by Tim McInnis, Esq | Nov 13, 2020 | Uncategorized
If you did not meet our firm’s requirements for a PPP case, you can either contact the National Center for Disaster Fraud (NCDF) at (866) 720-5721 or file an online complaint at: https://www.justice.gov/disaster-fraud/webform/ncdf-disaster-complaint-form. Complaints filed will be reviewed at the NCDF and referred to federal, state, local, or international law enforcement or regulatory agencies for investigation. Where you will be able to report the fraud but NOT receive a financial reward. Or you can contact another whistleblower attorney to try to obtain a financial reward by filing a federal qui tam False Claims Act lawsuit.
by Tim McInnis, Esq | Nov 9, 2020 | Our Cases
On October 14, 2020, medical device maker Merit Medical Systems Inc. (MMSI), of South Jordan, Utah, agreed to pay $18 million to settle allegations the company helped submit false claims to the federal Medicare and TRICARE programs and numerous state Medicaid programs by giving kickbacks to physicians and hospitals to induce the purchase and use of MMSI’s durable medical equipment devices and products. NYC attorney Timothy J. McInnis was a member of the legal team that successfully represented the whistleblower in the case, Charles J. (“CJ”) Wolf, M.D., who was the former Chief Compliance Officer of MMSI.
According to Dr. Wolf’s complaint and the government’s settlement agreement, for over six years MMSI paid kickbacks to physicians, medical practices, and hospitals. The payments were made indirectly under the guise of free advertising assistance, practice development, practice support, and so-called “educational” grants. All of this was intended to induce the healthcare providers to purchase and use MMSI’s products, including EmboSphere devices, which are used for uterine fibroid embolization procedures, and QuadraSphere devices, which are used for other types of embolization procedures. Among other things, MMSI used local advertising campaigns to steer patients to healthcare providers as a reward for past sales and to increase future purchases of MMSI products. Dr. Wolf and the government further alleged that MMSI disregarded numerous internal warnings, including from Dr. Wolf, that MMSI’s sales practices potentially violated the healthcare Anti-Kickback Statute (AKS).
The lawsuit was filed in the federal court in District of New Jersey, where attorney McInnis formerly served as an Assistant U.S. Attorney. The case is captioned United States ex rel. Wolf v. Merit Medical Systems, Inc., No. 2:16-cv-01855-CCC-MF (D.N.J.). Of the $18 million MMSI is paying to settle the case, $15.21 million will be go to the U.S. Treasury, and the remaining $2.79 million will go to the approximately 30 individual states that also joined the lawsuit.
Call us anytime 212-292-4573
Call us anytime 212-292-4573
by Tim McInnis, Esq | Jun 24, 2020 | Uncategorized
GREENBELT, MD – June 15, 2020 – The United States joined a lawsuit filed by Joseph,
Greenwald & Laake, P.A. on behalf of a former Chief Compliance Officer and whistleblower
against Utah-based medical device company, Merit Medical Systems, Inc. The False Claims Act
(qui tam) complaint alleges fraud schemes involving unlawful kickbacks to physicians to induce
their use of Merit’s devices over those of its competitors.
The whistleblower, (or “Relator”), Dr. Charles Wolf, is a non-practicing medical doctor and an
accredited healthcare compliance professional with over 20 years of experience.
The complaint
recounts how Dr. Wolf reported his concerns about the alleged fraud to Merit’s management
during his tenure as its Chief Compliance Officer, all to no avail. Unable to effect change from
within, Dr. Wolf resigned from Merit and reported his information to the Department of Justice,
which undertook a thorough investigation before deciding to intervene.
The lawsuit was made public on June 12, 2020, after the United States filed its notice of
intervention and the Court unsealed the case. The federal government is expected to file its own
complaint in intervention by July 13. In addition, 29 states are included in the lawsuit and will
have an opportunity to join it also.
The complaint focuses on kickback allegations where Merit provided paid advertising for loyal
Merit users and paid consulting fees in order to influence physicians to use Merit devices –
which are expected to be included in the federal government’s forthcoming complaint. The
lawsuit alleges that Merit “paid for advertising for high-volume users of its medical devices and
continues to pay consulting fees to high-use providers for little-to-no-work.” Disguised as
educational in nature, the suit claims that, instead, the money paid to physicians was meant to
effect and “induce hospitals and physicians to purchase additional equipment, supplies and/or
products from Merit.”
Federal and state laws prohibit payments of any kind to physicians – including marketing dollars
and consulting fees – to influence physician choice of medical devices. “Prosecuting these cases
protects patients. When medical device companies pay something of value to induce physicians
to use their devices to the exclusion of others, that can effect independent medical judgment and
patient care,” said Veronica Nannis, who, with her partner Jay Holland, represents the
whistleblower in this case along with former Assistant United States Attorney, Timothy J.
McInnis of McInnis Law.
by Tim McInnis, Esq | Feb 6, 2020 | Our Cases
On January 6, 2020, U.S. District Judge Lewis A. Kaplan approved a settlement stipulating to a whistleblower award in a Customs duties fraud lawsuit. Under the agreement with the government, Xing Wei will receive $170,000 for helping the U.S. Attorney’s Office for the Southern District of New York recover $1 million from Notations, Inc., a garment wholesaler from Warminster, Pennsylvania, with a Manhattan showroom.
On October 3, 2017, Notations admitted it ignored signs of duties evasion by Yingshun Garments, Inc., an importer of apparel from China, and two successor entities and an owner/officer of each entity. The government filed its lawsuit against Notations and the Yingshun defendants charging them with perpetrating a double-invoice scheme whereby the Yingshun companies presented false invoices to CBP, showing prices for imported garments that were falsely discounted up to 75 percent to avoid customs duties. Notations admitted it furthered this scheme by overlooking obvious indications that Yingshun’s business practices were “highly suggestive of fraud.”
The whistleblower, Xing Wei, alerted the government to Yingshun’s conduct, which she had learned about through a family member who once worked for Yingshun, by filing a qui tam law suit under the False Claims Act, 31 U.S.C. § 3729. Doing so potentially entitled Ms. Wei as the “relator” in the lawsuit to between 15% and 25% of any funds recovered after the government joined her case and took over the litigation.
According to one of Ms. Wei’s whistleblower attorneys, Timothy J. McInnis, of NYC-based McInnis Law, this settlement is significant for two reasons. First, the government pursued duties fraud claims against a US-based “downstream” commercial purchaser and re-seller, not just the foreign manufacturer and importers. And, second, the whistleblower received an award for opening the door to the investigation and later helping uncover Notations’ role even though her qui tam complaint did not name Notations specifically.
McInnis commended Ms. Wei for her courage in bringing this misconduct to light. “It goes to show that under some circumstances alerting the government to fraud will be rewarded even where the whistleblower doesn’t know all the participants or all the facts,” McInnis stated. He also acknowledged Washington, DC attorney Joseph Black’s assistance on the case and the efforts of the U.S. Attorney’s Office and CBP investigators.
by Tim McInnis, Esq | Aug 7, 2019 | Uncategorized
Under traditional Medicare, beneficiaries receive an array of inpatient and outpatient healthcare services from hospitals, doctors and other providers who are reimbursed on a “fee-for-service” basis. In that environment billing fraud typically arises where the provider does not render the reported service and/or provides medically unnecessary services. Medicare Advantage, in contrast, is a managed care program that utilizes a “capitated” payment system. In that context private Medicare Advantage organizations (MAOs) receive a fixed amount of money per patient from the government and pay healthcare providers for their member-patients’ covered services, keeping what is not paid out as their profits. The amount of the capitated payment depends on the member-patients’ age, health, diagnoses and other physical and medical conditions (known as the risk adjustment score), as determined and reported by the MAOs. In an audit released on July 19, 2019, the Centers for Medicare & Medicaid Services (CMS), the agency overseeing the Medicare and Medicaid programs, estimated approximately $16 billion (or nearly 10%) of its payments to MAOs were improper because of incorrect risk adjustment scores.
Recent whistleblower cases have also revealed a number of schemes by which MAOs “game the system” by falsifying risk adjustment scores to make their member-patients appear sicker than they are in order to fraudulently obtain higher capitated payments. For example, in October 2018, HealthCare Partners Holdings LLC, a company owned by DaVita, agreed to a $270 million false claims settlement with the Department of Justice and a whistleblower. HealthCare Partners allegedly overstated its patients’ diagnoses and engaged in a “one-way” review of past diagnoses, looking for mistakes that led to lower payments from the government while ignoring mistakes that led to higher ones. The whistleblower in the case received more than $10 million.
Similarly, in December 2018, the Department of Justice joined a whistleblower lawsuit against Sutter Health, a California health system with 24 hospitals and more than 5,000 physicians. In that case, Sutter Health allegedly submitted false diagnosis codes for its patients. The whistleblower there reportedly tried to bring this to light internally before starting her lawsuit, but was ignored by the company.
And in January 2019, a federal whistleblower lawsuit against St. Louis-based Essence Group Holdings Corp. was unsealed. That case alleges Essence Group and its technology arm, Lumeris, and its local partner, Lester E. Cox Medical Centers, used data-mining software to identify patients for an “enhanced encounter” that artificially raised patients’ risk adjustment scores to boost Medicare payments. The company disputes these allegations and says it intends to fight the lawsuit. However, on July 15, 2019, a federal judge denied the defendants’ attempt to dismiss the whistleblower’s complaint. Relatedly, an April 2019 government audit found that Essence Group could not substantiate fees for a significant percentage of patients diagnosed with stroke or depression.
Call us anytime 212-292-4573
Call us anytime 212-292-4573
by Tim McInnis, Esq | Jul 13, 2018 | Our Cases
NEW YORK, July 10, 2018
McInnis Law announces the resolution
of three whistleblower lawsuits against Health Quest Systems, Inc., a hospital
system and network of healthcare providers headquartered in Lagrangeville, NY.
According to settlement agreements released on July 9, 2018, Health Quest will
pay the US $14.7 million and New York $880,000 to resolve allegations that it
violated the federal and state False Claims Acts by submitting inflated and
otherwise ineligible claims for Medicare and Medicaid reimbursement payments.
The settlements stem from three separate qui tam whistleblower lawsuits filed in
the federal district court in the Albany. They are: US, ex rel. F. v. Health Quest
Systems, Inc., No. 1:15-cv-396; US, ex rel. Cleary v. Health Quest Systems, Inc., No. 16-
cv-76; and US, ex rel. Betaudier and Carroll v. Health Quest Medical, Practice, P.C.,
et al., No. 1:16-cv-1344.
Page 1
The settlements cover allegations, which Health Quest admitted, that:
From April 1, 2009 through June 23, 2015, Health Quest submitted claims
for evaluation and management services but did not sufficiently document
the services and billed two levels higher than supported by the medical
records.
From April 1, 2011 through August 2014, Health Quest submitted claims for
home health services that lacked sufficient medical records to support the
claim, including documentation of a face-to-face encounter with a
physician.
From March 1, 2014 through December 31, 2014, Health Quest subsidiary
hospital, PHC, submitted allegedly false claims for inpatient and outpatient
services referred to PHC by two orthopedic physicians, in alleged violation
of the Physician Self-Referral Law and in violation of the Anti-Kickback
Statute.
McInnis Law represented whistleblower G. F., who filed the first of the three
whistleblower lawsuits against Health Quest. G. F. will immediately receive
$967,651, representing 15% of the total recovered from his case by the US and
New York. He has reserved the right to seek up to 25% of the proceeds he helped
recover, according to his attorney Timothy J. McInnis, of NYC-based McInnis Law.
“This case is remarkable because three unrelated whistleblowers filed separate
lawsuits using different lawyers and alleging different violations against the same
hospital system,” McInnis observed. “It really shows that the whistleblower
Page 2 of 3
procedures are working well, but it also shows something is grossly amiss with
some hospitals and healthcare providers,” noted McInnis.
CONTACT: Timothy J. McInnis, Esq., 1-212-292-4573, tmcinnis@mcinnis-law.com
SOURCE McInnis Law
