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.
