for the less invasive EsophyX procedure using codes applicable to the more invasive procedure, which provided for a higher level of reimbursement. As a result, federal health care programs allegedly paid more than they should have for the procedures using EsophyX.

The government also alleged that EndoGastric Solutions knowingly paid illegal remuneration to certain physicians for participating in patient seminars and co-marketing agreements to induce them to use EsophyX, in violation of the Federal Anti-Kickback Statute.

A settlement has been reached to resolve False Claims Act Violations by Omni Surgical LP, doing business as Spine 360, and Dr. Jamie Gottlieb, an Indiana spinal surgeon.  They are accusation is that Spine 360 paid illegal kickbacks to Gottlieb to induce him to use the company’s products.

The settlement resolves allegations that Spine 360 made payments between 2007 and 2009 to an entity controlled by Gottlieb.  Although the payments were purportedly made pursuant to a series of intellectual property agreements, the United States contended that those agreements were shams, and that the payments were intended to compensate Gottlieb for using Spine 360 products in his surgeries.

A settlement has been reached in a whistleblower class action lawsuit brought against EBI LLC (dbaBiomet Spine, Bone Healing Technologies and Biomet Inc) who are accused of paying kickbacks to induce use of its bone growth stimulators and billing federal health care programs for refurbished stimulators.

The whistleblower's share of the settlement has not been determined. 

The whistleblower originally filed this case in April of 2009.  In the government's case aganst the Biomet companies, they alleged that, from 2001 to 2008, EBI paid staff at doctors’ offices to influence doctors to order its bone growth stimulators.  These payments were allegedly provided pursuant to personal service agreements with staff members. The United States concluded that these payments violated the Anti-Kickback Act and resulted in false billings to various federal health care programs, including Medicare.  The settlement also resolves EBI’s disclosure that it received federal reimbursements for bone growth stimulators that had been refurbished.    

A settlement has been reached in a whistleblower class action lawsuit brought against Medtronic Inc who is accused of causing certain physicians to submit false claims to federal health care programs for a medical procedure known as “SubQ stimulation”.

According to the settlement, the whistleblower will receive $602,000.

The whistleblower filed this action in 2009 and alleged that from 2007 through 2011, Medtronic knowingly caused dozens of physicians located throughout more than 20 states to submit claims to Medicare and TRICARE for investigational medical procedures known as SubQ stimulation that were not reimbursable.  In these procedures, Medtronic’s spinal cord stimulation devices were placed just beneath the skin near an area of pain, most often in the lower back, where the devices could provide electrical impulses to create a “tingling” sensation intended to alleviate chronic pain.  The government alleged that even though the safety and efficacy of SubQ stimulation had not been established as required by the Food and Drug Administration (FDA), the company promoted this procedure by, among other strategies, arranging to have physician-customers attend Medtronic-sponsored “on-site training programs” regarding the use of Medtronic spinal cord stimulation devices for SubQ stimulation.  

A settlement has been reached in a whistleblower class action lawsuit brought against AstraZeneca LP who is accused of engaging in a kickback scheme in violation of the False Claims Act.

The lawsuit was filed by former AstraZeneca employees who will collectively receive $1,422,000 as their share of the government's recovery.

The whistleblower case, filed in October 2010, alleged that AstraZeneca agreed to provide remuneration to Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities related to those Medco formularies.  The government further alleged that AstraZeneca provided some or all of the remuneration to Medco through price concessions on drugs other than Nexium, namely on Prilosec, Toprol XL and Plendil.  The complaint contended that this kickback arrangement between AstraZeneca and Medco violated the Federal Anti-Kickback statute, and thereby caused the submission of false or fraudulent claims for Nexium to the Retiree Drug Subsidy Program.

A settlement has been reached in a whistleblower class action lawsuit brought against two cardiovascular disease testing laboratories, Health Diagnostics Laboratory Inc. and Singulex Inc.  They are accused of paying remuneration to physicians in exchange for patient referrals and billing federal health care programs for medically unnecessary testing.

The settlement amount is broken down as follows,  Health Diagnostics will pay $47 million and Singulex will pay $1.5 million. The whistleblowers’ share of the settlements has not been determined.

The government's case stemmed from a series of whistleblower lawsuits, the first of which was filed in June of 2011.  The lawsuits alleged that three of the laboratories metioned in the suit induced physicians to refer patients to them for blood tests by paying them processing and handling fees of between $10 and $17 per referral and by routinely waiving patient co-pays and deductibles.  In addition to that allegation, two of the laboratories are accused of conspiring with a marketing company to offer these inducements on behalf of those labs. As a result, physicians allegedly referred patients to those three labs for medically unnecessary tests, which were then billed to federal health care programs, including Medicare.

A settlement has been reached in a whistleblower class action lawsuit brought against Medco Health Solutions Inc. who is accused of engaging in a kickback scheme in violation of the False Claims Act.

The whistleblowers' share of the settlement has not been determined.

The case, filed in 2013, alleged that Medco solicited remuneration from AstraZeneca, a pharmaceutical manufacturer, in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  The United States alleged that Medco received some or all of the remuneration from AstraZeneca in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  The United States contended that this kickback arrangement between Medco and AstraZeneca violated the Federal Anti-Kickback statute, and thereby caused the submission of false or fraudulent claims for Nexium to the Retiree Drug Subsidy Program. 

A settlement has been reached in a whistleblower class action lawsuit brought against Citizens Medical Center who is accused of engaging in improper financial relationships with referring physicians.

The whistleblowers will collectively receive a $5,981,250 share of the government's recovery.

Filed in October 2013, the case alleged that the hospital provided compensation to several cardiologists that exceeded the fair market value of their services.  The settlement also resolved allegations that the hospital paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals.

A settlement has been reached in a government lawsuit brought against Robinson Health System Inc who is accused of violations of the False Claims Act, the Anti-Kickback Statute and the Stark Statute by allegedly engaging in improper financial relationships with referring physicians.

The case alleged specifically that Robinson's financial relationships with a number of referring physicians included management agreements that Robinson had with two physicians groups. These physicians allegedly failed to provide sufficient bona fide management services to have justified the payments that they received. Robinson disclosed these issues to the government.

A settlement has been reached in a whistleblower class action lawsuit brought against Amedisys Inc who is accused of submitting false home healthcare billings to the Medicare program and coordinating patient care services at below market prices for referring physicians.

The $150 settlement resolves allegations from seven whistleblower lawsuits in federal court.

Filed in 2010, the case makes claims that between 2008 and 2010, certain Amedisys offices improperly billed Medicare for ineligible patients and services. Additionally the lawsuit alleges that Amedisys billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound and otherwise misrepresented patients’ conditions to increase its Medicare payments. These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients.  The case also accuses Amedisys of maintaining improper financial relationships with referring physicians.  More specifically the case alleges, that Amedisys’ financial relationship with a private oncology practice in Georgia – whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices – violated statutory requirements.