False Claims Act Successes

Since the time of our Landmark Victory, Goldberg Kohn’s False Claims Act practice has developed a nationwide track record of success for our clients. By carefully crafting complaints, working cooperatively with the government and litigating effectively against the most powerful law firms in the country, the firm has repeatedly obtained successful outcomes, government support and judicial decisions and opinions that positively shape the development of the False Claims Act.

The Department of Justice (DOJ) only intervenes in nearly a fourth of all whistleblower lawsuits. GK has led many high-profile Medicare/Medicaid FCA lawsuits over the years, and the DOJ has intervened in a number of these suits.

Examples of the firm’s successes, both in closed cases and active cases, include:

BAYADA Home Health Care, Inc. - United States of America, State of New Jersey, ex rel. David Freedman v. BAYADA Home Health Care, Inc., et al, No. 17-cv-06267 (NLH) (D. N.J.)

• The DOJ) intervened in a lawsuit filed by GK on behalf of the former Director of Strategic Growth of BAYADA Home Health Care, Inc.
• BAYADA allegedly had illegally purchased patient referrals through the purchase of two home health agencies from a retirement operator in Arizona, violating the Federal False Claims Act and the Medicare and Medicaid Anti-Kickback Statute.
• BAYADA agreed to pay $17 million to resolve these allegations.
• For more information, view the DOJ press release and GK’s press release.

Kaiser Permanente - United States ex rel. Bryant v. Kaiser Permanente, et al.

• GK represents two previous Kaiser employees who allegedly witnessed fraud on the Medicare Advantage program by their then-employer.
• The lawsuit alleges that Kaiser and their various affiliates defrauded Medicare by submitting diagnosis codes for patients that were unsupported by the medical record, thereby falsely inflating Kaiser's risk adjustment payments from the government. 
• The United States has intervened and combined the lawsuit filed by GK with other related cases filed by whistleblowers.

• This case is ongoing.
• For more information, view GK’s press release.

Community Health Systems, Inc. - United States ex rel. Plantz v. Community Health Systems, Inc., et al., Case No. 10C-0959 (N.D. Ill.)

• GK represented former employees of Community Health Systems, Inc. (CHS) in a qui tam lawsuit alleging that the company knowingly billed government health care programs for unnecessary ER admissions and inpatient services that should have been billed as outpatient or observation services in 119 of its hospitals.
• After intervening in the lawsuit filed by GK, the DOJ combined the lawsuit with seven other related cases filed by whistleblowers in other districts.

• According to the DOJ, CHS allegedly “engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s TRICARE program beneficiaries” and admitted patients when it was not medically necessary.
• CHS agreed to pay $98.15 million to resolve these allegations.
• Criminal charges and Medicare fraud allegations against subsidiary Health Management Associates, LLC resulting from this initial suit were resolved by a separate $260 million settlement.
• For more information on these settlements and the criminal proceedings, see the DOJ press releases here and here and the firm’s press releases here and here. 

Laynie Foundation, Inc. - United States of America, et al. v. Laynie Foundation Inc., et al. 

• The DOJ and State of Illinois intervened in a qui tam lawsuit originally filed by GK on behalf of a mental health professional who previously provided services to children and adolescents at Laynie Foundation.

• The lawsuit alleges that the Laynie Foundation received approximately $6.3 million in illegitimate Medicaid reimbursements over a four-year time period – having submitted false claims for payment to the Illinois Department of Healthcare and Family Services for ineligible services, unnecessary services or services that were not provided at all.
• This case is ongoing.

• For more information, see GK’s press release.

Allergan, Inc. - United States ex rel. Herbert J. Nevyas, M.D. and Anita Nevyas-Wallace, M.D. v. Allergan, Inc., Civil Action No. 09-CV-00432 (E.D. Pa.)

• Allergan, Inc. allegedly provided illegal kickbacks to ophthalmologists to induce them to write prescriptions for Allergan eye care products.
• Allergan agreed to pay $13 million to the federal government and 19 states to resolve these allegations.
• This suit was jointly filed and litigated by GK and Philadelphia law firm Pietragallo Gordon Alfano Bosick & Raspanti.
• For more information, see GK’s press release.

Illinois Medicaid – Securing Adequate Funds for Medicaid Program

• In 2015, GK scored a major win when a federal judge ordered the state to continue to make Medicaid payments, even during the budget impasse, to providers that treat Cook County children.
• The order relied on an October 2005 consent decree entered by Judge Lefkow, after a trial, also led by GK as counsel, in which she ruled that the state had failed to provide access to health care services guaranteed to children under the federal Medicaid Act.
• The Sargent Shriver National Center on Poverty Law and AIDS Legal Council of Chicago joined GK in this case.
• For more information, See GK’s press release.
• In 2017, GK and the previous co-counsel returned to court to ensure Medicaid was still adequately being funded during the state’s elongated budget crisis. As a result, Judge Lefkow issued an order, requiring the state Comptroller to increase the payments to the Medicaid system.
• For more information, see GK’s press release.

IPC The Hospitalist Company, Inc. - United States ex rel. Oughatiyan v. IPC The Hospitalist, Inc., et al., Civil Action No. 09 C 5418 (N.D. Ill.)

• GK represented a physician formerly employed by IPC in a qui tam lawsuit alleging that IPC engaged in a long-running "upcoding" scheme—encouraging physicians to bill for their services at the highest possible levels without regard for the services actually rendered, and in many cases billing for more services in one day than could possibly have been provided in a 24-hour period.
• Team Health Holdings, Inc. acquired IPC in 2015 and agreed to pay $60 million to resolve these allegations.
• Firm attorneys prosecuted the case alongside government attorneys from the DOJ and the United States Attorney's Office.
• For more information, see the DOJ press release and GK’s press release.
• This case was also covered in a Chicago Daily Law Bulletin article.

Allen School of Health Sciences - United States ex rel. Joshua Cage v. The Allen School and Jason Reich, Case No: 1:13-cv-04431 (S.D.N.Y.)

• GK’s client brought a case against the Allen School of Health Sciences, a for-profit school, and its former COO alleging they violated the incentive compensation ban and breached the school's Program Participation Agreement.
• The government intervened and litigated this case resulting in settlements totaling $4.29 million.
• For more information, see the DOJ press release and the GK press releases here and here.

Education Management Corp. - United States ex rel. Washington et al. v. Education Management Corp., et al., Civ. No. 07-461 (WDPA)

• Education Management Corp. (EDMC), a for-profit college company, allegedly falsely certified compliance with Title IV of the Higher Education Act and parallel state statutes in order to receive federal and state grants and loan monies.
• EDMC agreed to pay $95.5 million to resolve these allegations. The settlement amount reflected EDMC's financial situation and its ability to pay; the suit alleged billions in damages.
• GK was co-lead counsel to the whistleblowers who originated the case. The DOJ and the states of California, Florida, Illinois, and Indiana joined the suit, which was combined with three other cases filed in Pennsylvania and Tennessee.
• For more information see the DOJ press release.
• This case was also covered in a New York Times article.

Shire Pharmaceuticals LLC - United States ex rel. Hsieh, Harris, and Clark v. Shire PLC, et al., No. 09-6994 (N.D. Ill.). 

• GK represented three clients alleging Shire Pharmaceuticals made claims to prescribers about the uses and benefits of several drugs, including Adderall XR, despite a lack of clinical supporting data.
• The DOJ intervened in the case reaching a settlement with the company for $56.5 million to resolve the allegations.
• For more information, see the DOJ press release and GK’s press release.
• This case was also covered in a London Times article.

Omnicare, Inc.; Morris and Philip Esformes - United States ex rel. Nehls v. Omnicare Inc. et al., Case No. 1:07-cv-05777 (N.D. Ill.).

• GK represented a former employee of Total Pharmacy in a qui tam lawsuit alleging that Omnicare's $32 million purchase of Total Pharmacy included a multimillion-dollar kickback to secure long-term pharmacy contracts with more than two dozen nursing homes operated by Morris and Philip Esformes, who also owned Total Pharmacy.
• Omnicare agreed to pay $17.2 million to the government to settle its part of the ongoing lawsuit, and the individuals later settled for $5 million.
• See GK’s press release.
• This case was also covered in a Chicago Tribune article.

Rush University Medical Center - United States ex rel. Goldberg v. Rush University Medical Center, 680 F.3d 933 (7th Cir. 2012)

• GK represented two former employees in a qui tam lawsuit against Rush University Medical Center (Rush), which alleged in part that the hospital submitted false claims to Medicare from 2000 to 2007 by entering into certain leasing arrangements for office space with two individual physicians and three physician practice groups in violation of the Stark Law.
• Rush agreed to settle these allegations for $1.5 million.
• For more information, see the DOJ’s press release.
• Several matters remained unresolved by this first settlement, including allegations that the orthopedic practice at Rush was falsely billing Medicare for surgeries that residents performed unsupervised.
• Though the District Court for the Northern District of Illinois initially dismissed the case, GK successfully appealed and obtained a settlement of $5 million after the U.S. Seventh Circuit Court of Appeals reversed the dismissal.

• Landmark Victory
• False Claims Act Successes
• Awards and Recognition