April 2024 Thank you TAF.org for encouraging me to write (and publishing) this note on Deterring Fraud Through the False Claims Act’s Penalties Provisions.
March 2024 Thank you TAF.org and Tejinder Singh for inviting me to local counsel its amicus on the FCA’s constitutionality in U.S. ex rel. Zavirov v Physician Partners.
Jan 2024 Invited to speak as the only sole practitioner at Advanced Forum on False Claims and Qui Tam Enforcement in NY. All other speakers are government lawyers and large firm partners.
Oct. 2023 Chaired a panel on data-driven cases at the TAF conference in DC. TAF is the premier organization supporting plaintiff/relators.
Oct. 2023 The US (E.D. Va.) intervened in my client's case. The allegations include inferences from claims for an invasive diagnostic that involves puncturing facial bones (7mm or more, larger than a pencil eraser) to enter the sphenoid sinus. The dangerous and invasive diagnostic is rarely performed because safe diagnosis can be made with a scan. Risks include damaging nearby dura (membrane enveloping the brain), pituitary gland, optic nerve, pterygoid canal and nerve, internal carotid artery and the cavernous sinus with its associated cranial nerves. Optic nerve damage causes blindness. Damaging the pituitary gland could cause massive bleeding, cerebrospinal fluid leak and/or loss of function of the pituitary gland. Nicking carotid artery in an office setting would be uniformly fatal.
Sep. 2023 Co-authored Medicare Data is a Fraud-Fighting Resource for TAF's Fraud by the Numbers series.
July 2023 The United States settled my client’s case for $11.4 million, with $2.1 million for my client. Among the violations in DOJ’s press release, this chain of now-defunct pain clinics, Lags Spine, performed medically unnecessary spinal implant surgeries, even ignoring contraindications. They also required non-provider staff to fabricate symptoms and order “punches” (skin biopsies)—which left visible scars. If a patient refused the punch, they threatened and would actually reduce patients’ opioid medication. United States and California ex rel. Capeder v. Francis Lagattuta, M.D., Spine & Pain Treatment, et al, No. 2:18-cv-2928 KJM KJN (E.D. Cal.). Co-counsel Phil Benson and I have worked together before. As always, he is a delight to work with.
Feb. 2023 The United States filed its complaint in intervention in my client’s case, United States ex rel. v. Jackson,. 1:17-CV-925 (M.D. NC Feb. 16, 2023). In a separate criminal proceeding, the United States convicted Dr. Jackson for adulterating medical devices, fabricating medical records, re-using single use devices for more than 1,400 surgeries, performing medically unnecessary surgeries, and other charges. In June she was sentenced to 25 years.
Jan. 2023 The United States secured a $ 25,394,733 default judgment in my client’s case, including $8,218,350 restitution, damages, and civil penalties United States ex rel. v. Reddy, 3:19-CV-00245, 2023 U.S. Dist. LEXIS 15659 (N.D. Tex. Jan. 30, 2023).
Nov. 2022 The United States intervened in my client’s case against Rennova Health, Medytox, and others. The Complaint alleges fraud against the Provider Relief Fund Program, a program designed to assist healthcare providers in the response to the pandemic. The complaint alleges defendants secured funds through a complex web of entities and strawmen. I’m local counsel for Rory Delaney. More in this Compliance Week article.
Sept. 2022 A wonderful discovery order from Judge Hope Thai Cannon, ND Fla., granting our two motions to compel against defendant Escambia Co. Just before the hearing, Escambia conceded and agreed to a consent motion that included a one-page proposed order granting both motions. But Judge Cannon didn’t just sign our proposed bare-bones order. Instead, her Order began: “Independent of the parties’ consent, the Court finds both motions should be granted.” She then took the time (and seven pages) to detail the reasons she overruled all of Escambia’s many objections. ps. This is not the SD Fla. judge Cannon who’s been getting so much press lately.
June 2022 The United States litigated, settled, and awarded my client $ 120,532 (20%) relator share plus reasonable attorney’s fees for reporting unnecessary surgeries (surgically opening the roofs of patients’ mouths). The litigation also produced good law United States v. Sakr, 17-CV-907S, 2021 U.S. Dist. LEXIS 75648 (W.D.N.Y. Apr. 20, 2021) (striking five affirmative defenses). Big thanks to Asst. U.S. Attys David Coriell MaryEllen Kresse and Daniel Moar, and to NY Asst AG Soo Young Chang. DOJ Press Release.
Jan. 2022 We settled a case alleging false claims for unnecessary anesthetic injections, unnecessary neurotransmission studies, and unnecessary ultrasonic guidance imaging. United States ex rel. Doe v. Odom, 3:20-cv-00803-CMC. (D.S.C. Jan. 6, 2022). Defendant Odom gained local infamy when he abandoned his dog, leaving it tied to a tree on a Florida beach. The settlement has not been made part of the record. Kudos to top-notch South Carolina co-counsel, Lucy Dinkins and John Moylan.
Jan. 2022 The U.S. filed a superseding indictment for criminal fraud against the defendant in our civil false claim case. United States v. Jackson, 5:21-CR-259 (E.D. N.C. Jan 4, 2022). Unlike the original indictment which focused on altering documents, this superseding criminal indictment parallels many of our intervened civil case’s allegations of unnecessary procedures. 1:17-CV-925 (M.D. N.C. Nov. 18, 2021).
Nov. 2021 The U.S. intervened and filed its Complaint in Intervention in my client’s case alleging false claims for balloon sinuplasty (dilation of nasal sinus). United States ex rel. Craig v. Jackson, 1:17-CV-925 (M.D. N.C. Nov. 18, 2021).
Aug. 2021 Federal Judge Vinson issued the shortest most succinct order I have ever seen denying a false claim case defendant’s motion to dismiss. The entire analysis (typically many pages): “For all the reasons stated in plaintiff’s comprehensive and compelling response in opposition, the defendant’s arguments are unpersuasive and will be rejected.” Our client, the county's former medical director, alleged the county used paramedics and EMTs who lacked proper training and certification. United States ex rel. Edler v. Escambia County, 3:20-cv-05503-RV-HTC (N.D. Fla).
Feb. 2021 Lawyers who litigate FCA cases might find interesting the Order on Motion to Dismiss where Judge Currie analyzed and agreed the complaint’s data-driven allegations met FRCP 9(b)'s particularity requirements. United States ex rel. Doe v. Odom, 3:20-cv-00803-CMC, 2021 U.S. Dist. LEXIS 194229, at *41-42 (D.S.C. Feb. 2, 2021).
Oct. 2020 The U.S. intervened in my client’s case alleging false claims for unnecessary injections and aspirations including sacroiliac joint injections, anesthetic nerve injections, joint aspirations, and bile duct diagnostic injections and x-rays. When the government started asking questions fraudster Reddy wired $55 million to Mumbai, and left the US with his family. But then he returned! And was arrested when he stepped off the plane. United States v. Galbraith, Reddy et al., 3:19-cv-00245-E (N.D.Tex.).
Aug. 2020 The U.S. fully intervened in my client’s case, United States ex rel. Mandel v Sakr, 1:17-cv-00907-WMS (W.D.N.Y.). Allegations in the government's complaint paralleled my client's complaint, and detailed support for thousands of Medicare and Medicaid false claims by Rochester-based Dr. Sakr. The United States is litigating this case.
Mar. 2020 The U.S. rewarded my clients $305,000. The United States intervened and settled my clients’ data-driven case alleging dermatology fraud. United States ex rel. Moore and Green v. Tran,15-cv-60-OC-41PRL (M.D. Fla.). To the best of our knowledge, this was the first False Claims case supported with CMS data. DOJ Press Release announcing $1,744,000 settlement. To encourage compliance, the Office of Inspector General required an Integrity Agreement.
Mar. 2020 The Florida Bar Journal published my response to an article. The article had "The typical amount awarded may be in the range of 5% to 15% when the government intervenes." This is incorrect, the range is 15% to 25% (and 30% without intervention). The article also claimed: "The DOJ requires hard evidence in the form of specific invoices, memoranda, emails, or other material to corroborate the testimony of the relator." The authors cite no support for this because there is none. The government has intervened in my clients' whistleblower cases (following investigation), notwithstanding the lack of the article's requisite "hard" evidence. The False Claim Act encourages us to help fight fraud against the government. But the article can mislead inexperienced and less knowledgeable lawyers by overstating the burdens and understating the benefits of filing these cases. If you suspect fraud and have questions about how to proceed, contact me for a free consultation on how you can help bring it to an end, and possibly enjoy a reward of up to 30% of what you help recover for the United States treasury.
Dec. 2019 Dermatology fraud intervention. The United States intervened in my clients' case alleging dermatology fraud. United States ex rel. Moore and Green v. Tran. Intervention means the U.S. found my clients’ allegations sufficient for the DOJ to take the case. This happens in only a small percent of False Claim cases.
Aug 2019 The U.S. intervened and rewarded my client $502,425 for bringing to light serious healthcare frauds including alleged upcoding, double billing, illegally importing pharmaceuticals from foreign countries, and improperly pooling leftover Remicade in a 2013 case filed in Texas. DOJ Press Release. United States ex rel. Garcia v Moreno, SA:13-CA-0992XR (W.D. Tex).
July 2019 I represented the city of Baltimore in a successful false claim suit against against LexisNexis for failing to pay fees for resale of accident reports.
Apr 2019 Thank you to Taxpayers Against Fraud Education Fund for bringing me in to file an amicus (friend of the court) appellate brief to help employees fight against retaliation. The brief addresses the standard for determining when an employee's whistleblowing is legally protected. We argue that employees need show only they had a “reasonable belief” that their employers would commit or had committed a violation. The case is Hickman v. Spirit of Athens, 19-10945-HH, brought by Huntsville, Alabama lawyers Tony Mastando and Eric Artrip. Co-counsel Jacklyn DeMar (TAFEF), and Janel Quinn (Employment Law Group) did the heavy lifting on the appeal.
Nov 2017 The U.S. declined my physician-client’s case against tax-exempt Naples Community Hospital. My client alleged NCH paid kickbacks to referring physicians by paying them excessive annual salaries, such as $640,000 (psychiatrist); $950,000 (gastroenterologist); and $2.2 million (orthopedic surgeon). Although my courageous client decided not to pursue this on his own, I appreciate his courage in shedding light on these payments.
Oct 2017 The U.S. intervened and settled my client’s case against a portable x-ray company for $300,000, for alleged kickbacks to nursing homes in exchange for patient referrals. I co-counseled with Ross Begelman and Regina Poserina, Begelman & Orlow, PC; and Robin Green, Lubbock Tx. United States ex rel. McDonough v. PDQ Imaging Services LLC, et al., 1-cv-138 (E.D. Tex.).
Sept 2017 The U.S. declined to intervene in a False Claims Act case alleging kickbacks related to political shenanigans after Defendant 21st Century Oncology filed for chapter 11 bankruptcy protection. I was hired as local counsel, and proud to help shine some light on this. The Wall Street Journal tells more.
Aug 2017 The United States intervened in my clients’ Texas-based False Claims Act case against a portable x-ray company alleged to have paid kickbacks to nursing homes to refer patients.
Feb 2017 The U.S. intervened and settled for $750,000, based on my client’s allegations of medically unnecessary sinus procedures. DOJ intervened and settled my client’s case against Dr. Tartell, an ENT. My client did something unusual — he read the “explanation of benefits” on his doctor’s bill. Miami Herald says the ENT paid “through the nose.”
July 2016 DOJ intervened and settled for $7.4 million , and awarded my client $1,332,000 in a case alleging unnecessary cardiac procedures. The settlement rewarded an 18% relator share plus statutory fees. United States ex rel. Green v Qamar, 5:11-CV-406-OC-KRS (M.D. Fla.).
May 2016 FCA Actions are Exempt from Bankruptcy’s Automatic Stay. Judge Roy Dalton Jr. found FCA actions are exempt from the Bankruptcy Code’s automatic stay, 11 U.S.C. § 362(a). United States ex rel. Green v. Inst. of Cardiovascular Excellence, PLLC, 2016 U.S. Dist. LEXIS 64647 (M.D. Fla. May 16, 2016).
April 2016 Work Product Doctrine Protects False Claims Act Disclosure Statement. Judge Julie S. Sneed ruled for my client that his disclosure statement is eligible for protection under the work product doctrine. United States ex rel. Bingham v. Baycare Health Sys., 2016 U.S. Dist. LEXIS 50940, *16 (M.D. Fla. Apr. 15, 2016).
Aug 2015 Federal Judge Merryday denied Baycare Health Systems’ motion to dismiss my client’s case. My client alleged Baycare spent millions to construct parking garages, and then transferred to referring physicians a near permanent right to use the garages. U.S. ex rel. Bingham v. BayCare Health Sys., 2015 U.S. Dist. LEXIS 107220 (M.D. Fla. Aug. 14, 2015).
Dec 2014 U.S. Intervenes in Case Alleging Unnecessary Cardiovascular Procedures, United States ex rel John Doe v. Asad Qamar and Institute of Cardiovascular Excellence, MD Fla, 2011. My client alleged unnecessary catheterizations, and other unnecessary procedures. Necessary catheterizations can save lives. But if you don’t need one, having a wire shoved in and around you risks many harms. Whistleblowers like my client save taxpayers millions of dollars and in cases like these, whistleblowers can saves lives too.
Oct. 2014 U.S. Intervenes in Community Mental Health Center Case against Biscayne Milieu, and various individuals. The Court unsealed our case in August, but by then there had been plenty of press on the criminal side, reporting arrests, pleas, trials, over 25 convictions, and sentences (including one for 50 years). Professor Joel Hesch, brought me in as local counsel on this.
Sep 2014 Surgical Chain Meridian paid $5.12 Million in my client’s declined and litigated whistleblower suit under the federal Anti-Kickback law, which prohibits payments to doctors for patient referrals, which Mr. Kroner filed in May 2011, in Nashville with Michael Hamilton of the Provost Umphrey Law Firm. We later brought in Sanford Heisler, LLC.
May 2014 Judge Denies Motion to Exclude Expert Witness in case alleging unlawful kickbacks paid by ambulatory surgical center owners to physicians to induce patient referrals. United States ex rel. Simmons v. Meridian Surgical Partners, LLC, 2014 U.S. Dist. LEXIS 71918 (M.D. Tenn. May 27, 2014). A year earlier Judge Campbell denied defendant’s motion to dismiss. 2013 U.S. Dist. LEXIS 62729, 2013 WL 4098663 (M.D. Tenn. May 2, 2013). Co-counseling here with Ross Brooks and Michael Palmer at Sanford Heisler, LLP, New York, and Michael Hamilton, Provost, Umphrey Law Firm, LLP, Nashville.
Apr 2014 Tenet Healthcare Paid $5 Million to settle my client’s declined case alleging unlawful kickbacks channeled through medical office building. More here in Corporate Crime Reporter, reporting a one one million dollar ($1,000,000) relator share award to my client and $1 million fees. Settlement followed two dismissals without prejudice with leave to amend.
Jan 2014 Published Article: The False Claims Act: Protecting Your Client When Amending a Sealed Complaint, American Bar Association, Litigation Section – Business Torts. Issues to consider when amending a sealed complaint. Written with Erin Campbell, Cincinnati; Jennifer McIntosh, San Francisco; and Shankar Ramamurthy, Chicago.
Aug. 2013 Judge enforces my client’s $1.6 million settlement, overturning Magistrate Judge’s recommendation, and notwithstanding DOJ and US Atty’s Office opposition, and defendant’s attempt to renege. United States ex rel. Osheroff v. MCCI Group Holdings, LLC, 2013 U.S. Dist. LEXIS 108741, 2013 WL 3991964 (S.D. Fla. 2013).
Mar 2013 Tenet’s Motion to Dismiss Denied. Tenet Healthcare Can’t Dodge For lawyers: Memo in Opposition to Motion to Dismiss, 9/21/12, successfully arguing sufficiency of allegations and plausibility for AKS and Stark, “certification”, and Stark “financial arrangement;” Order at United States ex rel. Osheroff v. Tenet HealthCare Corp., 2013 U.S. Dist. LEXIS 44235, 4, 2013 WL 1289260 (S.D. Fla. 2013); and Memo in Opposition to MTD covering Rule 9(b) and public disclosure, 31 U.S.C. § 3730(e)(4), United States ex rel. Osheroff v. Tenet Healthcare Corp., 2012 U.S. Dist. LEXIS 96434, 27, 2012 WL 2871264 (S.D. Fla., 2012).
January 2013 Judge awards my client $16 million default judgment and 27.5% Relator share in U.S. v. Koplowitz, et al., 0:10-cv-61570 (S.D. Fla., 2010).
