Whistleblower

A settlement has been reached in a whistleblower class action lawsuit brought against Jackson-Madison County General Hospital who is accused of overbilling Medicare and Medicaid for certain cardiac procedures.

The whistleblower's portion of the settlement was not disclosed.

The lawsuit, filed in 2007, alleged that Jackson-Madison County General Hospital placed cardiac stents in patients when the procedure was not required, together with other cardiac procedures that were deemed not medically necessary. The hospital, according to allegations stemming from an investigation and a whistleblower healthcare fraud lawsuit, then billed Medicare and Medicaid.

A settlement has been reached in a whistleblower class action lawsuit brought against Dey Inc, Dey Pharma LP (formerly known as Dey, LP) and Dey LP Inc.  They are accused of  engaging in a scheme to report false and inflated prices for numerous pharmaceutical products.

The whistleblowers will receive a share of approximately $67.2 million.

The initial whistleblower complaint against Dey Inc was filed in the Southern District of Florida on August 13, 1997. Eventually the United States interevened in August 2006.  The United States alleged that Dey reported false prices for the following drugs: Albuterol Sulfate, Albuterol MDI, Cromolyn Sodium and Ipratropium Bromide. The difference between the resulting inflated government payments and the actual price paid by health care providers for a drug is referred to as the “spread.”  The larger the spread on a drug, the larger the profit for the health care provider or pharmacist who is reimbursed by the government.  The government alleges that Dey created artificially inflated spreads to market, promote and sell the drugs to existing and potential customers.  Because payment from the Medicare and Medicaid programs was based on the false inflated prices, the government alleged that Dey caused false and fraudulent claims to be submitted to federal health care programs and, as a result, the government paid millions of claims for far greater amounts than it would have if Dey had reported truthful prices.

A settlement has been reached in a whistleblower class action lawsuit brought against John D. Archbold Memorial Hospital Inc who is accused of submitting false claims to the state of Georgia’s Medicaid program.

The whistleblower will receive $695,151 from the settlement amount.

The whistleblower case, filed in 2008, alleged that between November 2002 and July 2008, the Thomasville, Ga.-hospital made false representations to the Georgia Department of Community Health, the state agency that administers the Medicaid program in Georgia, that it was a public hospital for Medicaid purposes in order to increase the amount of Medicaid funds provided to the hospital. Under Medicaid rules, only public hospitals may participate in the Medicaid Upper Payment Limit (UPL) program. In addition, public hospitals receive additional Disproportionate Share Hospital (DSH) program funds that are not available to private hospitals. Contrary to its certification to the Georgia Department of Community Health, Archbold Memorial was in fact a private hospital, and as a result received millions of dollars in UPL and DSH funds to which it was not entitled.

A settlement has been reached in a whistleblower class action lawsuit brought against St. Joseph Medical Center (SJMC) in Towson, MD who is accused of paing unlawful remuneration in a series of professional services contracts with MidAtlantic Cardiovascular Associates (MACVA).

The whistleblowers recovery amounts were not disclosed.

The original lawsuit was filed in June 2010 and it alleged that SJMC paid kickbacks to MidAtlantic under the guise of professional services agreements, in return for MACVA’s referrals to the medical center of lucrative cardiovascular procedures, including cardiac surgery and interventional cardiology procedures, over the period from Jan. 1, 1996, to Jan. 1, 2006. The settlement agreement resolves issues relating to 11 professional services agreements between MidAtlantic and St. Joseph under which MACVA received payments above fair market value, for services not rendered or that were not commercially reasonable and were entered into for the purpose of inducing referrals by MACVA to SJMC.

Under the settlement the hospital also agrees to settle allegations that it received from federal health benefit programs between Jan. 1, 2008, and May 12, 2009, for medically unnecessary stents performed by Mark Midei, M.D., a one time partner in MACVA who was later employed by SJMC.

A settlement has been reached in a whistleblower class action lawsuit brought against PC Specialists Inc., doing business as Technology Integration Group (TIG), who is accused of inflating prices of computers sold through another company to the National Nuclear Security Administration (NNSA).

The whistleblower's recovery amount has not been determined.

The case was filed in 2014 and alleged that from 2003 to 2013, TIG sold Dell computers to Sandia Corporation for resale to the United States under Sandia’s contract with the NNSA.  The NNSA purchased the computers for use at Sandia National Laboratories.  The United States alleged that TIG knowingly inflated the amounts it charged Sandia by failing to give credits for rebates and discounts it received from Dell as required by its contract and causing false claims to the government for the inflated prices.  

In a separate but related matter, in April 2015, TIG entered into a non-prosecution agreement with the U.S. Attorney’s Office of the District of New Mexico regarding allegations that three employees in TIG’s Albuquerque branch office engaged in a scheme to defraud the United States by inflating the amounts it charged Sandia for computers.  The non-prosecution agreement in that matter required TIG to terminate the employment of the three employees in its Albuquerque branch office – a vice president, a senior account executive and an accounts executive – who participated in and profited from the scheme.  The non-prosecution agreement also required TIG to retain and pay for an independent monitor selected by the U.S. Attorney’s Office who is responsible for monitoring TIG’s compliance with the agreement, and TIG policies, procedures and training relating to federal government contracts over the agreement’s three-year term. 

A settlement has been reached in a whistleblower class action lawsuit brought against Mercy Health Springfield Communities, formerly known as St. John’s Health System Inc., and Mercy Clinic Springfield Communities, formerly known as St. John’s Clinic.  They are accused of engaging in improper financial relationships with referring physicians.

The whsitleblower will receive $825,000 from the recovery.

Originally filed in 2013, the lawsuit allges that the defendants submitted false claims to the Medicare program for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic.  Federal law restricts the financial relationships that hospitals and clinics may have with doctors who refer patients to them.

A settlement has been reached in a whistleblower class action lawsuit brought against CDI Corporation who is accused of charging the military for work not actually performed. 

Under the terms of the settlement, the whistleblower will receive $360,750.

The whistleblower cae was originally filed in 2005. The United States alleged that CDI wrongfully charged labor costs to work orders under military aircraft engine contracts for The General Electric Company (GE). The civil investigation examined CDI’s labor and billing records from Jan. 15, 2001, to Dec. 31, 2006. The civil investigation found that during this time period, CDI directed the mischarging of employees’ labor costs to purchase orders that would be reimbursed by the U.S. military. In fact, the employees did not perform the work billed to those military projects. CDI entered these mischarged labor costs in increments of 0.5 hours or less to evade detection.

A settlement has been reached to resolve False Claims Act allegations against Cisco Systems and Westcon Group North America (formerly d.b.a. Comstor). They are accused of making misrepresentations to the General Services Administration (GSA) and other federal agencies.

Under the terms of this agreement, the United States has agreed to dismiss a whistleblower case filed in 2004.

The United States alleged that Cisco and Westcon knowingly provided incomplete information to GSA contracting officers during negotiations in regard to Westcon's contract with the GSA, which resulted in defective pricing of Cisco products and submission of false claims to the United States.

A settlement has been reached in a whistleblower class action lawsuit brought against El Centro Regional Medical Center who is accused of defrauding Medicare.

The whistleblower will receive $375,000.

The original lawsuit was filed in May 2006. The United States alleged that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient “observation” basis or as emergency room visits.

A settlement has been reached in a whistleblower class action lawsuit brought against St. Jude Medical Inc, Parma Community General Hospital, and Norton Healthcare. They are accused of violating the False Claims Act in relation to certain illegal kickbacks to secure heart-device business.

Under the terms of the settlement, St. Jude, headquartered in St. Paul, Minn., will pay $3,725,000. Parma Community General Hospital, located in Parma, Ohio, will pay $40,000, and Norton Healthcare in Louisville, Ky., will pay $133,300. The government asserted that Parma and Norton were recipients of improper rebates from St. Jude.  The reward for the whistleblower will be $640,050.

The whistleblower case was originally filed in 2006. The United States alleged that St. Jude paid illegal kickbacks to two hospitals to secure heart-device business and that these kickbacks caused false claims to be submitted to federal health care programs in violation of the False Claims Act. The kickbacks included alleged rebates that were "retroactive" and paid based on a hospital’s previous purchases of St. Jude heart-device equipment and rebates that St. Jude paid for purchases of heart-device equipment sold by its competitors to induce purchases of similar equipment from St. Jude in the future.