by Tim McInnis, Esq | May 18, 2023 | Our Cases
Whistleblower attorney Timothy J. McInnis announced his client, Clemire Young, will receive $60,000 (20%) from the proceeds of a $300,000 Government healthcare fraud settlement with The Brookdale Hospital Medical Center (“Brookdale Hospital”), a 530-bed, nonprofit teaching hospital located at One Brookdale Plaza, Brooklyn, NY.
The settlement, which was approved by US District Judge I. Leo Glasser on 5/17/2023,
resolves allegations brought by Ms. Young , a former employee of Brookdale Hospital, under the qui tam whistleblower provisions of the Federal and NY False Claims Acts. Her complaint, which had been under seal since April 2019, alleged Brookdale Hospital violated these acts by causing ineligible participants to receive WIC benefits and misappropriating WIC grant funds by, among other things, paying employees for no show jobs and buying things for personal use, such as furniture.
WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. It is a federal funded/state administered program serving low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, including breastfeeding promotion and support, and referrals to health care.
Ms Young, through attorney McInnis, expressed appreciation for the investigative and
settlement efforts of the U.S. Attorney’s Office for the Eastern District of New York and the Office of Inspector General for the US Department of Agriculture. “This case is an example where a concerned employee saw the tip of the iceberg and reported it to authorities who then were able to expose the whole iceberg,” said McInnis.
by Tim McInnis, Esq | Mar 12, 2023 | Our Cases
Whistleblower to Receive $210,000 from
$1M Government Customs Fraud
Settlement with Samsung C&T America
NYC whistleblower attorney Timothy J. McInnis announced that his client, Devyn Taylor, will receive $210,000 from the proceeds of a $1 million Government Customs fraud settlement with Samsung C&T America, Inc. (“SCTA”), a global trading and investment company. The settlement, which was approved by U.S. District Judge Paul G. Gardephe on February 6, 2023, resolves allegations brought by the United States against SCTA under False Claims Act. Taylor had previously filed under seal a qui tam whistleblower case pursuant to the False Claims Act against another party and that filing help lead to the Government’s settlement with SCTA, according to McInnis. The award to Ms. Taylor was also approved by J. Gardephe and publicly reported by the court on February 16, 2023.
As the U.S. Attorney for the Southern District of New York reported in a press release issued February 7, 2023, its settlement with SCTA resolved claims “that between May 2016 and December 2018, SCTA violated the False Claims Act by misclassifying imported footwear under the Harmonized Tariff Schedule (“HTS”) and by not paying the full amount of customs duties owed.”
Ms Taylor, through her attorney, McInnis, expressed appreciation for the investigative and settlement efforts of the U.S. Attorney’s Office for the Southern District of New York, the U.S. Customs and Border Protection (CBP) and Homeland Security Investigations (HIS). The Government’s case is captioned, United States of America, Plaintiff-Intervenor, v. Samsung C&T America, Inc., Defendant, 16 Civ. 7216 (PGG), in the United States District Court for the Southern District of New York. Further details of the Government’s allegations are set out in its Complaint in Intervention, which can be found on the court’s electronic docket. For additional information about this case or other False Claims Act matters, please contact:
Timothy J. McInnis, Esq.
McInnis Law
521 Fifth Avenue, 17 Fl., New York, NY 10175
(212) 292-4573
tmcinnis@mcinnis-law.com
by Tim McInnis, Esq | Oct 30, 2022 | Our Cases
NEW YORK, Oct. 25, 2022 NYC whistleblower attorney Timothy J. McInnis announced a $86,676 settlement against The Rensselaerville Institute (TRI), a non-profit organization providing educational services for young people located in Delmar, NY. The settlement resolves False Claims Act allegations in a qui tam whistleblower complaint filed by former CFO Alexandra Poole under seal in August 2021 in the U.S. District Court for the Northern District of New York. The case was unsealed October 25, 2022, by order of United States Magistrate Judge Andrew T. Baxter. The United States Attorney’s Office for the Northern District of New York intervened in the action on October 18, 2022 and spearheaded the settlement, according to Attorney McInnis.
Poole’s complaint alleged that TRI defrauded the Small Business Administration (SBA) Payroll Protection Program (PPP) by knowingly overstating its average monthly payroll. TRI did this to unlawfully increase the amount of an SBA-guaranteed loan it could receive. The SBA subsequently determined TRI had, in fact, overstated its average monthly payroll on its PPP loan application and received excess funding of $86,676. Under the terms of the Settlement Agreement, TRI acknowledged and accepted responsibility for this conduct.
As stated in the Settlement Agreement, the PPP was established pursuant to the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, in March 2020. It was designed to provide emergency financial assistance to small businesses suffering economically from the COVID-19 pandemic through forgivable loans for payroll and other specified expenses. Poole’s complaint further alleges the SBA made approximately 5.2 million PPP loans, totaling nearly $700 billion, many with little or no lending controls or oversight.
While ensuing PPP fraud was rampant, there have been very few recoveries under the civil qui tam provisions of the False Claims Act, observed Attorney McInnis. These provisions allow private citizens to sue on behalf of the Government in order to help stop fraud against the United States and recover ill-gotten gains, McInnis explained. Even more rare, is a successful qui tam suit against a non-profit organization, McInnis said, noting he believes this is the first of its kind.
Under the terms of the Settlement Agreement, Poole, who is known as a qui tam relator, will receive $17,000 (19.6%) as a reward for initiating the lawsuit and prompting the Government’s investigation. Poole also alleged whistleblower retaliation/wrongful termination by TRI and that claim, as well as the amount of attorneys’ fees to be awarded to McInnis Law and co-counsel Tabner, Ryan and Keniry, LLP remain unresolved by the Settlement Agreement.
On behalf of Ms. Poole and her attorneys, Attorney McInnis expressed appreciation for the investigative and settlement efforts of the U.S. Attorney’s Office for the Northern District of New York and the SBA. The case is captioned, United States ex rel. Alexandra Poole v. The Rensselaerville Institute, Inc., et al., 1:21-cv-943, United States District Court for the Northern District of New York.
For additional information, please contact Attorney Timothy J. McInnis, of McInnis Law, 521 Fifth Avenue, 17th Fl., New York, NY 10175, at (212) 292-4573 or tmcinnis@mcinnis-law.com.
Complaint
ECF Settlement Agreement
by Tim McInnis, Esq | Oct 30, 2022 | Our Cases
NEW YORK, Oct. 28, 2022 NYC whistleblower attorney Timothy J. McInnis announced a $98,694 settlement against Oswego Hospital. The settlement resolves False Claims Act allegations in a qui tam whistleblower complaint filed by former employee Maureen Bradley under seal on April 10, 2019 in the U.S. District Court for the Northern District of New York. The United States Attorney’s Office for the Northern District of New York and the New York Attorney General’s Office intervened in the action on September 9, 2022 and led the settlement negotiations, which the government publicized on October 26, 2022, according to Attorney McInnis, who was co-counsel to Ms. Bradley.
The case involved allegations Oswego Hospital billed the Medicare and Medicaid programs for outpatient mental healthcare services by unsupervised licensed master social workers (LMSWs) and not making or maintaining documents to support such services.
Oswego Hospital settles whistleblower suit involving unsupervised LMSWs for $98,694 Under the terms of the Settlement Agreement, Bradley, who is known as a qui tam relator, will receive a total of $19,739 (20%) from the US and NYS governments for initiating the lawsuit and prompting their joint investigation.
“Conscientious healthcare employees, like Maureen Bradley, help foster patient safety and preserve financial resources for our healthcare system,” noted Attorney McInnis. “When they shed light on improper or fraudulent billing practices by filing a qui tam lawsuit under the False Claims Act, they can receive between 15% and 30% of any recovered funds,” McInnis added. Ms Bradley, through her attorneys, McInnis Law and Tabner, Ryan & Keniry, LLP, expressed appreciation for the investigative and settlement efforts of the U.S. Attorney’s Office for the Northern District of New York and the New York Attorney General’s Office/Medicaid Fraud Control Unit.
The case is captioned, United States of American and State of New York, ex rel. Maureen Mounce Bradley, 5:19-cv-0431 (GTS/ATB), United States District Court for the Northern District of New York.
For additional information, please contact Attorney Timothy J. McInnis, of McInnis Law, 521 Fifth Avenue, 17th Fl., New York, NY 10175, at (212) 292-4573 or tmcinnis@mcinnis-law.com.
SOURCE McInnis Law
by Tim McInnis, Esq | Oct 14, 2022 | Qui Tam
Medicare Advantage Fraud occurs when healthcare insurers knowingly abuse the Medicare Part C program in order to make money unlawfully. Many American seniors are increasingly choosing Medicare Advantage Plans (MA Plans) over traditional Medicare Part A (hospital), Part B (physician) and Part D (prescription) healthcare coverage. Under the Medicare Advantage program, healthcare insurers get a monthly capitated fee from Medicare/CMS, plus a monthly premium from the members, and the insurers are supposed to provide superior healthcare and wellness services to the plan members at a lower cost to the members and U.S. tax payers.
The capitated amount Medicare pays the MA Plan sponsor (usually an insurance company) is based on a given member’s Medicare Risk Adjustment (MRA) score. In other words, the sicker the person is the more the insurance company receives from Medicare/CMS. This simple equation has motivated unscrupulous healthcare insurers with Medicare Advantage Plans to “game” or inflate their members’ MRAs with diagnoses that make members look sicker than they really are. It also incentivizes the MA Plan sponsors to “cherry pick” healthy members and/or provide substandard healthcare services to members in order to save money improperly.
If you work in this field you may have felt at times you would like to report Part C Medicare Advantage Fraud. It is likely you’ve seen an MA Plan sponsor implement one way audit programs which seek to add supposedly overlooked negative diagnoses to ramp up MRA scores, while not looking to uncover mistaken diagnoses that caused MRAs to be artificially high. Sometimes patient medical charts may even have been fabricated with outright bogus diagnoses. Maybe you are also aware of plan member recruitment tactics designed to bring in healthier members and keep out sicker ones. And it is possible you’ve seen systemic practices where a Medicare Advantage Plan sponsor tries to save money by failing to arrange for its members to receive the level of healthcare services they need. It’s conceivable you alerted a MA Plan sponsor about specific instances where any of these or similar practices have occurred and your concerns have fallen on deaf ears. It can be extremely disheartening. There is, however, an alternative way of trying to end MA Plan fraud.
If you have observed anyconduct you believe is improper and would like to report Medicare Advantage Fraud and help stop it, your best course of action may be to contact an experienced qui tam whistleblower attorney who can help guide you, assess your rights, contact the Government to report the fraud and even file a federal qui tam whistleblower lawsuit on your behalf. Many attorneys in this field will not charge you for a consultation and any communications you have with them will be privileged and confidential.
It is always best to begin this dialogue as soon as possible, especially if you still have access to evidence that can corroborate your allegations.
by Tim McInnis, Esq | Jul 9, 2022 | Uncategorized
You can support the Department of Justice’s National Nursing Home Initiative by filing a qui tam action under the federal False Claims Act for substandard nursing home care and fraudulent billing practices.
Since March 2020, DOJ has been focusing on long-term care providers, such as nursing homes, sub-acute rehabilitation centers and skilled nursing facilities (SNFs), who provide grossly substandard care to Medicare beneficiaries and/or bill for services that have not been rendered or were “upcoded,” including, rehabilitation treatment, like physical, occupational and speech therapy.
The government is looking for whistleblower cases involving gross abuse and neglect of Medicare patients and blatantly fraudulent billing practices. This includes inadequate care stemming from severely low staffing levels and the use of unlicensed and uncredentialed healthcare providers and aides. It also includes withholding necessary services and activities, including, psychiatric care. Failing to establish or follow plans of care and treatment. And not properly creating and maintaining medical records.
The government is also very focused on significant patient safety issues, like failing to follow
hygiene and infection control protocols. Dispensing unnecessary medications or failing to
provide necessary ones. Housing residents in unsafe or unacceptable living quarters. Failing to
provide adequate food and nourishment. Not attending to bed-ridden patients resulting in
pressure sores. Infrequently bathing and washing residents. Subjecting patients to verbal or
physical abuse. Physically restraining or sedating patients when not warranted. And
inadequately protecting patients’ safety and their personal belongings.
Overbilling and gaming the system for rehabilitation services is also a potential targeted area of
concern. The government is particularly interested in cases where the provider fails to establish
compliance programs and protocols. Turns a blind eye to patient and staff complaints and
warnings. And implements polices and practices that put profits far above quality of care.
Pervasive, long-standing and widespread misconduct involving substandard nursing home care
can result in a provider’s liability under the False Claims Act and a substantial reward to
whoever alerts the government to such conditions.
In the eyes of the law it is improper to file a claim for Medicare reimbursement for services to
nursing home residents knowing the quality of the care was grossly substandard. This is
because every provider’s Medicare claim for reimbursement carries with it an implication that all
material rules and regulations concerning patients’ wellbeing, safety and care have been
complied with. When they have not, then the claim for reimbursement might constitute a false
representation.
If that is what a court or jury finds, then the provider is potentially liable for three times the
amount of the improper payments it received, plus per claim fines of over $25,000, or even
criminal penalties. And, whoever blows the whistle on nursing home or elder care fraud is
potentially eligible for as much as 30% of any funds the government recovers.
The people in the best position to bring successful False Claims Act cases for nursing home
and elder care fraud are current employees. This is because it is important to have or be able to
amass patient-specific and detailed information and evidence corroborating allegations of
substandard nursing home care or Medicare billing fraud.
If you are aware of misconduct in a nursing home or other facility treating seniors and are
confident you have or can obtain strong proof of it, then you should immediately contact an
experienced qui tam whistleblower lawyer to learn about your rights and options.
by Tim McInnis, Esq | Jun 13, 2022 | False Claims Act
It’s no secret that private equity (PE) firms are increasingly acquiring healthcare and life science
businesses. And it is also no secret that when they do, these firms employ typical investment
strategies and practices that may make sense in some industries, but not those involving
patient treatment and care. After all, private equity (PE) firms usually seek to increase the debt
held by their portfolio companies, while trying to ramp up revenues and drastically cut costs.
In the healthcare and life science arenas this can lead to debt-laden balance sheets and
bankruptcies, unethical or unlawful sales and marketing schemes to boost revenues (including
by paying kickbacks) and massive cuts in essential staff and service levels. All of which can result
in underserving and improperly treating the patient population, many of whom are Medicare,
Medicaid and TRICARE beneficiaries. It can also lead to falsely billing government insurance
programs, resulting in False Claims Act violations and substantial rewards for whistleblowers.
Due to increasing fraud and abuse in the healthcare and life science fields, the U.S. Department
of Justice is taking a closer look at charging private equity (PE) firms with False Claims Act
“upstream” liability for the misconduct of their portfolio companies. This has resulted in a
number of large settlements in recent years.
Successfully pursuing False Claims Act cases against private equity (PE) firms requires two
things above and beyond the normal elements of proof in FCA cases. First, you need to show
that one or more members of the private equity (PE) firm had some role in causing the portfolio
company to submit false claims to a government program. This is usually done by showing their
control over, and involvement in, the day to day management and operation of the business.
For example, by controlling the board and through consulting and management service
contracts and the receipt of payments for such services. The second vital fact you need to
establish is that one or more members of the private equity (PE) firm knew about the
fraudulent and improper billing practices of the portfolio business. Often this can be proved by
showing that these investors turned a deliberate blind eye to such misconduct in their quest for
profits and/or that they failed to set up and monitor effective compliance programs.
If you believe a Private Equity (PE) firm might have upstream False Claims Act liability for the
misconduct of one or more of its portfolio companies (whether in the healthcare field or
otherwise), you should immediately contact an experienced qui tam whistleblower attorney.
Time is often of the essence, especially in larger organizations where many people know about the fraud and some may rush to preserve their rights since there is a first-to-file rule that generally bars subsequent whistleblowers from receiving a reward.
by Tim McInnis, Esq | May 21, 2022 | Uncategorized
False Claims Act Recoveries Top $5.6 Billion in 2021
In 2021, the United States government recovered more than $5.6 billion in False Claims Act
recoveries. A good deal of this money came from so-called “qui tam” law suits filed by private citizens.
Those with winning cases typically received between 15%-25% of the recovered amount, some even got
as much as 30%.
As has been true for a number of years, the lion’s share of the False Claims Act settlements and
judgments arose from healthcare fraud cases, mostly involving Medicare and Medicaid, and to a lesser
extent Tricare and Federal Employees Health Benefits (FEHB) program. We expect that trend to continue
for the foreseeable future, including in the Medicare Part C, Medicare Advantage Program, where “risk
factor gaming” has become more prevalent. Anti-Kickback Statute (AKS) and Stark Law violations for
improper referrals are also likely to loom larger. Of course, there will likely be no shortage of
unnecessary procedures, upcoding and billing for services not rendered cases.
With the trillions of dollars handed out during the COVID pandemic, one should also expect to
see any number of schemes where undeserving companies and organizations, as well as individuals, got
Stimulus money, PPP loans, CARES Act funds and Provider Relief money to which they were not entitled.
While this is not an exhaustive list of types of fraud cases heading our way, we do also want to
mention the government’s Cybersecurity Initiative, which aims to tackle the problem of hacking and
theft of government and government contractor data and the failure of those responsible for thwarting
these attacks. This is just one of the many types of procurement fraud the False Claims Act addresses,
along with more traditional defense industry and grant fraud.
If you think might have information about these and other types of potential qui tam False
Claims Act cases, you should immediately contact an experience whistleblower lawyer
by Tim McInnis, Esq | May 16, 2022 | False Claims Act
HOW TO REPORT CYBER SECURITY FALSE CLAIMS FRAUD
Did you know the Department of Justice introduced a new IT cyber security false claims initiative in 2021?
You might benefit from this IT cyber security false claims program if you report government contractors and grantees who didn’t protect sensitive electronic data from hackers. Reporting such activities in the right way could entitle you to a monetary reward.
What kinds of misconduct is covered by the government’s IT cyber security false claims initiative?
Broadly speaking, it falls into two categories. The first concerns government IT contractors, consultants and auditors who were supposed to provide protection against unauthorized access to government networks, hardware, devices, computer systems, software and electronic files and who knowingly provided substandard cyber security products or monitoring services and then submitted false claims to the government.
The other involves ordinary government contractors and grant recipients, such as those in the defense, aerospace, NASA, GSA and healthcare industries, who don’t meet acquisition and contracting regulations (like FARS, DFARS , NASA FARS, NIST, CMMC, FedRAMP, and HIPAA) requiring them to adequately monitor and provide a certain level of security for the sensitive government data they handle when performing under their contracts. Often the data at stake is unclassified controlled technical information (UCTI), sensitive but unclassified information (SBU), personally identifiable information (PII), personal health information (PHI), or other types of confidential information.
Who might be in a position to bring a cyber security case against an IT Contractor?
The ideal combination is someone who is knowledgeable about the IT products and services, the regulatory and contractual requirements, and the facts concerning the fraud, including, possible security breaches and the failure to accurately report them when submitting false claims to the government. For example, someone who works in a cyber security, compliance and controls unit of a government contractor may be in a good position to bring a successful case.
What do you need to do to benefit from the government’s cyber security fraud initiative?
You can bring a “qui tam” lawsuit under the False Claims Act against the contractor or grantee. If your case is successful and the defendant returns money to the government, you could be entitled to between 15% and 30% of the recovery. To do so, you must hire an attorney and file a lawsuit in federal court. If you even suspect some organization is submitting false claims to the government and think you may want to report it you should immediately contact an experienced and trusted whistleblower attorney to protect your rights.
by Tim McInnis, Esq | Feb 4, 2022 | Our Cases
NYC whistleblower attorney Timothy J.
McInnis, and Chicago attorneys Stephen B. Diamond and Tony Kim, jointly announced a $2.5 million settlement against Call One, Inc., a Chicago-based provider of telecommunications
services. The settlement resolves allegations contained in a qui tam whistleblower complaint that had been led under seal in September 2018 in the Circuit Court of Cook County Illinois and ordered unsealed on January 25, 2021, by Circuit Judge Jerry A. Esq
The complaint, brought under Illinois’ False Claims Act by two former employees, alleged that Call One failed to collect and remit state taxes for telecommunications services. Specially, the ex-employees alleged that Call One failed to pay telecommunications excise taxes, simplified municipal telecommunications taxes, and telecommunications infrastructure maintenance fees on contracts with some of its sales tax-exempt customers, such as municipalities.
The State of Illinois, through the Of ex of the Attorney General, joined in the lawsuit, according to a notice of intervention led on January 22, 2021. The Attorney General’s of ex also negotiated the terms of the settlement, noted Attorney McInnis.
Under the terms of the Settlement Agreement, which became effective on January 21, 2021, Call One was to pay the State $2.5 million by January 22, 2021. Further, according to its terms, the two former employees collectively are to receive 15% of the settlement amount shortly after it is paid to the State and they can petition the court for up to a total of 25% within 21 days.
The former employees can also seek reimbursement for reasonable attorneys’ fees and expenses in a separate petition on or before that date, stated Attorney Diamond. All three attorneys for the whistleblowers express their appreciation to the State, and its attorneys and representatives in the Of ex of the Attorney General and Department of Revenue, for the decision to intervene in the case and see it through to a successful resolution.
The case is captioned, State of Illinois ex rel. John Havis and Robert Kintz v. Call One, Inc., Index
No. 2018 L 010085, Circuit Court of Cook County, Illinois, County Department, Law Division.
For additional information, please contact Timothy J. McInnis, Esq., of McInnis Law, at (212) 292-4573
