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Other False Claims Act Successes

By aggressively and effectively advocating for our whistleblower clients, Goldberg Kohn routinely obtains both government support, as well as judicial decisions and opinions that help positively shape the development of the False Claims Act.

IPC The Hospitalist Company, Inc.

  • In December 2013, the federal government intervened in a whistleblower  lawsuit against IPC The Hospitalist Company, Inc. (IPC), a national hospitalist  company that employs approximately 2,000 physicians who work in hospitals in 28  states. The initial qui tam lawsuit, which was filed by Goldberg Kohn, on behalf of a former IPC employee alleged that IPC intentionally and systematically over-billed Medicare and other government  health care programs for services provided by its physician employees.
  • Specifically, the lawsuit alleges that IPC engaged in “upcoding” by encouraging its doctors to bill at the highest levels regardless of the level of service provided, trained its doctors to use higher level codes, and encouraged doctors with lower billing levels to “catch up” to their peers.
  • For more information, see the Department of Justice’s press release.
  • Describe and cite press coverage of surviving motion to dismiss

Rush / Goldberg 

  • In 2012, Goldberg Kohn obtained a favorable decision from the U.S. Seventh Cirucit Court of Appeals in the case of U.S. ex rel. Goldberg and Beecham v. Rush University Medical Center, et al.  (“Goldberg”). In an opinion written by Judge Easterbrook, the Seventh Circuit Court of Appeals reversed a decision of the district court, thereby reviving claims that had been dismissed based on the False Claims Act’s public disclosure bar. The decision continued the trend in the Seventh Circuit narrowing the applicability of the public disclosure bar when the government is aware of general, industry-wide, fraudulent practices.
  • At issue in the case was whether investigations conducted in the 1990s by the Department of Health and Human Services and the General Accounting Office (GAO) concerning billing practices of physicians at teaching hospitals (the PATH Audits) publicly disclosed those allegations and, if so, whether the relators’ claims were “based on” the PATH Audits. Rejecting the district court’s conclusion that the relators’ allegations were “based on” the PATH Audits, the court held that the district court had inappropriately applied the substantially similar standard “at a high level of generality.” Judge Easterbrook wrote that “a very high level of generality is inappropriate because then disclosure of some frauds could end up blocking private challenges to many different kinds of fraud.” 
  • The Seventh Circuit’s reversal of the district court’s dismissal ultimately lead to a favorable settlement.

Omnicare, Inc. 

  • In July 2013, Goldberg Kohn obtained a favorable summary judgment ruling in a False Claims Act case against Morris and Philip Esformes, alleging that they had received illegal kickbacks in connection with the sale of Total Pharmacy, which they owned and operated, to Omnicare. The judge’s decision to deny summary judgment ultimately led to a $5 million settlement.
  • The decision received significant press coverage, including an article in the Chicago Tribune.
  • Note the private insurance statute in Illinois
  • Briefly describe ruling on summary judgment

Gentiva Health Services

  • On June 25, 2014, a federal court held that Gentiva Health Services – a home-health agency that provides home-health services to more than 350,000 patients nationwide – must face charges that it violated the False Claims Act by falsely certifying patients in need psychiatric care.
  • The case had originally been filed by Goldberg Kohn on behalf of their client in 2010, in which the client alleged that Gentiva engaged in various fraudulent healthcare schemes. Specifically, Gentiva allegedly billed for unnecessary home visits, improperly marketed home health services, falsely certified patients as home-bound, billed for subpar skilled nursing services, and falsely certified patients in need psychiatric care.

Attorneys at Law

55 East Monroe Street
Suite 3300
Chicago, Illinois 60603-5792
Tel: 312-863-7222
Fax: 312.332.2196
Email: whistle@goldbergkohn.com

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