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Other False Claims Act Successes

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

Government Intervention

According to a 2017 Bloomberg article, the Department of Justice (DOJ) intervenes in only about 25% of Medicare/Medicaid qui tam fraud cases, and "the government chooses to cherry pick the strongest whistleblower cases for intervention". Goldberg Kohn has led many high-profile Medicare/Medicaid FCA lawsuits over the years, and the DOJ has intervened in a number of these suits.

United States ex rel. Plantz v. Community Health Systems, Inc., et al.
  • Goldberg Kohn filed this qui tam lawsuit on behalf of a well-respected emergency room physician. The relator alleged that Community Health Systems Inc. ("CHS") knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services. After intervening in the lawsuit filed by Goldberg Kohn, the DOJ combined the lawsuit with seven other related cases filed by whistleblowers in other districts.[1]
  • CHS agreed to pay over $97 million to resolve some of the allegations brought by these cases. CHS subsidiary Health Management Associates, LLC later agreed to pay $260 million to resolve criminal charges and civil claims relating to a similar fraud scheme.
  • 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 (DOD) TRICARE program beneficiaries", including by forcing emergency room physicians to admit patients to the hospital when it was not medically necessary. CHS was then overpaid for these unnecessary admissions.
  • For more information, see the Department of Justice’s press releases here and here or Goldberg Kohn's press releases here and here.
United States ex rel. Oughatiyan v. IPC The Hospitalist Company, Inc.
  • The DOJ intervened in this whistleblower lawsuit originally filed by Goldberg Kohn against IPC The Hospitalist Co. Inc. ("IPC"), a national hospitalist company that employs approximately 2,000 physicians in 28 states. The initial qui tam lawsuit 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 alleged that IPC billed for more expensive levels of service than were actually provided, and encouraged doctors with lower billing levels to “catch up” to their peers.
  • Ultimately, IPC's successor company TeamHealth Holdings agreed to pay $60 million plus interest to settle the false claims allegations. The whistleblower and his attorneys received approximately $11.4 million of this settlement
  • For more information, see the DOJ’s press release or Goldberg Kohn's press release. The case is captioned United States ex rel. Oughatiyan v. IPC The Hospitalist, Inc., et al., Civil Action No. 09 C 5418 (N.D. Ill.). 
United States of America, et al. v. Laynie Foundation Inc., et al.
  • The DOJ and the State of Illinois intervened in a qui tam lawsuit Goldberg Kohn filed against the Laynie Foundation, a youth counseling center, on behalf of a mental health professional formerly employed by the 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 Goldberg Kohn's press release. The case is captioned United States of America, et al. v. Laynie Foundation Inc., et al., Case No. 1:14-cv-08511 (N.D. Ill.).

Helping Shape the False Claims Act Today

Goldberg Kohn has obtained judicial decisions that positively shape the development of the "public disclosure bar," which imposes restrictions on the type of original information necessary to be a whistleblower in a False Claims qui tam lawsuit. The following decisions reflect a narrow interpretation of the public disclosure bar, allowing these cases to proceed and ultimately settle successfully even though the defendants had challenged whether the whistleblower qualified as an original source of information.

United States ex rel. Goldberg and Beecham v. Rush University Medical Center
  • After a district court dismissed a case filed by Goldberg Kohn based on a broad interpretation of the False Claims Act's "public disclosure bar," Goldberg Kohn successfully appealed the decision to the Seventh Circuit Court of Appeals, thereby reviving the case. 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 concerning billing practices of physicians at teaching hospitals (the "PATH Audits") publicly disclosed allegations of fraud 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 led to a favorable settlement. The decision is captioned United States ex rel. Goldberg v. Rush University Medical Center, 680 F.3d 933 (7th Cir. 2012).
United States ex. rel. Nehls v. Omnicare, Inc. et al.
  • Goldberg Kohn successfully fought off a motion for summary judgment 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 from the Esformeses. Omnicare had previously agreed to pay $17.2 million to the government to settle their part of this lawsuit.
  • In denying the defendants' motion for summary judgment, Judge Tharp ruled that the whistleblower was an original source of information concerning the allegations of the case. Although another individual had previously alleged that wrongdoing was occurring at Total Pharmacy during an interview with the FBI, there was no evidence to show that the allegations made during this interview were "publicly disclosed prior to the filing of this suit and in the 'public domain,' even assuming those allegations contained the 'critical elements' of the FCA claims at issue here" (United States ex rel. Nehls v. Omnicare Inc. et al., Case No. 1:07-cv-05777 (N.D. Ill.)).
  • Judge Tharp's ruling received significant press coverage, including an article in the Chicago Tribune. as did the settlement announcement, which was also reported in the Chicago Tribune.

[1] The eight qui tam cases that were combined in this multi-district litigation are captioned United States ex rel. Bryant v. Community Health Systems, Inc., et al., Case No. 10-2695 (S.D. Tex.); United States ex rel. Carnithan v. Community Health Systems, Inc., et al., Case No. 11-cv-312 (S.D. Ill.); United States ex rel. Cook-Reska v. Community Health Systems, Inc., et al., Case No. 4:09-cv01565 (S.D. Tex.); United States ex rel. James Doghramji; Sheree Cook; and Rachel Bryant v. Community Health Systems Inc., et al., Case No. 3-11-cv-00442 (M.D. Tenn.); United States ex rel. Mason v. Community Health Systems, Inc., et al., Case No. 3:12-cv-817 (W.D.N.C.); United States ex rel. Plantz v. Community Health Systems, Inc., et al., Case No. 10C-0959 (N.D. Ill.); United States ex rel. Reuille v. Community Health Systems Professional Services Corporation, et al., Case No. 1:09-cv-007RL (N.D. Ind.).

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