Articles Posted in Whistleblowers and Qui Tam Lawsuits

daan-stevens-282446-copy-300x191CHRISTUS St. Vincent Regional Medical Center, located in Santa Fe, New Mexico, and CHRISTUS Health, located in Irving, Texas, have agreed with the U.S. Department of Justice to resolve allegations of violating the federal False Claims Act (FCA) with a settlement of $12.24 million plus interest.

A Qui Tam Suit

The allegations against the CHRISTUS health care companies were made by a former indigent healthcare administrator under the qui tam provision of the FCA. This whistleblower provided information that the two health care companies were making illegal donations to county governments. Between 2001 and 2009, the CHRISTUS companies allegedly made donations in bad faith to various counties, which in turn caused New Mexico to present false claims to the federal government through the Medicaid program.

christina-sicoli-19892-copy-300x212Whistleblower George Gage has made it clear he is not happy with the current judge for his qui tam case, U.S. District Judge Sam Sparks. Gage claims that throughout his False Claims Act (FCA) case against Rolls-Royce North America Inc., Judge Sparks has handed down orders that attempt to divest him of jurisdiction in order to try and have Gage’s case thrown out before Rolls-Royce submitted an answer. He has tried two different ways to obtain a different judge on his case and each time has failed. That is because it takes a great deal of evidence of bias or impartiality to get a judge taken off a case.

If you are currently part of a qui tam case and believe the judge is not able to be partial, contact the experienced California qui tam attorneys of Brod Law Firm as soon as possible.

Gage’s Attempts for a New Judge

daan-stevens-282446-copy-300x191The U.S. Department of Justice (DOJ) announced August 18 that the owner and operator of five home health agencies located in the Houston area, Godwin Oriakhi, 61, was sentenced to 480 months in prison for conspiring to defraud Medicare and the Texas’ Medicaid programs: Home and Community-Based Service (HCBS) and Primary Home Care (PHC), which are known as provider attendant services (PAS). The authorities found Oriakhi defrauded Medicare and the Medicaid programs for more than $17 million, making this the largest PAS fraud case in all of Texas’ history.

More on Oriakhi’s Fraud

Oriakhi pleaded guilty to two counts of conspiracy to commit health fraud and one count of conspiracy to launder monetary instruments in March 2017. This came after Oriakhi admitted that he and his daughter, a co-defendant in the case, and other members of his family obtained patients for his home health agencies through illegal kickbacks to patient recruiters, his office employees, and physicians. His five facilities receive hundreds of patient referrals this way.

When qui tam cases under the False Claims Act (FCA) are first filed, they are to remain under seal for 60 days. During this time, the case is secret. The defendant is not even served yet, so it likely does not know there is a suit filed against it unless there are quiet rumblings or leaks. During this 60-day period, the government is given an opportunity to investigate the allegations and decide whether to join the suit or not. Once the government makes its decision, the case is unsealed. In certain instances, this is when the defendant is served. However, in many cases, the seal is partially lifted and the defendant is served prior to the whistleblower case being made public.

The truth of the matter, though, is that a qui tam case is never under seal for just 60 days. The FCA, the government can ask for extensions of the seal period if they can show it is for good cause. This happens regularly and continuously to the point where many qui tam cases remain confidential for years.

How Long Do Qui Tam Cases Remain Under Seal?

andres-de-armas-103880-copy-300x200On July 24, the U.S. Attorney’s Office for the Central District of California announced that Celgene Corp., a pharmaceutical manufacturer headquartered in New Jersey, will pay $280 million to numerous states and the federal government to settle claims that it submitted false claims to the federal government and state health programs. From the settlement, $259.3 million will go to the federal government, $20.7 million will be divided among 28 states and the District of Columbia. California is set to receive more than any other state at $4.7 million.

U.S. ex rel. Brown v. Celgene Corp.

The settlement is the result of a whistleblower lawsuit filed by Beverly Brown under the qui tam provision of the False Claims Act. Brown, who was a sales manager at Celgene, brought a lawsuit on behalf of the federal and state governments. She provided evidence that Celgene promoted two cancer drugs, Thalomid and Revlimid, for uses that were not approved by the U.S. Food and Drug Administration and therefore not covered by federal healthcare programs.

david-everett-strickler-196946-copy-300x195On July 13, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the Department of Justice’s largest ever health care fraud enforcement action. The work of the Medicare Fraud Strike Force, established in 2007, led to 412 defendants being charged with health care fraud offenses based on information they all participated in fraudulent schemes to obtain about $1.3 billion in false billings to Medicare, Medicaid, and TRICARE. Additionally, HHS has begun the suspension process against 295 health care providers’ licenses.

Hundreds of Individuals Charged With Health Care Fraud

Of the 412 defendants, 115 are physicians, nurses, and other licensed medical professionals. Many of these defendants were charged with federal crimes for prescribing medically unnecessary drugs and compound medications, many of which were not actually distributed to the patients or purchased. Providers could then bill for these unnecessary or unpurchased medications and receive a greater amount of reimbursements from state and federal health services.

jimi-filipovski-189724-copy-300x176There are currently two False Claims Act (FCA) qui tam cases against United Health Group (UHG) pending in the Central District of California. The cases are: U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc. and U.S. ex rel. Swoben v. Secure Horizons, et al. The cases were brought by James Swoben, who was previously an employee of Senior Care Action Network Health Plan and a consultant within the risk adjustment industry, and Benjamin Poehling, who was the former finance director of a UHG group that managed the insurer’s Medicare Advantage Plans.

The Qui Tam Cases Against UHG

On May 2, the U.S. intervened in the Swoben False Claims Act suit against UHG based on the allegations the insurer overcharged Medicare Advantage and prescription drug programs. In the DOJ’s complaint, it alleges the insurer knowingly ignored patients’ medical conditions to increase payments it received from Medicare and funded chart reviews to increase the risk adjustment payments it reviewed. However, any information the reviews uncovered regarding misdiagnoses were disregarded to avoid repaying Medicare.

daan-stevens-282446-copy-300x191The U.S. Department of Justice announced on June 28 that PAMC Ltd. and Pacific Alliance Medical Center Inc. have agreed to pay $42 million to settle allegations that they violated provisions of the False Claims Act. The two companies, which operate together as Pacific Alliance Medical Center in Los Angeles, allegedly had unlawful financial relationships with doctors.

Qui Tam Suit Against Pacific Alliance Medical Center

The qui tam lawsuit against the defendants was filed by Paul Chan, who was a manager with one of the defendant businesses. A qui tam suit is a civil lawsuit brought by a private citizen on behalf of the government. The private citizen, known as the relator during the suit, provides information regarding the claims that is not available to the public. If the government receives a settlement or jury award in relation to the relator’s allegations, then he receives part of the monetary recovery. In this case, Chan is set to receive more than $9.2 million.

rhema-kallianpur-275251-copy-300x200To encourage private citizens to come forward regarding fraud against the government, qui tam cases entitle the citizen, also called the relator, to a portion of any settlement or jury award that arises from his or her evidence and allegations. Individuals can bring qui tam cases under the federal False Claims Act when there is fraud against the federal government or can sue under a state-specific false claims act when the fraud is against the state. However, this award has sometimes led individuals to move forward qui tam suits for profit and not altruistic motives. There may be an even more profound issue when attorneys act as both the relator in a qui tam suit and their own lawyer.

Attorney-Relator Cannot Benefit Twice in Qui Tam Suit in Illinois

This issue came up in Illinois when an attorney brought hundreds of qui tam suits against retailer My Pillow Inc. for failing to collect and remit tax on products sold in Illinois. The attorney acted as both the relator in the suit as well as the attorney. This meant the attorney not only received a portion of the judgment against the company, but he also asked for attorney’s fees.

benjamin-child-90768-300x200Qui tam suits often make the news, though you may not be sure of what they are and why they matter. Qui tam suits have to do with fraud against the federal or a state government. In recent years, the U.S. and individual states have made a concerted effort to recapture the money that individuals and businesses have wrongfully obtained or kept from them. By learning more about qui tam suits, you may be better able to recognize fraud when you see it and understand what you can do with this concerning information.

Common Questions Regarding Qui Tam Suits

  • What is a qui tam suit? A qui tam lawsuit is a civil lawsuit brought by a private citizen on behalf of the federal or a state government. It is also known as a whistleblower lawsuit since the private citizen is blowing the whistle on illegal actions against the government.