“Wheeling Hospital, Inc. has agreed to pay the United States a total of $50,000,000 to resolve claims that it violated the False Claims Act by knowingly submitting claims to the Medicare program that resulted from violations of the Physician Self-Referral Law and the Anti-Kickback Statute, the Justice Department announced Wednesday,” reports MetroNews Staff in MetroNews.

“According to the Justice Department, in this case, the United States alleged that from 2007 to 2020, under the direction and control of its prior management R&V Associates, Ltd. and Ronald Violi, Wheeling Hospital systematically violated the Stark Law and Anti-Kickback Statute by knowingly and willfully paying improper compensation to referring physicians that was based on the volume or value of the physicians’ referrals or was above fair market value.”

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“Bayer will pay about $1.6 billion to settle nearly all of the U.S. lawsuits that, over several years, have claimed the company’s Essure birth control implant caused serious injuries,” reports Conor Hale in Fierce Biotech’s MedTech.

“The German drugmaker’s agreements with plaintiff law firms cover about 90% of nearly 39,000 filed and unfiled claims, within all of the jurisdictions with significant numbers of Essure cases, Bayer said in a statement.”

“The company is also currently in talks with lawyers representing the remaining plaintiffs. Most of the terms of the settlement agreements are confidential, but they contain no admission of wrongdoing or liability.”

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“In one of the largest COVID-relief fraud cases to date, nine Ohio and Florida individuals are alleged to have conspired to obtain fraudulent PPP loans guaranteed by the CARES Act and to have received kickbacks for filing fraudulent loan applications,” reports D. Jacques Smith, Randall A. Brater, Alexander S. Birkhold, Michael F. Dearington, Mohammed T. Farooqui, Rebecca W. Foreman, Nadia Patel, Stephanie Trunk, Laura Zell in Arent Fox’s Investigations Blog.

“In federal criminal complaints filed in the Northern District of Ohio and the Southern District of Florida, the nine individuals were charged with a combination of bank fraud, wire fraud, conspiracy to commit bank and wire fraud, and obstruction for conspiring to obtain fraudulent PPP loans and receiving kickbacks for filing fraudulent PPP loan applications. The nine individuals are: (1) Wyleia Nashon Williams of Ft. Lauderdale, Florida; (2) Phillip J. Augustin of Coral Springs, Florida; (3) Damion O. Mckenzie of Miami Gardens, Florida; (4) Andre M. Clark of Miramar, Florida; (5) Keyaira Bostic of Pembroke Pines, Florida; (6) James R. Stote of Hollywood, Florida; (7) Ross Charno of Ft. Lauderdale, Florida; (8) Deon D. Levy of Bedford, Ohio; and (9) Abdul-Azeem Levy of Cleveland, Ohio.”

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“A Florida-based specialty pharmacy will pay $3.5 million to resolve allegations it served as a conduit for a Teva Pharmaceutical Industries Ltd subsidiary to pay kickbacks to Medicare patients, the U.S. Justice Department said on Thursday,” reports Nate Raymond in Reuters’ U.S. Legal News.

“The settlement with Advanced Care Scripts Inc was the latest to result from an industry-wide U.S. probe of drugmakers’ financial support of patient assistance charities that has resulted in nearly $921 million in settlements.”

“Representatives for Teva and ACS did not respond to requests for comment. Teva has said it has been cooperating with the investigation since first receiving a subpoena from the U.S. Attorney’s Office in Boston in 2017.”

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“As employees increasingly transition back into the physical workplace, employers have begun to grapple with whether and how to deploy COVID-19 diagnostic testing as a return-to-work solution. Many employers want to avoid extended employee quarantine or isolation requirements that prevent their employees from returning to the office for weeks and disrupt their operations. But is this potential solution legal? And is it effective?” ask Danielle M. Bereznay, Michael S. Arnold, Corbin Carter in Mintz’ Insights Center.

In this post they discuss practical considerations for employers to consider for a return to work COVID-19 testing strategy.

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“A bill regulating the use of contact tracing data has moved its way through both chambers of the New York State legislature. Senate Bill S8450C regulates all information that includes or can reveal the identity of any individual and any COVID-19 related information or test results,” reports Dominic Panakal in HeyDataData.

“New York State established a tracing initiative to control the spread of the coronavirus pandemic across the state. The tracing program is part of the larger strategy of reducing transmission and ensuring affected individuals are appropriately isolated. As part of this initiative, the state employs contact tracers to communicate with individuals diagnosed with COVID-19, as well as any parties who have been in contact with them and therefore exposed to the virus.”

“During the early stages of the pandemic, Governor Cuomo said ‘once you trace, and you find more positives, then you isolate the positives — they’re under quarantine, they can’t go out, they can’t infect anybody else.’ Municipalities and local governments in New York have also engaged in this program or a variant of it. For example, New York City hired 3,000 disease detectives and case monitors to identify anyone who has come into contact with individuals who have tested positive for COVID-19.”

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“Recently, the National Labor Relations Board (NLRB), overruling an important Obama-era decision, held that employers do not have a pre first-contract duty to bargain before disciplining employees in a manner consistent with an existing policy or practice. The Board’s Care One at New Milford unanimously overruled Total Security Management Illinois 1, LLC, and will be applied retroactively to all cases pending before the NLRB,” write Anne Marie Buethe and Matthew C. Tews in Stinson’s News & Insights.

“In Care One, an employer suspended three employees and discharged another pursuant to its disciplinary policy. The employees were newly union-represented, but not yet covered by a collective bargaining agreement (CBA). The employer did not provide the union with prior notice or an opportunity to bargain. The union brought an unfair labor practice charge claiming that the employer violated the Total Security rule. The Board’s 2016 Total Security decision had held that an employer must provide a newly certified union with notice and an opportunity to bargain before imposing serious discipline (i.e., suspension, demotion, discharge), during the time after the union was certified but before the parties had entered a first CBA if the imposition of such discipline involved any discretion.”

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“Despite citing the surge in coronavirus cases and economic fallout from the pandemic in California, Sutter Health failed to persuade a state judge on Thursday to delay the $575 million settlement it reached last December over accusations of price gouging and monopolistic practices,” reports Reed Abelson in The New York Times’ Health.

“Sutter, which has already received hundreds of millions of dollars in federal coronavirus aid, argued it needed three more months to decide whether it should try to abandon the settlement terms. The sprawling health system in Northern California warned that the costs of the pandemic might force it to raise rates for patient care beyond caps set by the proposed settlement.”

“But Superior Court Judge Anne-Christine Massullo was not swayed. While sympathetic to concerns over the rising number of infections in California, the judge refused to give Sutter more time, scheduling a hearing next month on the preliminary agreement. Sutter Health could still try to block final approval of the settlement, which also prevents it from forcing insurers to include all of its health facilities in insurance policies rather than coverage for some.”

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“Florida’s largest nursing home provider is again facing a quarter-billion-dollar judgment for fraud,” reported with updates in The St. Augustine Record by Ryan Mills Naples of the Naples News.

“An appeals court last week affirmed part of a jury’s finding that Consulate Health Care, which operates a tenth of all Florida nursing homes, systematically defrauded the government by providing medically unnecessary treatments to patients.”

“While calling the judgment ‘huge,’one industry watcher predicted that Consulate homes will continue operating, even if the company continues to appeal the ruling or files for bankruptcy.”

“Consulate, based in Maitland, a suburb of Orlando, owns about 70 of Florida’s 693 nursing homes, and operates in every metro area. In all, the privately held company owns and controls about 150 nursing homes and assisted living facilities, mostly in the Southeast and the Mid-Atlantic states.”

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“Drug company Hoffmann-La Roche (OTCMKTS – RHHBY) falsified scientific conclusions and mounted a high-powered marketing and lobbying campaign to deceive the government about the effectiveness of Tamiflu (oseltamivir) for fighting a flu pandemic, according to new filings in a federal False Claims Act lawsuit. The case seeks to recover more than $1.4 billion of taxpayer dollars that the federal government wrongly spent to add Tamiflu to the Strategic National Stockpile,” reports Lanier Law Firm in Herald Mail Media’s State News.

“In a highly anticipated response to Roche’s motion to dismiss the lawsuit, whistleblower Dr. Thomas Jefferson alleges that Roche was aware that studies didn’t show that Tamiflu could protect individuals from acquiring influenza, reduce contagiousness of those infected or treat secondary symptoms. At best, studies have found that Tamiflu might slightly shorten the duration of flu symptoms.”

“The federal Food and Drug Administration repeatedly denied Roche’s efforts in the early 2000s to approve Tamiflu for pandemic use. According to the latest filings by whistleblower lawyers at The Lanier Law Firm and Halunen Law, once thwarted by the FDA, Roche began a campaign to fund, produce and publish misleading medical journal articles to create the appearance that Tamiflu would be effective at responding to a flu pandemic. The global conglomerate then used those studies and articles to create a false narrative for marketing and to lobby the CDC and Congress. As alleged, federal and state governments purchased tens of millions of doses of Tamiflu for the Strategic National Stockpile based on Roche’s misrepresentations.”

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“The U.S. Court of Appeals for the Eleventh Circuit this week reinstated part of a False Claims Act (FCA) verdict that was overturned in 2018, issuing a judgment of more than $255 against two skilled nursing facilities, two related entities providing management services at the facilities, and an affiliated company providing rehabilitation services,” reports Maggie Flynn in Skilled Nursing News’ Fraud.

“The original judgment of roughly $350 million was thrown out by U.S. District Judge Steven D. Merryday, who argued that the claims were not enough to merit such an amount.”

Registered nurse Angela Ruckh brought the qui tam action against multiple companies alleging “that the defendants violated the False Claims Act by misrepresenting the services provided to Medicare beneficiaries, while also failing to comply with specific Medicaid requirements.”

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“Six months after agreeing to a $575 million settlement in a closely watched antitrust case filed by California Attorney General Xavier Becerra, Sutter Health has yet to pay a single dollar, and no operational changes have gone into effect. The not-for-profit healthcare giant was accused of using its market dominance in Northern California to illegally drive up prices,” reports Jenny Gold in Modern Healthcare’s Providers.

“Late last week, Sutter’s lawyers filed a motion requesting that Judge Anne-Christine Massullo of the California state Superior Court in San Francisco delay approving the settlement for an additional 90 days, due to “catastrophic” losses stemming from the COVID-19 pandemic. Massullo originally was scheduled to rule on the agreement in February, but in April granted an earlier request from Sutter for a 60-day delay in the proceedings.”

“In court documents supporting its request, Sutter argues the pandemic has upended the financial landscape for hospitals and made numerous aspects of the agreement untenable. Last month, Sutter reported an operating loss of $404 million through April, citing declining patient revenue and expenses resulting from the pandemic. System officials said that loss took into account the more than $200 million the system received in COVID-19 relief funds from the federal government via the CARES Act.”

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“Two decades after Florida reached a landmark legal settlement with tobacco companies, an appeals court is slated to hear arguments Tuesday in a dispute about more than $100 million in payments,” reports News Service of Florida in Florida Politics.

“R.J. Reynolds Tobacco Co. wants the 4th District Court of Appeal to overturn a ruling that said the company is responsible for making payments to the state related to four brands of cigarettes: Salem, Winston, Kool and Maverick.”

“R.J. Reynolds was part of the 1997 settlement in which cigarette makers agreed to pay hundreds of millions of dollars a year to the state because of smoking-related health costs and, in exchange, received liability protections. An R.J. Reynolds parent company in 2015 sold the four cigarette brands to ITG Brands, LLC, which was not part of the settlement. As a result of the sale, R.J. Reynolds contends it is no longer responsible for making payments linked to the four brands.”

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“Shortly before COVID-19 halted jury proceedings across the United States, a Mississippi jury sided with the Government to return a $10.8 million verdict against Stone County Hospital and several affiliates for what the jury found were false Medicare claims submitted in violation of the False Claims Act (“FCA”),” reports Siena Caruso in Dorsey & Whitney’s Penalties.

“In May 2007 a complaint was filed alleging the Defendants submitted false records to secure payment under Medicare for services not actually performed and otherwise conspired to submit false claims in violation of the FCA. The Government investigated for nearly eight years before intervening in the lawsuit in 2015.”

“The intervening complaint contained detailed allegations that the Defendants and others abused the special Medicare rules for Critical Access Hospitals from 2004 through 2015 by improperly claiming expenses for work not performed. Such false claims allegedly included the excessive and unwarranted compensation of Mr. Cain—who owned both Stone County Hospital and Corporate Management—as well as claims submitted for Mr. Cain’s personal luxury automobiles. The Government further alleged that Stone County Hospital’s Medicare cost reports misallocated expenses of Corporate Management to the hospital and contained inflated, unnecessary, and duplicative costs purportedly incurred by Corporate Management and related businesses owned by Mr. Cain. The Government alleged the Defendants submitted false records and statements to Medicare seeking reimbursement for these false and fraudulent expenses.”

“After a nine-week trial, a Mississippi jury returned a $10.8 million guilty verdict against Ted Cain, Julie Cain, Stone County Hospital, Corporate Management, and Tommy Kuluz on March 12, 2020. The jury found the sixth defendant—Starann Lamier, the Chief Operating Officer of Corporate Management—not guilty.”

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Agreement ensures funds will benefit victims of opioid epidemic 

 TYLER, Texas – A landmark agreement between the Texas Attorney General’s office and a group of Texas counties and cities impacted by the country’s opioid epidemic paves the way for future settlement money to be directed to rural communities battling the crisis, lawyers with Tyler-based Martin Walker said Friday. 

 “This agreement is historic in that combining efforts with the Texas Attorney General’s office strengthens our position immensely and gives us one united and powerful voice,” said Martin Walker attorney Reid Martin. “But it also allows us to learn the lessons of settlements past. After the Big Tobacco settlement in the 1990s, we saw that many of the funds never made it to those who needed it most. This agreement will prevent that from happening. We know that the money will go to fund opioid addiction treatment, help impacted communities and ultimately save lives.” 

The Martin Walker legal team represents 29 counties in opioid litigation in Texas, most in east and northeast Texas. 

Under the agreement announced by Texas Attorney General Ken Paxton, state and county representatives will be included in all negotiations currently underway with opioid drug distributors and manufacturers. In the event of a settlement, the agreement creates an allocation structure that guarantees state and local governments will each receive a 15 percent share of the funds. The remaining 70 percent will be administered by the Texas Opioid Council to be dispersed to treatment programs operated by 20 regional health care partnerships across Texas. 

“This agreement is the result of years of hard work, and we are proud to see that our own Smith County has held a leadership role in the negotiations,” said Martin Walker attorney Jack Walker. “This agreement ensures that Tyler’s medical facilities, which serve all of East Texas, will get the funds they need to help in the fight against opioid addiction.”  

 Martin Walker PC is a Tyler-based law firm with significant trial expertise representing individuals and businesses in high-stakes litigation, including medical malpractice, catastrophic injuries involving 18-wheeler accidents, oilfield injuries, wrongful death, and product liability.

For more information visit Martin Walker Law

“In response to the COVID-19 pandemic, state and federal authorities have recognized a need for as many trained, experienced, and qualified health care providers as possible. To ensure those providers are fully enabled to provide critical care in response to COVID-19, several laws limit the tort liability of health care providers providing services in response to COVID-19,” writes Jeremy Belanger and Mark Wilson in Dickinson Wright’s Health Law Blog.

“Under Section 7 of Executive Order 2020-30, Michigan Governor Gretchen Whitmer used the Emergency Management Act, MCL 30.401 et seq., to limit the liability of health care professionals to provide care. Specifically, the Order provides: [A]ny licensed health care professional or designated health care facility that provides medical services in support of this state’s response to the COVID-19 pandemic is not liable for an injury sustained by a person by reason of those services, regardless of how or under what circumstances or by what cause those injuries are sustained.”

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“West Palm Beach attorneys William D. Zoeller and Michael V. Baxter of Schuler Halvorson Weisser Zoeller Overbeck obtained a $4 million jury verdict for the family of a 72-year-old man who died after his doctor tried to insert a catheter 14 times—for a procedure the plaintiffs alleged could have waited,” reports Raychel Lean in News.law’s Civil Plaintiff.

“But not all the facts were on their side. Gerald Sanford had a history of mitral valve regurgitation, a heart problem that can cause a back flow of blood. He also had an 80% to 90% blockage in one of his arteries, which the defense said warranted surgery to unclog.”

“Zoeller and Baxter argued that wasn’t as bad as it sounds because Sanford wasn’t experiencing symptoms, such as chest pain or shortness of breath. They claimed the risks of opening that artery outweighed the benefits.”

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“A 2018 Sixth Circuit panel upheld a jury verdict convicting Dr. Richard Paulus of submitting fraudulent medical claims. That same panel, with 2020 hindsight(!), reversed that conviction. It held that the trial court’s order unconstitutionally blocked exculpatory evidence,” reports Thomas Zeno in Squire Patton Boggs case updates.

“The ‘twisted’ history of the verdict began when a jury deadlocked twice and needed an Allen charge in order to convict Dr. Paulus of billing angiograms that were unnecessary.  The trial court rejected the jury’s verdict and set aside the conviction: a doctor’s decision about the degree of blockage of an artery was a matter of subjective medical opinion that ‘could be neither be false nor fraudulent.’  The government disagreed and appealed.  (Double jeopardy does not prevent appeal of a judgment of acquittal after verdict.)”

“In the first appeal, the panel (McKeague, Batchelder, Griffin) recognized the difficulty of distinguishing a fraudulent medical opinion from mere expert disagreement.  Relying on the U.S. v. Persaud, however, the panel reaffirmed that fraud occurs when a doctor deliberately inflates artery blockage in order to bill for unnecessary procedures.  The panel emphasized that “it is up to the jury – not the court – to decide whether the government’s proof is worthy of belief.”  Deferring to the jury, the panel reversed, reinstated the conviction, and remanded the case for sentencing.”

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“Directors of the Tulare Local Health Care District (TLHCD) voted  … to file a formal complaint against their former attorney with the California State Bar Association,” reports Dave Adalian in Valley Voice.

“’This is a mechanism to remove a bad apple from the profession,’ said TLHCD director Xavier Avila before the board voted unanimously to approve making the complaint. ‘If you’re driving down the road and you see an obstruction, a branch laying in the way, you remove it.’”

“Avila was describing the TLHCD’s former general counsel Bruce Greene.”

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“In April 2019, a federal jury found seven defendants associated with the Forest Park Medical Center (FPMC) in Dallas, Texas guilty on charges of conspiring to pay or receive health care bribes. The defendants in United States v. Beauchamp were convicted of collecting over $200 million dollars in a kickback scheme under which doctors were paid to refer patients to FPMC,” reports Alan J. Bozer and Joshua Glasgow in Phillips Lytle’s articles.

“Prosecution of this case was in many ways unsurprising. In 2018 alone, the federal government prosecuted more than 30 health care fraud cases yielding over $2.5 billion dollars in settlements and fines. The Beauchamp case is notable, however, because of the particular charges filed by the Department of Justice (DOJ).”

“In addition to alleging violations of the Anti-Kickback Statute … the government charged several defendants with violating the Travel Act of 1961 … an anti-racketeering statute that is rarely used in health care fraud cases. This novel use of the Travel Act may foreshadow a new government enforcement strategy that could broaden the scope of liability for uninformed physicians and health care administrators across the United States.”

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