A $12 million settlement was reached in a False Claims Act case alleging kickbacks to physicians for using Sightpath Medical Products in eye surgeries. The relator, Kipp Fesenmaier, was vice president of the company and reported that kickbacks were being offered to physicians to bribe them to use Sightpath Medical products. These kickbacks came in the form of sham consulting agreements and free entertainment – including hunting, fishing, and skiing trips. Halunen Law was proud to work with lead counsel from Morgan Verkamp LLC in this case. Susan Coler, head of Halunen Law’s Whistleblower/Qui Tam practice group, stated, “It’s great to see a result like this, where an employee’s report of illegal conduct caused significant corporate change and helped protect the integrity of medical decision making.
Employer Fraud
Has a potential client come to you who is talking about fraud involving a contract or program that receives government funding? That person just might have a strong suit for filling a qui tam case. To give you an idea of what we are talking about consider just a few of the following examples of frauds that have been uncovered; keep in mind that the list goes on and on.
- Billing for goods and services that never existed
- Upcoding either for false illnesses or treatments or for employee work by charging higher doctors rates
- Defective testing saying something passed a test when it failed
- Failure to report known product defects while still billing the government for the product
The False Claims Act is an important federal law that combats fraud against the Government, but many people have never heard of it. This vital act allows individuals with evidence of fraud to sue companies on behalf of the government for damages.
With all of the news surrounding the fate of the Affordable Care Act lately, you may have missed that the government intervened in two lawsuits alleging fraud against the country’s largest health insurance company, Minnetonka-based UnitedHealth Group. Since the beginning of this year, the Department of Justice joined two separate False Claims Act cases against UnitedHealth. Both qui tam lawsuits (the Latin phrase commonly used for False Claims Act cases brought by a whistleblower) allege that UnitedHealth fraudulently inflated its Medicare Advantage risk adjustment scores.
So, what is the Medicare Advantage program? What are risk adjustment scores? And how can a major health insurance company, like UnitedHealth, defraud the government? The answers to each of these questions can be found in this post.
I get calls several times a week from executives and professionals who want me to review a severance agreement that was just presented to them by their employer. When I ask if they think they have any potential claims against the company, people seem bewildered. I’m often told they just want me to review the severance—that they don’t want to risk losing what is offered, and have no interest in seeing if they could get more. I, on the other hand, am often dumbfounded. After all, negotiation is part of business—right? As an executive or professional part of your job typically includes some form of negotiation. So then, why would you not negotiate over a severance?
MINNEAPOLIS–(BUSINESS WIRE)–Halunen Law (www.halunenlaw.com) has initiated an investigation into MiMedx Group, Inc. (NASDAQ: MDXG) (“MiMedx” or the “Company”) regarding whether the Company’s board breached its fiduciary duties to shareholders or engaged in other violations of state or federal law.
On Dec. 15, 2016, Halunen Law filed a complaint on behalf of two employee whistleblowers against MiMedx and its Chief Executive Officer, Parker Petit, in the U.S. District Court for the District of Minnesota (No. 16-cv-4171). The complaint alleges that MiMedx and its senior executives have engaged in the illegal practice of booking phantom sales of one of the company’s most lucrative product lines, EpiFix, for the purposes of artificially inflating revenue and deceiving MiMedx’s shareholders. While developing the factual background for this whistleblower lawsuit, Halunen Law uncovered what it believes to be evidence of securities fraud by MiMedx since at least 2014. As alleged in Halunen Law’s whistleblower complaint, “CEO Parker ‘Pete’ Petit ordered the MiMedx sales force to submit false orders for unpurchased product for the purpose of recognizing the ‘revenue’ in the company’s financial statements.”
Access the original amended complaint against MiMedx at: https://1drv.ms/f/s!Apr_gPRDSPDNgfww6C1lM2CNA3PfKg
Halunen Law is a national class action law firm with offices in Minneapolis and Chicago. For more information on Halunen Law, visit the firm’s website at www.halunenlaw.com.
Contacts at Halunen Law
If you are a MiMedx shareholder and are concerned about your rights, or if you possess information that would assist Halunen Law in its investigation of this matter, please contact:
Chris J. Moreland
612-638-5019
moreland@halunenlaw.com
Honesty is the best policy. It’s one of the first lessons we learn, and yet it seems there is an epidemic of selective memory loss among providers who choose to defraud Medicare. Our journey begins in South Carolina where another medical provider is paying out millions in an effort to put the allegations of wrongdoing behind them.
This past summer, the Justice Department announced that Lexington County Health Services District Inc. d/b/a Lexington Medical Center located in West Columbia, South Carolina, had agreed to a $17 Million settlement. (1) The settlement resolved allegations that the Center had maintained improper financial relationships with physicians they employed and submitted fraudulent claims to Medicare. This is extremely troubling considering a large percentage of their income is from Government funded programs.
People who rely on Medicare are among our nation’s most vulnerable citizens, including the elderly, disabled and terminally ill. In many cases, this is truly their only hope for receiving the medical care they so desperately need, but many could not otherwise afford. Subsequently an extensive body of law protects the rights of these recipients and safeguards the tax payer dollars funding these services with severe penalties for those who choose to ignore them.
Hospice and greed. Two words that are diametrically opposed and when combined—toxic.
At its inception, hospice in America was mostly a philanthropic movement led by volunteers and non-profit entities. Today the hospice industry is big business including a large percentage of for-profit providers. According to the Medicare Payment Advisory Commission (MEDPAC) in 2013 Medicare hospice expenditures alone totaled about $15.1 billion for services rendered by over 3,900 providers. (1)
The hospice movement is built on the core belief that patient dignity and respect are fundamental to providing compassionate care to the dying. When the prognosis of a terminal illness carries a life expectancy of 6 months or less it’s devastating. Hospice includes access to essential medical care along with emotional and psychological support which enables individuals and their loved ones to live as fully as possible in the time remaining while striving to come to terms with saying good-bye.
Halunen partner and whistleblower/False Claims Act attorney Susan Coler recently spoke at the National Employment Lawyers Association 2016 Annual Conference in Los Angeles. Her topic was proving discrimination and retaliation when there is no “smoking gun” — that is, when there is no direct evidence of illegal conduct.
She noted that the law allows juries to infer retaliation and discrimination from many different kinds of conduct. This includes, for example, evidence that an employer engaged in a sham investigation, did not follow its policies, fabricated or exaggerated the reasons given for termination, or treated the plaintiff differently than other employees. The panel on which she spoke included Professor Michael Foreman from Penn State Law and New Jersey attorney Patricia Barasch.
Discover more about Susan Coler.
Forged Under Civil War Fire, The False Claims Act Continues To Serve As Basis For Private Citizens To Blow The Whistle On Would-Be Fraudsters Of The Government Trust
Under a little-known law, private citizens with knowledge of fraud against the government can bring a lawsuit against the offending organization. Called the False Claims Act, the law—often called the original Whistleblower Law — originated in the Civil War era, when rampant fraud against the U.S. government threatened the very existence of the country.
Sickened by the spectacle of contractors supplying the army with broken guns and sand-packed bullets, lame pack mules and cardboard boots, President Lincoln pressed Congress for a law setting severe financial penalties for fraud against the government. The law also included a provision to empower private citizens to sue fraud perpetrators on behalf of the government. Known by its Latin name as “qui tam,” this provision allows the courts to award whistleblowers, called “relators” under this law, a share of the monies recovered by the government in fraud cases. In Lincoln’s time, the law brought corrupt defense contractors to heel. Today it serves to protect taxpayers against fraud from contractors in any number of industries. Equally important, the law protects individuals, like the Civil War soldiers fighting with inferior equipment, who suffered injury as a result of the fraud. Many states, including Minnesota, have adopted whistleblower laws to protect against fraud against state agencies.
The diagnosis: Cancer. Few words have the power to alter one’s life as dramatically as those six letters linked with the phrase – “test results.” The Journey begins. The two critical elements for any cancer patient are affordable care and a physician that, above else, you can trust with your life. There is an ethical expectation that providers will live up to their oath to make the patient’s need their top priority, abstain from medical malfeasance and recognize and be mindful of the impact their patients’ care can have on the stability of their families and finances.(1)
Tuesday, March 8, 2016, a press release by the Department of Justice (2) announced a $37-million-dollar settlement with 21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider, and its wholly owned subsidiary South Florida Radiation Oncology LLC. The False Claims Act lawsuit included allegations that they defrauded Medicare and other federal health care programs including TRICARE, the Department of Defense military health program supporting our uniformed services.