Articles Posted in Whistleblower Lawsuits

Two men have filed a whistleblower case in what may be one of the largest incidents of Medicare fraud in the country’s history. The plaintiffs are Dr. Alon Vainer, a dialysis clinics medical director, and nurse Daniel Barbir. They contend that their employer, dialysis company DaVita Inc., overbilled Medicaid and Medicare by hundreds of millions of dollars between 2003 and 2010 for the purpose of making a profit.

According to Vainer and Barbir, the Medicare/Medicaid billing fraud took place at over 1,800 clinics that treated tens of thousands of patients. Per CNN, Vainer said that for example, with the drug Venofor only part of a 100 milligram vial would be administered to a patient, while the rest of it would be disposed of (while the company billed the government based on use of the entire vial) and the same would be done with other100-milligram vials of Venofor. The more vials that were used, the more money DaVita was able to make off its alleged scam.

Barbir and Vainer claim that they attempted to get this practice stopped but were told to back off and keep following protocols. Barbir eventually left the company while Vainer, who stayed on, said his medical directorship wasn’t renewed as punishment.

Ex-Deutsche Bank quantitative risk analyst Dr. Ben-Artzi has filed a whistleblower lawsuit against the financial firm. He claims that the bank accurately report its credit derivatives portfolio’s value and that he made his concerns known internally. Ben Artzi is one of three whistleblowers accusing Deutsche Bank of improper reporting to hide $12B in losses. He says that that he decided to notify enforcement authorities because the problem was not addressed or corrected by the firm.

Per his claims, between 2007 and 2010 Deutche Bank, the biggest holder of LSS trades at the time, did not give proper value to the gap option part of its Leveraged Super Senior tranches of credit derivatives portfolio and, as a result, who knows how many investors were hurt. Failure to give proper value to the trades, Ben-Artzi contends, caused the bank to continue projecting the image that it was doing a better job of handling the global economic crisis than other financial firms.

In addition to notifying the Securities and Exchange Commission of these alleged violations through its Whistleblower Program, Ben-Artzi has filed a retaliation complaint with the Labor Department claiming violations of the Sarbanes-Oxley Act’s whistleblower protection provisions. Ben-Artzi says that as he made his way up the chain of command at the bank to try to get the valuation problems remedied, he began to experience isolation and hostility on the job, was not allowed to access records he needed to perform his duties, and lost certain responsibilities as well as a degree of autonomy. He also claims that when he came back from paternity leave last year, Deutsche Bank told him that is position had been transferred to Europe, and he was laid off without being offered the offered the opportunity to transfer or find a new position within the company.

During this past fiscal year, the SEC received 3,001 whistleblower tips from tipsters in all 50 states and from 49 nations. Outgoing SEC Chairman Mary Schapiro said that the Commission’s whistleblower program has proven valuable in uncovering financial fraud. Earlier this month, the agency issued its “2012 Annual Report on the Dodd Frank Whistleblower Program.”

The SEC whistleblower program allows parties to offer up original, quality information about possible securities law violations. Should the information result in a successful SEC enforcement action that leads to over $1 million in monetary sanctions, the whistleblower is entitled to 10-30% of this amount. The award is paid to the whistleblower from the Investor Protection Fund.

If you are someone who has such information, do not hesitate to contact our Boston whistleblower lawyers at Altman & Altman, LLP today. Filing a Qui Tam case can be a complicated process especially when done without legal help. In addition to making sure that your rights are protected throughout the process, an experienced Massachusetts whistleblower attorney can make sure you receive the reward that you are owed.

Did you know that the Securities and Exchange Commission’s SEC Whistleblower Program also applies to reporting of violations of the Foreign Corrupt Practices Act? This means that if you are a whistleblower who reports original information regarding the bribery of a foreign official, you could be entitled to 10-30% of what is recovered as a result of your claim if monetary sanctions are over $1 million. If you have information about such wrongdoing and and are wondering whether this is enough to file a case, you should contact our Boston whistleblower lawyers at Altman & Altman, LLP right away. We can help you assess whether you have grounds for a claim.

Per the Foreign Corrupt Practices Act, US Companies, US Citizens, and certain foreign companies are not allowed to offer to pay, promise to pay or actually make a payment to a foreign official/foreign political candidate/foreign political party with the intention of affecting the recipient or obtaining any improper upper hand in the obtaining or retaining of business. Under the act, a bribe is defined as “anything of value,” which may include money, its equivalent, gifts, property, charitable contributions, stock, commissions, stock options, discounts, employment offers, transportation, insurance benefits, services, use of facilities, equipment, and other items meant to exert influence on the other party.

There is no minimum value to what constitutes a bribe that violates the Foreign Corrupt Practices Act. Even if the payment has not actually been made yet, a Foreign Corrupt Practices Act violation may still have occurred. (However, one except to the Act is when the payment is made to a foreign official to secure or expedite the execution of a routine government action.) Also, a person or company that makes the bribe does so through a third party, such as a foreign subsidiary, agent, distributor, or partner is not exempt from having committed a bribery violation.

According to filings by the US government in federal court in Boston, GlaxoSmithKline has entered a guilty plea to misdemeanor charges that it illegally promoted Wellbutrin and Paxil for uses not that were not FDA-approved, as well as failed to report clinical data about the diabetes drug Avandia. As part of the settlement, Glaxo will pay $3 billion, including a $956.8 million criminal fine and a $300 million civil settlement for not providing best prices and underpaying rebates under the Medicaid drug program. The pharmaceutical company will forfeit $43 million.

This is considered the largest health care fraud case in the US and it involves the biggest UK drug maker. Four Boston whistleblower lawsuits relating to this case will also be resolved from this settlement.

Federal prosecutors started investigating Glaxo’s drug marketing practices with nine of the company’s biggest sellers in 2004. Paxil, which was only approved by the FDA for adult use, was promoted by the drug maker for use by teens under age 18 who were suffering from depression. Glaxo also promoted depression med Wellbutrin for the unapproved treatment of substance abuse, weight loss, and sexual dysfunction. (Although doctors can prescribe medications for uses that are not approved, drug companies are not allowed to market drugs for unapproved uses. To do so means a manufacturer has promoted a drug for off-label uses, or “misbranded” it.)

The US government also contended that Glaxo did not give certain safety data about Avandia between 2001 and 2007. Since then, the FDA now mandates that there be two black box warnings on the diabetes medication’s label warning doctors about the possible risks of heart attack and congestive heart failure.

Massachusetts Whistleblower Lawsuits
According to the lawyer of two of the whistleblowers, they were the ones that first told Glaxo it was marketing the drugs illegally in 2001. Now, as part of its settlement, Glaxo will pay $210 million to the states and $832 million to the US government. The Massachusetts whistleblowers are entitled to a percentage of the recovery.

GlaxoSmithKline settles healthcare fraud case for $3 billion, Reuters, July 2, 2012
GlaxoSmithKline Reaches Plea Agreement Over Drug Labeling, Bloomberg, July 2, 2012


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Virologists File Whistleblower Lawsuit Against Merck Over MMR Vaccine, Boston Injury Lawyer Blog, June 16, 2012

Pharmaceutical Fraud May Be Grounds for Filing a Massachusetts Whistleblower Lawsuit, Boston Injury Lawyer Blog, July 23, 2011

$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 5, 2012 Continue reading

Stephen Krahlin and Joan Wlochowski, two ex-Merck virologists, have filed a whistleblower complaint against their former employer. They are claiming that Merck committed fraud against the federal government by overstating the effectiveness of its MMR vaccine. As a result, they contend, the government ended up spending hundreds of millions of dollars on about four million doses of the vaccine, used against mumps, measles, and rubella, that were, in fact, mislabeled and misbranded and not as effective as touted.

According to their Qui tam action, rather than rework the vaccine to make it more effective, Merck decided to revise its testing technique to get the desired results. The vaccine manufacturer began manipulating its clinical lab trials of the MMR-11 vaccine as early as the late 1990’s so that it could retain its monopoly as the manufacturer and seller. (In order to do this, the vaccine had to test as 95% effective.) The whistleblowers claim that they were asked to participate in Protocol 007, which is the name of this modified testing. Meantime, millions of children ended up not getting the full immunization they required.

Massachusetts Whistleblower Lawsuits
In Massachusetts, our Boston injury lawyers also represent whistleblowers with Qui tam clams filed on behalf of the government. Our Massachusetts whistleblower attorneys understand that stepping forward to expose fraud against the state or the federal government takes a lot of bravery and we are dedicated to protecting our clients’ rights and making sure they aren’t retaliated against. We have the experience, skills, and resources to take care of our whistleblower clients’ lawsuits from the beginning until its resolution.

Class Says Merck Lied About Mumps Vaccine, Courthouse News, June 27, 2012

Merck Whistleblower Suit A Boon to Vaccine Foes Even As It Stresses Importance of Vaccines, Forbes, June 27, 2012

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Whistleblower Accuses Planned Parenthood Affiliate of Submitting $5.7M in Fraudulent Medicaid Claims, Boston Injury Lawyer Blog, May 31, 2012

WellCare Health Plans Settles Whistleblower Lawsuits in Medicare/Medicaid Fraud Case for $137.5 Million, Boston Injury Lawyer Blog, April 2, 2012
Qui Tam Cases Result in $2.B Recovered in 2011
, Boston Injury Lawyer Blog, January 4, 2012 Continue reading

A recently unsealed federal whistleblower lawsuit accuses Planned Parenthood Gulf Coast of turning in over 87,000 reimbursement claims to Medicaid that were either “false, fraudulent, or ineligible.” Abby K. Johnson, the plaintiff, is an ex-director at one of the defendant’s clinics. She says she had “system-wide” access to billing activities and the records of patients for approximately two years.

Per her whistleblower complaint, the fraudulent reimbursement claims were made by all of Planned Parenthood Gulf Coast’s 10 clinics. The claims were submitted to the Texas Women’s Health Program, which is the Medicaid program in that state. Johnson contends that even though only office visits having to do with the management of contraception were reimbursable under the contract between her former employer and the Medicaid program, staff proceeded to submit for other services, such as Pap tests, STD tests, and pregnancy tests.

Johnson is accusing the higher ups of acknowledging the fraud that was going on. Meantime, staff allegedly modified patient charts to conceal the Medicaid fraud. Also, although by law Planned Parenthood Gulf Coast is supposed to refer women who are pregnant to clinics or doctors that do not conduct or advocate for elective abortions, the organization would send these patients to its own abortion clinics. (Johnson is a pro-life activist.)

WellCare Health Plans Inc. has consented to pay $137.5 million to settle four whistleblower lawsuits filed against it over allegations of fraudulent Medicaid and Medicare claims. The health care provider is accused of falsely inflating the amount it claimed to have spent on medical care so it wouldn’t have return the money to Medicaid and programs, including Florida Healthy Kids and Florida Medicaid. WellCare offers managed health care service for about 2.6 million Medicaid and Medicare beneficiaries throughout the US.

The Qui Tam lawsuits also accused WellCare of keeping the overpayments for child care that it got from Medicaid, falsifying information that misrepresented the medical conditions that patients had and were treated for, operating a bogus Special Investigations Unit, manipulating performance metrics related to its call center, and committing marketing abuses.

U.S. Attorney Robert E. O’Neill said the settlement and restitution would go to the state and federal programs that sustained losses as a result of the Medicaid/Medicare fraud. Law enforcement will get the forfeited funds, which will go toward paying for future investigations.

Meantime, the whistleblowers that filed their cases under the False Claims Act should be getting back a percentage of what the US government recovers. For example, according to one Florida newspaper, whistleblower Sean Hellein is expected to receive close to $21 million for helping to instigate the federal government’s probe into WellCare. Hellein was a senior financial analyst at the health care provider when he secretly recorded executives talking about how to double bill for patient services in 2006. If WellCare didn’t spend a certain percentage of the money given to it by the government on care, it was supposed to give back the difference.

WellCare Health Plans whistle-blower to receive about $21 million, Tampa Bay Times, April 4, 2012

WellCare will pay $137.5 million to resolve fraud allegations, TBO, April 3, 2012


More Blog Posts:

$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 25, 2012

Qui Tam Cases Result in $2.B Recovered in 2011, Boston Injury Lawyer Blog, January 4, 2012

Whistleblower Testifies on the Toll Medicaid Fraud Can Take On Patients, Boston Injury Lawyer Blog, December 16, 2011

Whistleblower Lawsuit: Hospice Care Provider Vitas Healthcare Accused of Medicare Fraud, Boston Injury Lawyer Blog, November 27, 2011 Continue reading

A $25 million settlement has been reached in the whistleblower lawsuit filed by a former nurse employee against Odyssey HealthCare Inc. Per her Qui Tam complaint, submitted in 2008, between 2006 and 2009 Odyssey enrolled and recertified patients who were non-terminal for hospice care, and billed for services that weren’t reasonable or necessary.

Medicare’s benefit, which covers hospice care, is only for patients that are terminally ill. To be eligible for palliative hospice care, a patient must be diagnosed as having six months of less to live.

The plaintiff who filed the whistleblower lawsuit alleging Medicare fraud, Jane Tuchalski, was fired by Odyssey after she expressed concerns about how the hospice care company was run. (She has since settled a separate settlement related to retaliatory termination claim.) Other Odyssey employees also filed their own whistleblower complaints alleging hospice care fraud. While one of the cases was added to Tuchalski’s lawsuit, the other was later dismissed.

Odyssey is now part of Gentiva Health Service, which noted that the allegations of hospice care fraud were for a period of time that occurred prior to its acquisition of the company. Gentiva said that settling the whistleblower case is a reflection of its commitment to making sure compliance is company-wide.

Whistleblower Lawsuits
Because Tuchalski filed her whistleblower lawsuit under the False Claims Act, she is entitled to a percentage of what the government recovers. Also, under the act, employees who are fired for disclosing fraud are eligible to recover double back pay, special damages, and benefits.

In cases when multiple claims are submitted by different employees or others, it is usually the first person to file whistleblower lawsuit that receives the most from the financial recovery. In the hospice fraud case against Odyssey, claimants will get about $4.6 million.

Whistle-blower case on hospice fraud settled for $25 million, JSOnline, March 1, 2012

Hospice Provider Odyssey Healthcare Agrees to Pay $25 Million to Resolve False Claims Act Allegations, Justice.gov, March 1, 2012

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Whistleblower Lawsuit: Hospice Care Provider Vitas Healthcare Accused of Medicare Fraud, Boston Injury Lawyer Blog, November 27, 2011
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The US Justice Department says that 636 qui tam complaints were filed for fiscal year 2011, resulting in $2.8B recovered. Of the more than $3B involving the False Claims Act that resulted in settlements and judgments from fraud cases, $2.4 billion was related to fraud committed against a number of federal programs, including Medicare, TRICARE, and Medicaid. Usually, no more than 400 whistleblower cases are filed annually.

$2.2B was recovered from civil claims made against pharmaceutical companies alone. GlaxoSmithKline PLC agreed to pay $750 million to settle allegations involving false claims related to medications and adulterate drugs that didn’t satisfy FDA specification. $900 million came from drug companies accused of engaging in unlawful pricing to up their profits.

The False Claim Act
Federal and state False Claims Acts cover fraud committed against any state or federal funded program or contract. Since amendments were made to the federal False Claims Act in 1986, the US Justice Department has gotten back more than $30 billion. The amendments provided stronger incentives for whistleblowers to come forward and file lawsuits on behalf of the government. A whistleblower could end up entitled to up to 30% of what the government recovers.

Kinds of fraud that fall under the False Claims Act include those involving:

• Billing for goods the buyer never received • Billing for services that were never rendered Falsifying testing data or results • Falsifying employee records • Performing unnecessary medical treatments on Medicaid/Medicare patients

Justice Department Recovers $3 Billion in False Claims Act Cases in Fiscal Year 2011, US Department of Justice, December 19, 2011
Qui Tam Action, Legal Information Institute

More Blog Posts:
Whistleblower Lawsuit: Hospice Care Provider Vitas Healthcare Accused of Medicare Fraud, Boston Injury Lawyer Blog, November 27, 2011
Medicare Fraud?: Cigna, UnitedHealth Group, and Aetna Under Scrutiny for Possible Kickback Violations, Boston Injury Lawyer Blog, November 22, 2011
Whistleblower Lawsuit Accuses Florida Hospital of Defrauding Medicare of $2M, Boston Injury Lawyer Blog, November 15, 2011 Continue reading

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