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.

lukasz-szmigiel-413-copy-300x169Pharmaceutical companies Mylan Inc. and Mylan Specialty L.P. agree to pay $465 million to settle a lawsuit brought under the False Claims Act (FCA). According to the FCA-based suit brought by a whistleblower, Mylan intentionally misclassified EpiPen as a generic drug – knowing it was a brand name drug – in order to not have to pay higher rebates to Medicaid. EpiPen is a brand name drug because there is no therapeutically equivalent drug provided by other manufacturers. Mylan is the single source of EpiPen. By willfully and incorrectly deeming it a generic drug, Mylan was not required by law to pay a higher rebate to Medicaid, thereby retaining a greater amount of money and increasing their profits.

More on Mylan’s Actions

The purpose of the Medicaid Drug Rebate Program is to ensure state Medicaid programs were not injured to price gouging by manufacturers that were the only source of a drug, like EpiPen. When a drug manufacturer is a single course for a medication, there is no market competition to balance the price of the drug. Instead, that manufacturer can continually raise the price and there will always be a demand for the drug out of necessity.

aidan-bartos-313782-copy-300x200On August 10, the Department of Justice (DOJ) announced victory in another healthcare fraud case. A federal jury convicted registered nurse, Evelyn Mokwuah, 52, of criminal involvement in a $20-million Medicare fraud scheme. Mokwuah owned two home health companies based out of Houston, Beechwood Home Health and Criseven Health Management Corporation. She and these companies were convicted of making fraudulent claims to Medicare for home health services.

Healthcare Fraud Trial Ends Well for Government

There was a four-day trial regarding Mokwuah’s fraudulent activities. She was convicted of four counts of health care fraud and one count of conspiracy to commit health care fraud. Evidence at trial was based on claims made to Medicare by the two companies between 2008 and 2016. Fraudulent claims were made for home health services that were either not provided or were provided when not medically necessary.

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.

andres-de-armas-103880-copy-300x200The Department of Justice (DOJ) for the Eastern District of California announced on July 7 that Wal-Mart Stores, Inc. (Walmart) paid $1.65 million to resolve accusations related to unlawful medical claims. This is an important suit as it demonstrates that the federal and state governments will go after large retailers for false claims. Pursuing whistleblower suits and securing government funds that were unlawfully obtained remains a top property for the DOJ.

Walmart’s False Claims

Through a qui tam suit brought by a former Walmart pharmacist in the Sacramento area, the California government learned that Walmart was allegedly submitting false claims to the state’s Medi-Cal program in order to increase reimbursements. Supposedly, Walmart would knowingly submit claims that were not supported by a proper and relevant diagnosis or documentation. More specifically, Walmart would submit reimbursement claims for Code 1 drugs that were not based on proper and pre-approved diagnoses. Medi-Cal only reimburses for Code 1 drugs if they were prescribed for approved diagnoses. If a Walmart pharmacy wanted reimbursement for a Code 1 drug for something else, it would need to submit a specific request with the reasoning for a non-approved use. Walmart pharmacists intentionally submitted claims without confirming the approved diagnosis and obtaining the necessary documentation or for non-approved uses.

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.