Archive for January, 2014

Bucks County Hospital Settles For $2.3M

Monday, January 20th, 2014

Langhorne-based St. Mary Medical Center has agreed to pay the federal government more than $2.3 million to resolve allegations that it overpaid doctors who referred patients to the hospital.

The 15 doctors who received the overpayments referred patients covered by Medicare and Medicaid, according to the government, resulting in violations of the federal False Claims Act.

St. Mary voluntarily disclosed the alleged overpayments.  After an investigation, the hospital agreed to pay $2,339,224.70 to resolve the matter.

DOJ In 2013: Mo’ Problems, Mo’ Money

Monday, January 20th, 2014

The Department of Justice raked in more than $8 billion in fiscal year 2013, scoring big on a variety of civil and criminal enforcement actions.

Almost $6 billion came from civil actions, with $3.2 billion related to health-care fraud.  Big hauls included $800 million from a settlement with Abbott Laboratories and about $750 million from a settlement with Amgen.

Whistleblower Collects $20M From IRS

Monday, January 20th, 2014

With due respect to our friends at the Internal Revenue Service, most people would rather not hear from them this year.  (Well, unless they have a hankering to discuss “Party of Five” with an IRS agent. But we digress.)

But we’re guessing the whistleblower who recently received $20 million for a tip he gave the IRS in 2006 feels differently.  The reward, paid in late 2013, is among the largest ever in the history of the IRS whistleblower program.

The IRS program allows whistleblowers with information about frauds that cause more than $2 million in losses to the U.S. treasury to recoup 15 to 30 percent of the money recovered by the government.  If the whistleblower is dissatisfied with the percentage awarded by the government, he may challenge that decision in U.S. Tax Court.

In this case, though, we’re guessing the whistleblower is satisfied with the reward.  (Well, unless he or she is a big Lacey Chabert fan.  But we digress.)

CMS Proposes Rule That Could Leave Antidepressants ‘Unprotected’

Monday, January 20th, 2014

The Centers for Medicare & Medicaid Services released a proposed rule this week that could allow Medicare Part D plans to curtail coverage for antidepressants.

The rule would remove antidepressants and immunosuppressants from so-called “protected” status in 2015 and would potentially ax antipsychotics from the list a year later.

For classes of drugs that are on protected status, plans must carry all “or substantially all” of the drugs in that class on their formularies.

The new rule will be published in the Federal Register on January 10.  Comments are due by March 7.

Feds Take Bite Out Of Big Apple

Wednesday, January 15th, 2014

New York City will pay the federal government more than $1 million to settle a whistleblower claim alleging fraud by the city’s schools.

The $1.375-million settlement, announced Monday, resolves allegations that the New York Education Department submitted false claims for Medicaid services not provided to special-education students.

The suit was brought by Dana Ohlmeyer, a counselor in the city schools.  She will get 15 percent of the settlement, or $206,250.  The city will also pay $40,000 to cover Ohlmeyer’s legal fees and costs.

Government Intervenes In Lawsuits Against Health Management Associates Inc. Hospital Chain Alleging Unnecessary Inpatient Admissions And Payment Of Kickbacks

Monday, January 13th, 2014

For the full press release, please see:
http://www.justice.gov/opa/pr/2014/January/14-civ-037.html

Allergan Faces Whistleblower Lawsuit Alleging Payment Of Kickbacks To Induce Prescriptions For Lucrative Eye Care Drugs

Tuesday, January 7th, 2014

Allergan Inc. paid kickbacks to induce prescriptions of the pharmaceutical company’s eye care drugs, according to allegations raised in a lawsuit unsealed on December 17, 2013 in federal court in Philadelphia. The lawsuit alleges that Allergan provided illegal inducements to eye care professionals throughout the United States, including business consulting services through its team of Eye Care Business Advisors, and that Allergan explicitly requested that in exchange for those benefits, eye doctors and optometrists prescribe Allergan’s drugs.

According to the complaint, Allergan touted that its free consulting services would boost the profitability of eye care professionals’ practices by, among other things, advising practices on how to target patients with “dry eye” and prescribe Allergan’s blockbuster drug RESTASIS®, as opposed to significantly less expensive treatment alternatives. According to the complaint, the Eye Care Business Advisors were part of an array of valuable services that Allergan provided to eye care professionals in order to persuade them to prescribe a host of eye care products. These products were paid for by the Medicare and Medicaid health insurance programs.

The complaint was filed under the qui tam, or whistleblower provisions of the False Claims Act. This Act encourages private citizens to come forward and report fraud against the government by allowing them to sue on behalf of the government and receive a share of any government recovery. Under the law, 70 percent of any recovery goes back to federal and state treasuries.

“Patients deserve to know that their medical professional is making decisions based on their best interests and not because a drug company is offering incentives to steer patients to specific drugs,” said Pietragallo Gordon attorney Marc S. Raspanti. “We look forward to prosecuting this case to a successful conclusion for federal and state taxpayers and for all of us who are concerned about the integrity of medical decision-making in this country,” said David Chizewer of Goldberg Kohn. “It is rare for successful, well-respected physicians to blow the whistle on the health care industry,” says Raspanti’s partner, Michael Morse.

“We are proud to represent our clients who not only run one of the most prestigious eye care practices in the Philadelphia area, but had the rare courage and integrity to come forward and report Allergan’s practices,” said Pietragallo Gordon’s Pamela Brecht. “The False Claims Act provides private law firms with the unique opportunity to litigate and vindicate the interests of federal and state governments, and we intend to do just that,” commented Chizewer’s partner, Matthew Organ.

The lawsuit is captioned United States ex rel. Nevyas, et al. v. Allergan, Inc., No. 09-0432 (E.D. Pa.). The claims asserted against the defendants are allegations only; there has been no determination of liability.

HMA And EmCare Face A One-Two Punch In National Whistleblower Lawsuit By Large ER Physician Group

Tuesday, January 7th, 2014

On December 30, 2013, the United States District Court for the Western District of North Carolina, in response to a Department of Justice motion, unsealed a whistleblower lawsuit filed by North Carolina Emergency Room Physicians against Health Management Associates and Emergency Medical Services Corporation (“EmCare”). The “qui tam” whistleblower lawsuit was filed in Charlotte, North Carolina in 2010 by Thomas L. Mason, M.D., Steven G. Folstad, M.D. and Mid-Atlantic Emergency Medical Associates, PA (“MEMA”), a large physician-owned practice providing high quality emergency and acute medical care throughout greater Charlotte and the Piedmont area of North Carolina. MEMA had held the ER physician services contracts at two HMA hospitals in North Carolina for more than a decade.

The lawsuit alleges that HMA and Emcare cheated the Medicare and Medicaid Programs in its hospitals across the United States by: admitting ER patients to HMA when it wasn’t medically necessary; paying ER physicians kickbacks to incentivize them to order expensive ED services and to admit ER patients to HMA hospitals when it was not medically necessary or appropriate; and subjecting ER patients to expensive ED services. including unnecessary and inappropriate diagnostic tests. The lawsuit alleges that EMCARE conspired with HMA to perpetuate the fraudulent scheme to submit claims for unnecessary tests and admissions, accepted kickbacks from HMA to recommend or refer patients to HMA facilities; and agreed to further HMA’s fraud related to unnecessary emergency room care and hospital admissions in order to retain and secure ED contracts.

The qui tam lawsuit alleges that when HMA and EMCARE defrauded the Medicare and Medicaid Programs, whistleblowers Mason, Folstad, and MEMA stood up for patients in the face of HMA’s and EmCare’s profit-centered corporate control over the Emergency Department and exposed this significant fraud. HMA tried to silence the Whistleblowers (Drs. Mason and Folstad and other MEMA physicians). When they could not, HMA attempted to entice the Plaintiffs at both North Carolina hospitals with illegal cash inducements to meet corporate mandates to order unnecessary tests and to recommend that ED patients be admitted to the hospital unnecessarily. The Whistleblowers refused HMA’s cash offer. HMA leaders responded with escalating retributions against the Whistleblowers, eventually terminating without cause the Relators’ contracts to staff two ERs. After illegally terminating MEMA, HMA awarded exclusive contracts for the Lake Norman emergency room and hospitalists services to EMCARE — as a financial inducement to refer patients to HMA for lucrative hospital services.

The United States has partially intervened in the Relators’ allegations, namely, that HMA submitted false claims for ER patients who were admitted, but who should have been in observation or treated and discharged. The United States has also elected to intervene in the Relators’ allegations that HMA submitted false claims related to violations of the Anti-Kickback statute resulting from incentives paid by HMA to Emergency Department physicians or physicians groups for improving metrics and benchmarks related to inpatient admissions. The United States and a number of states have requested a 90-day extension to determine if they will intervene in the Relators’ allegations against EMCARE. The matter is being investigated by the United States Department of Justice, the United States Attorney’s Office for the Western District of North Carolina, the United States
Department of Health & Human Services – Office of the Inspector General (HHS-OIG), and the Federal Bureau of Investigation (FBI).

“This is a massive, nationwide fraud on the American taxpayers, that subjected patients to unnecessary tests and hospital admissions,” said lead counsel in the case, Marc S. Raspanti, of the Philadelphia law firm of Pietragallo Gordon Alfano Bosick & Raspanti, LLP. “Dr. Mason, Dr. Folstad, and MEMA have exhibited tremendous personal and professional courage in repeatedly standing up to HMA’s improper pressures.” Pamela C. Brecht, an attorney with Pietragallo Gordon Alfano Bosick & Raspanti, LLP, who has worked tirelessly for years, investigating and pursuing the fraud allegations in this case, added: “The fraudulent conduct, and callous disregard for the medical needs of vulnerable patients, particularly the elderly and children, that HMA and EMCARE exhibited is eye opening.”

Pietragallo Gordon Alfano Bosick & Raspanti, LLP, are pursuing this case with co-counsel, James F. Wyatt, III and Robert Blake of the Charlotte, North Carolina law firm of Wyatt & Blake, LLP, on behalf of the American taxpayers. The lawsuit is captioned United States et. al. ex rel. Mason, Folstad and MEMA v. Health Management Associates, Inc., et. al., No. 3:10CV472 (W.D. NC-Charlotte). A copy of the unsealed complaint can be found at www.FalseClaimsAct.com.