Qui Tam Whistleblower Lawyer
Settlements and Verdicts
Miami Man Pleads Guilty in $3 Million Medicare Fraud Scheme
Category: Settlements and Verdicts
Juan Carlos Castaneda, a Miami resident, pleaded guilty on August 29, 2008 to allegations of Medicare fraud in excess of $3 million. Castaneda also admitted to assisting Dilcia Marinez and others in a Medicare money laundering scheme through G&S Medical Center, Inc, a Miami HIV treatment clinic. One million eight hundred thousand dollars of the Medicare fraud funds were laundered through G&S by submitting false claims to Medicare and by writing checks drawn from G&S's accounts to various companies, most of which were fake companies. The checks would be made out in amounts under $10,000 so as not to alert authorities. Castaneda also admitted involvement in another money laundering scheme with Best Medical Inc. by submitting fraudulent invoices to Medicare for HIV infusion services that were never provided or were medically unnecessary.
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General Dynamics To Pay $4 Million To Settle False Claims Act Allegations
Category: Settlements and Verdicts
General Dynamics Corp. will pay $4.06 million to the U.S. government to settle allegations of fraudulent billing to the government for parts used in military aircraft by one of its subsidiaries.
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$2.1 Million Settlement By BlueCross BlueShield for False Claims Act Allegations
Category: Settlements and Verdicts
BlueCross BlueShield of Tennessee (BCBS-T) agreed on August 11, 2008, to pay $2.1 million to the United States to settle allegations that it violated the False Claims Act. Specifically, BCBS-T settled claims that between 2000 and 2002, the Medicare Part A Fiscal intermediary for New Jersey did not adjust cost-to-charge ratios for Hospitals in the state. The result was "outlier payments" by Medicare to those hospitals and facilities. Outlier payments are supplemental reimbursement payments by Medicare to hospitals where the cost for care is high.
$35.2 Million to be Paid by WellCare in Medicaid Fraud Investigation
Category: Settlements and Verdicts
WellCare has agreed to pay a total of $35.2 million for Medicaid fraud stemming from claims in 2002 through 2006. Their payment includes $24.5 million in Medicaid repayments and $10.7 million remaining will be put into escrow until investigators complete the fraud inquiry. The repayment does not settle the investigation.
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BlueCross BlueShield of Tennessee to Pay $2.1 Million to U.S. Under the False Claims Act
Category: Settlements and Verdicts
BlueCross BlueShield of Tennessee (BCBS-T) has settled with the United States in the amount of $2.1 million regarding allegations of violating the False Claims Act. BCBS-T is headquartered in Chattanooga, TN and operates as Riverbend Government Benefit Administrators.
Medicare Fraud Fugitive Problem Increases
Category: Settlements and Verdicts
Since 2004, fifty-six fugitives have been charged with filing at least $272 million in fraudulent Medicare claims in the Miami-Dade area. Thirty-three of the fugitives are Cuban immigrants who escaped justice using Cuban Passports.
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$260,568 to be Repaid Under False Claims Act
Category: Settlements and Verdicts
Everett Wilson, a 60 year old Chatauqua County New York resident, has reached a settlement to repay $260,568 under the False Claims Act. Wilson used two Social Security numbers between 1993 and 2006, fraudulently receiving $86,856. U.S. Attorney Terrance P. Flynn said "The resolution of this case resulted in treble damages payable to the Social Security Administration."
Pratt & Whitney Agree to Pay More Than $52 Million in Settlement
Category: Settlements and Verdicts
Pratt & Whitney and one of its subcontractors, PCC Airfoils LLC, has agreed to pay the United States over $52 Million in a False Claims Act settlement for a case which alleged that the companies deliberately sold defective turbine blade replacements for jet engines used in military aircraft.
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Fraud costs the Military Health Insurance Program more than $100 Million
Category: Settlements and Verdicts
The United States military's health insurance program has been defrauded for more than $100 million during the past 10 years. Doctors, hospitals and clinics in the Philippines have plotted with U.S. veterans to submit false health claims.
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Medicaid Fraud Allegations Settle, Walgreens Pays $35 Million
Category: Settlements and Verdicts
The Pharmacy America Trusts settled allegations by a whistleblower pharmacist by paying $35 million. The suit alleged that Walgreens knowingly defrauded Medicaid by switching prescriptions for ranitidine, the generic form of the brand-name drug Zantac®, and fluoxetine, the generic form of Prozac®.
Qui tam Relator Bernard Lisitza, on behalf of the United States, 42 states and Puerto Rico, alleged that Walgreens unlawfully caused its pharmacies to switch prescription Medicaid patients from ranitidine tablets to ranitidine capsules, and from fluoxetine capsules to fluoxetine tablets.
The alleged fraud lasted for more than four years, from July 16, 2001 through December 31, 2005. The Relator brought the Complaint in 2003, under qui tam provisions of federal and state False Claims Acts.
The investigation and prosecution was led by the Attorneys General of the 42 states. Relator Lisitza pursued the case with the assistance of his attorneys, Michael I. Behn and Linda Wyetzner, of Behn & Wyetzner, Chartered, Chicago.
Four Florida Men Charged With $110 million In False Medicare Claims
Category: Settlements and Verdicts
Carlos, Jose and Luis Benitez, along with Thomas McKenzie, a physician's assistant, were charged with money laundering by the Department of Justice's Criminal Division and the U.S. Attorney's Office for the Southern District of Florida. The four allegedly made more than $110 million worth of false claims to Medicare between 2001 and 2004.
According to the indictment, two of the brothers, Carlos and Luis Benitez, paid Medicare beneficiaries at eleven clinics they oversaw to submit claims for HIV infusion services that were neither provided nor medically necessary. The physician's assistant, Thomas McKenzie, allegedly trained staff on how to prepare and submit false claims to Medicare.
Prosecutors in this case asked that the suspects receive up to 155 years imprisonment for Carlos and Luis Benitez, the maximum sentence of 40 years of imprisonment for Jose Benitez, and 50 years for Thomas McKenzie.
Philadelphia U.S. Attorney Announces $700,000.00 Settlement Linked To Personal Care Facilities
Category: Settlements and Verdicts
Pat Meehan, U.S. Attorney in Philadelphia, announced that his office has reached a $700,000 civil settlement with Ivy Ridge Personal Care Center, Inc., Brookwood Personal Care Home, Inc., Conlyn House, Inc., Throughgood, Inc. Health Horizons Unlimited, Inc. and owner Rosalind S. Lavin.
Lockheed Martin Pays $10.5 Million to Settle False Claims Act Case
Category: Settlements and Verdicts
Lockheed Martin Space Systems, a Denver-based division of Lockheed Martin Corporation, has settled a False Claims Act case for $10.5 million resulting from allegations that Lockheed had submitted invoices for payment it was not entitled to receive.
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Bristol-Myers Squibb Co. ("BMC"), and its subsidiary, Apothecon, agreed to pay $515 million to settle allegations relating to pricing practices and drug marketing.
Category: Settlements and Verdicts
According to the government, BMS paid illegal kickbacks to physicians from 2000 to mid-2003, in order to get the physicians to promote BMS drugs. These payments were in form of consulting fees and other programs, of which some involved travel to extravagant resorts.
Allegations centered around the use and sale of the drug Abilify, an atypical antipsychotic drug. BMC allegedly encouraged Abilify's use as a pediatric drug and for dementia-related psychosis, both of which are "off-label" uses. A drug's use is considered off-label when it has not been approved by the FDA for that particular use. Here, Abilify has been approved to treat adult psychiatric disorders but not for the use in children or teenagers or for dementia-related illnesses.
Although doctors are permitted to prescribe drugs with or without FDA-approval for that particular use, companies are forbidden to promoted drugs for off-label uses.
U.S. Achieves $6.7 million settlement in healthcare fraud case in Florida.
Category: Settlements and Verdicts
On May 12, 2008, Broward County doctor, Aleyda Borge, M.D., along with the operators of Leonza Health Management Group, settled with the federal government for $6.7 million on allegations of healthcare fraud.
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Three Miami Doctors and Six Others Charged in $56 Million HIV Infusion Fraud Schemes
Category: Settlements and Verdicts
On May 30, 2008, the Criminal Division of the Department of Justice and the Attorney General's office released a statement indicating that three doctors and six other individuals that have been charged in four different indictments for involvement in a $56 million HIV infusion fraud scheme.
McKesson Corporation to Pay Over $13 Million to Settle Allegations It Violated Federal Reporting Requirements
Category: Settlements and Verdicts
Without admitting liability, McKesson Corporation, a national distributor of prescription medications, has settled a claim for violating federal reporting requirements related to the sale of prescription medications. McKesson has agreed to pay $13,250,000 in civil penalties under an agreement between McKesson and multiple U.S. Attorney's Offices, including the District of Maryland.
National City Mortgage Settles False Claims Act Case for $4.6 Million
Category: Settlements and Verdicts
Direct Endorsement lender National City Mortgage (NCM), based out of Miamisburg, Ohio, is paying the United States $4.6 million based upon the False Claims Act, to settle allegations relating to mortgage fraud. The settlement was announced by PRNewswire on May 22, 2008.
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Pharmacy owner faces up to 130 years in prison for his part in $3m Medicare fraud
Category: Settlements and Verdicts
A Miami jury found Gustavo Smith, 43, guilty of all 17 counts charged against him in the September 2007 indictment, including: conspiracy to defraud the U.S. government, to commit health care fraud, and to submit false claims to the Medicare program; seven counts of health care fraud; seven counts of submitting false claims to the Medicare program; conspiracy to commit money laundering; and one count of money laundering. Sentencing has been scheduled for July 2, 2008.
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$1.1 Million settlement for False Claims Act violations entered against psychiatrist for billing fraud
Category: Settlements and Verdicts
$1.1 million consent judgment has been entered against Cleveland psychiatrist Gulshan Sultan to resolve claims against her for alleged violations of the federal False Claims Act and the Tennessee Medicaid False Claims Act.
Miami's Medicare Strike Force Scores Another Conviction
Category: Settlements and Verdicts
A Miami federal jury has convicted a physician and the owners and operators of two durable medical equipment companies as well as a home health care agency of Medicare fraud.
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Alabama AG announces $6.75mm settlement
Category: Settlements and Verdicts
Alabama Attorney General Troy King announced January 9, 2008 that the State has settled claims against pharmaceutical manufacturers Dey, LP and Takeda Pharmaceuticals North America, Inc. for $6.75mm...
Hospital Agrees to Pay $7.5 Million for Medicare Overbilling
Category: Settlements and Verdicts
Warren Hospital, headquartered in Phillipsburg, has agreed to pay the United States $7.5 million to settle allegations that it defrauded the federal Medicare program...
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Underpayment of Natural Gas Royalties Leads to $97.5 Million Settlement
Category: Settlements and Verdicts
A subsidiary of Conoco Phillips has agreed to pay $97.5 million to the United States to settle allegations that it underpaid royalties owed on natural gas produced from federal and Indian leases.
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Minorities' Contracting Requirements Cost Construction Firms $11.75 Million
Category: Settlements and Verdicts
The Department of Justice announced in March that Ajax Paving Industries, Inc. and Dan's Excavating Inc. have agreed to pay $11.75 million to resolve claims that they knowingly violated Disadvantaged Business Enterprise (DBE) contracting requirements for federally funded construction projects at Detroit Wayne County Metropolitan Airport.
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Amerigroup Is Levied $334 Million in FCA Case
Category: Settlements and Verdicts
Amerigroup Illinois and Amerigroup Corporation was hit with a $334 million judgment in March, 2007 for its violations of the False Claims Act. The state of Illinois had hired Amerigroup to administer its Medicaid program.
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Amerigroup $334 Million Judgment
Category: Settlements and Verdicts
Amerigroup decided to fight its FCA lawsuit all the way through trial and was rewarded with a $334 million verdict.
Mail-order pharmacy pays $155 million to settle fraud claims
Category: Settlements and Verdicts
Medco Health Solutions Inc., one of the nation's largest mail-order pharmacy, has settled allegations that it submitted false claims to the government between 1998 and 2004 in providing mail order prescription drug services to federal employees under the Federal Employee Health Benefits Program.
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University Hospital Health Systems settles allegations of improper referrals
Category: Settlements and Verdicts
University Hospital Health Systems has agreed to settle allegations that some of its affiliated physicians improperly referred Medicare cases. The allegations, brought about by a federal whistleblower lawsuit three years ago, will cost the Cleveland hospital system $14 million.
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Medicare Durable Medical Equipment wholesaler to pay $20 million
Category: Settlements and Verdicts
The Justice Department announced that Beverly Enterprises, Inc. will settle the allegations that its former wholly owned subsidiary, MK Medical, submitted false claims for payment to Medicare and Medi-Cal from 1998 until 2002. Beverly Enterprises will pay the United States and California $20 million.
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HHS expects to recover $1.02 billion for the first half of 2006
Category: Settlements and Verdicts
According to the Semiannual Report to Congress by the Department of Health and Human Services Office of Inspector General, $228 million will be recovered based on OIG audits and $732.4 million will be recovered due to OIG investigations as part of its efforts to reduce fraud, waste and abuse in HHS programs.
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No. 2 U.S. hospital to pay $900 million to settle Medicare fraud allegations
Category: Settlements and Verdicts
The U.S. Department of Justice announced that Tenet Healthcare Corporation, operator of 68 hospitals nationwide, will pay $725 million and waive another $175 million in government payments for alleged unlawful billing practices. According to Bloomberg News, Medicare payments constituted 28 percent of Tenet's hospital revenue in 2005 alone.
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Pharmaceuticals Fraud Draws Government Involvement
Category: Settlements and Verdicts
The Justice Department alleges that pharmaceutical companies Abbot Laboratories Inc. and Hospira Inc. conspired to inflate Medicare and Medicaid reimbursements on certain drugs from 1991 to 2001. The companies are accused of reporting inflated prices for its drugs as much as 1,000% higher than the prices they charged hospitals and doctors.
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Doctor Settles Medicare Fraud Case for $2 Million
Category: Settlements and Verdicts
A Massachusetts based doctor, Philip Chiotellis, has agreed to pay nearly $2 million to settle allegations by the Department of Health & Human Services that he over-billed Medicare.
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Federal Cell Phone Auction Case Nears $100 million Dollar Settlement
Category: Settlements and Verdicts
A False Claims suit alleging one of Wall Street's most famous money managers and others schemed to defraud the Federal Communications Commission of more than $160 million is reported to be near settlement with the government, according to the Wall Street Journal.
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Bank Settles Federal Farm Loan Case For $2.127 Million
Category: Settlements and Verdicts
Farmers Bancorporation (also known as the Farmers Exchange Bank), a federally guaranteed agricultural lender, recently settled a claim brought against it under the False Claims Act, agreeing to pay $2.127 million. The two farmers bringing the claim accused the bank of charging farmers excessive interest rates and fees on Farm Service Agency loans, on which the bank submitted claims to the United States government on guaranteed loss claims and interest assistance payments. This is the second settlement by a FSA guaranteed lender in Oklahoma in recent years. Gold Banc Corporation also paid over $16 million for claims that it violated a federal farm loan program.
One doctor $1.9 million
Category: Settlements and Verdicts
One doctor in Massachusetts just paid $1.9 million to settle False Claims Act claims from Medicare overbilling.
Two billion dollar settlement?
Category: Settlements and Verdicts
Thursday, the San Diego Union-Tribune reported that analysts now estimate the long-anticipated settlement between the federal government and Tenet Healthcare will be around $2 billion.
Medco likely to settle for $163 million
Category: Settlements and Verdicts
Medco Health Solutions, Inc. is a pharmacy benefits manager that has long been under scruitiny for possible False Claims Act violations. Now, it appears that Medco will be settling three whistleblower lawsuits (at least one of which appears to be a qui tam) for around $163 million.
County pays $18.5 million plus interest
Category: Settlements and Verdicts
The York Daily Record reports a settlement between York County, Pennsylvania and the federal government for overpayment in the housing of immigration detainees.
Matria Settles False Claims Act Lawsuit for $9 Million
Category: Settlements and Verdicts
Matria Healthcare, Inc., a Georgia company, has agreed to pay $9 million to the United States to settle allegations of Medicare fraud relating to its former subsidiary, Diabetes Self Care, a Virginia-based provider of mail-order diabetic supplies. Two former employees, Kim Politsky and Sandra Clarke, had filed separate qui tam lawsuits against Matria and DSC in Georgia and Virginia. The two whistleblowers will split a relator's share of $1,980,000, or 22% of the settlement amount.
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