Looking for a False Claims Act Attorney Atlanta? The False Claims Act is our practice. Our firm knows the False Claims Act as well as anyone in the country. We review every judicial opinion that even mentions the False Claims Act the very day they become available. We correspond with False Claims Act attorneys around the country to stay current on unpublished opinions and legal trends. We know what has happened, what is happening, and what will happen to False Claims Act litigation in every court and circuit in this country. Only a small handful of firms in the country can claim to be 100% qui tam practices like ours.
Representing whistleblowers since 1996, Atlanta-based Bothwell Law Group has always been a pioneer in the field of False Claims Act qui tam litigation. Bothwell Law Group has the expertise to be at the cutting edge of the law. Years ago, we were among the first in the country to recognize that Medicare fraud was recoverable under the False Claims Act–now a “garden variety” claim. We brought the first successful mortgage-fraud case under the False Claims Act. Because we practice solely in the whistleblower arena, we are able to devote 100% of our time to keeping up-to-speed on the latest developments in this fast-changing specialty and are constantly looking for new and creative ways to use this flexible tool to recover taxpayer dollars from those who cheat the government.
In addition to our own cases, Bothwell Law Group is often called to consult with other lawyers on False Claims Act issues. The firm has a strong pro bono practice of advising less experienced attorneys, mentoring attorneys new to the field of False Claims Act litigation, and providing amicus briefs to nonprofit organizations like Taxpayers Against Fraud and for other practitioners. Bothwell Law Group is frequently asked to make presentations to national, state, and local groups, and is among only a handful of firms personally invited to meet with the Department of Justice regarding whistleblower relations.
Our Cases in the News
The following are articles published about a couple of recent cases in which Bothwell Law Group provided legal representation for whistleblowers.
Beaumont Health has agreed to pay $84.5 million to settle U.S. Justice Department allegations concerning improper pay arrangements with eight high-earning doctors following complaints in newly unsealed whistle-blower lawsuits. The settlement resolved allegations that between 2004 and 2012, the hospital system, then based in Royal Oak, overpaid the doctors and provided them with free or below-market office space and other perks so that they would refer more patients to Beaumont.
The behavior may have violated the federal Stark Law, Anti-Kickback Statute and False Claims Act, as it affected claims made to Medicare, Medicaid and TRICARE programs, according to a statement issued Thursday by the Justice Department. The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce patient referrals covered by Medicare and Medicaid. The Stark Law prohibits a hospital from billing Medicare for services referred by doctors with whom the hospital has an improper financial arrangement, such as excessive compensation.
The allegations predate Beaumont’s 2014 three-way merger with what was Dearborn-based Oakwood Healthcare and Farmington Hills’ Botsford Hospital. It also occurred under a different Beaumont executive team. “Offering financial incentives to physicians in return for patient referrals undermines the integrity of our health care system,” Acting Assistant Attorney General Chad Readler of the Justice Department’s Civil Division said in a statement.
The allegations were first brought forth in four separate whistle-blower lawsuits filed in 2010 and 2011 under provisions in the False Claims Act that allow whistle-blowers to share a portion of any recovery. The lawsuits — unsealed Thursday for the first time — include detailed allegations and name numerous Beaumont doctors and administrators. How much money the whistle-blowers will get has yet to be determined, the Justice Department said.
The settlement also resolves claims that Beaumont allegedly misrepresented that a CT radiology center qualified as an outpatient department of Beaumont in claims to federal health care programs. That distinction could have affected the amount of Beaumont’s reimbursement. One of the newly unsealed lawsuits alleged that “Beaumont has engaged in a consistent practice of rewarding top referral sources with medical directorships and other ‘perk’ appointments where they are required to perform little if any work in return for sizable salaries.”
In another unsealed lawsuit, a whistle-blowing doctor claimed he was marginalized by top hospital administrators after sharing his belief that some doctors were essentially receiving kickbacks, among other concerns. “You need to learn to just go along with the physicians, help them to do what they want, and not create waves or try to be a crusader,” the whistle-blower claimed he was told, according to court documents. “If you keep creating waves, you will be destroyed.”
That whistle-blower’s lawsuit also claims a former Beaumont comptroller was laid off in part for his attempts to correct some of the improper practices going on. Beaumont Health president and CEO John Fox said in a statement that since the 2014 merger, the hospital system has implemented additional procedures and legal reviews to ensure “that these types of issues do not arise again.”
“As part of our settlement with the DOJ, we will enter into a Corporate Integrity Agreement with representatives of the Department of Health and Human Services for five years,” said Fox, who did not work at Beaumont when the alleged behavior occurred.
The allegedly overpaid doctors included four cardiologists with 2009 salaries between $702,000 and $753,000, which a whistle-blower considered to be well above the typical cardiologist’s salary at the time. In addition to the big salaries, those doctors were allowed to keep revenue from their private practices, even though that work cut into their time for Beaumont.
“These enormous salaries are provided to the cardiologists as a pure kickback for conducting their practice at Beaumont,” the whistle-blower’s lawsuit said. “This illegal arrangement is openly discussed at Beaumont.” The lawsuit also claims that a group of oncologists threatened to walk out of Beaumont and set up their own oncology practice if they didn’t also get a “special deal,” presumably one like the cardiologists.
After an agreement was struck that raised the oncologists’ earning potential, one of the most productive research oncologists resigned, “in large part because he did not want to be party to what he considered an illegal kickback scheme,” the lawsuit said.
Another of the unsealed whistle-blower lawsuits claimed that Beaumont grossly overpaid one surgeon with an $800,000 salary who it knew was committing billing fraud. This surgeon routinely performed a surgical weight-loss procedure that wasn’t covered by private insurance, Medicare or Medicaid, yet he would bill it as a “partial gastrectomy and hiatal hernia repair” that was covered by insurance.
That lawsuit also claimed that Beaumont, despite having its own MRI machines, leased MRI facilities from a physicians’ group as a financial incentive for the group to refer more patients to Beaumont. That lawsuit’s whistle-blower says she informed a top Beaumont executive that the Beaumont Urology Center had been operating for two years without a state-required Certificate of Need. But she was told that shutting down the urology center would affect Beaumont’s patient referrals.
Under the U.S. Justice Department settlement, Beaumont Health paid $82.74 million to the U.S. and $1.76 million to the State of Michigan. “I would like to commend the new leadership at Beaumont Hospital for making things right once its past wrongdoing was brought to its attention by federal investigators,” said U.S. Attorney Matthew Schneider for the Eastern District of Michigan.
Detroit Area Hospital System to Pay $84.5 Million to Settle False Claims Act Allegations Arising From Improper Payments to Referring Physicians
WASHINGTON – William Beaumont Hospital, a regional hospital system based in the Detroit, Michigan area, will pay $84.5 million to resolve allegations under the False Claims Act of improper relationships with eight referring physicians, resulting in the submission of false claims to the Medicare, Medicaid and TRICARE programs, the Justice Department announced today.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs. The Physician Self-Referral Law, commonly known as the Stark Law, prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has an improper financial arrangement, including the payment of compensation that exceeds the fair market value of the services actually provided by the physician and the provision of free or below-market rent and office staff. Both the Anti-Kickback Statute and the Stark Law are intended to ensure that physicians’ medical judgments are not compromised by improper financial incentives and instead are based on the best interests of their patients.
“Offering financial incentives to physicians in return for patient referrals undermines the integrity of our health care system,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “Patients deserve the unfettered, independent judgment of their health care professionals.”
“We are very pleased with the outcome of this case. This result should impress on the medical community the fact that we will aggressively take action to recover monies wrongfully billed to Medicare, through the remedies provided in the federal False Claims Act,” said U.S. Attorney Matthew Schneider for the Eastern District of Michigan. “I would like to commend the new leadership at Beaumont Hospital for making things right once its past wrongdoing was brought to its attention by federal investigators.”
The settlement resolves allegations that between 2004 and 2012, Beaumont provided compensation substantially in excess of fair market value and free or below-fair market value office space and employees to certain physicians to secure their referrals of patients in violation of the Anti-Kickback Statute and the Stark Law, and then submitted claims for services provided to these illegally referred patients, in violation of the False Claims Act. The settlement also resolves claims that Beaumont allegedly misrepresented that a CT radiology center qualified as an outpatient department of Beaumont in claims to federal health care programs. As a result of this settlement, Beaumont will pay $82.74 million to the United States and $1.76 million to the State of Michigan.
“Health care providers that offer or accept financial incentives in exchange for patient referrals undermine both the financial integrity of federal health care programs and the public’s trust in medical institutions,” said HHS-OIG Special Agent in Charge Lamont Pugh. “Our agency will continue to protect both patients and taxpayers by holding those who engage in fraudulent kickback schemes accountable.”
The allegations resolved by the settlement were brought in four lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery. The four qui tam cases are captioned: United States ex rel. David Felten, M.D., Ph.D. v. William Beaumont Hospitals, et al., No. 2:10-cv-13440 (E.D. Mich.), United States ex rel. Karen Carbone v. William Beaumont Hospital, No. 11-cv-12117 (E.D. Mich.), United States ex rel. Cathryn Pawlusiak v. Beaumont Health System, et al., No. 2:11-cv-12515 (E.D. Mich.), and United States ex rel. Karen Houghton v. William Beaumont Hospital, No. 2:11- cv-14312 (E.D. Mich.). The whistleblower shares to be awarded in the cases have not yet been determined.
These matters were investigated by the U.S. Attorney’s Office for the Eastern District of Michigan, the Civil Division’s Commercial Litigation Branch, and the State of Michigan Attorney General’s Office. Investigative assistance was provided by the Office of Inspector General of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, and the Department of Defense’s Defense Criminal Investigative Service.
In addition to resolving its False Claims Act liability, Beaumont has entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General which includes, among other things, an arrangements review to be conducted by an Independent Review Organization.
The government’s investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The claims resolved by the settlement are allegations only, and there has been no determination of liability.