Philadelphia Personal Injury Lawyer – Sheridan & Murray Sheridan & Murray Thu, 09 Nov 2017 21:44:46 +0000 en-US hourly 1 Philadelphia Personal Injury Lawyer – Sheridan & Murray 32 32 Over $10 Million To Be Paid in Healthcare Fraud Case Tue, 06 Dec 2016 20:02:25 +0000

New York radiology group Zwanger-Pesiri Radiology has agreed to pay just over $8 million in civil damages and $2.4 million in criminal restitution in connection with a qui tam lawsuit alleging that the company committed Medicare and Medicaid fraud between 2008 and 2014. The fraudulent acts include billing Medicare and Medicaid for radiology services that were performed unnecessarily and claiming that a Medicare and Medicaid enrolled provider performed procedures that were actually performed by different, unenrolled providers. New York’s attorney general, Eric Schneiderman, stated that the fraud cost the state of New York millions of dollars.

The whistleblowers in this qui tam case were Linda Gibb and Donna Geraci, who used to work for Zwanger-Pesiri and who attempted to get the company to address their fraud by complaining to supervisors when they initially discovered it. Unfortunately, their concerns went unheeded, and they were encouraged to make sure all claims got paid regardless of whether they were fraudulent or not. Because the fraud continued to be ignored and even encouraged, the two women decided to file their lawsuit under the False Claims Act on behalf of the government. Now, they have been vindicated, and the government will finally be able to recoup some of its losses.

Qui Tam Case Against Oncologist Settles for $5.3 Million Thu, 17 Nov 2016 22:04:11 +0000

In a recently settled qui tam case brought against a New York hematology-oncology practice, the whistleblower alleged that the practice spent years giving patients kickbacks while overcharging Medicare and Medicaid for their services. The state of New York and the U.S. government decided to get involved in the case, which was originally brought in April of 2014 as part of the False Claims Act, and they pursued the case together to its conclusion, in which the practice agreed to pay $5.3 million to resolve the allegations of health care fraud.

The whistleblower used to work as a billing representative for the practice and reported seeing things such as bills to Medicare that included copayments that had been waived due to financial hardship, and bills to Medicare for evaluation and management services that they couldn’t prove ever took place. As a result of this lawsuit and its outcome, the practice is now part of a corporate integrity agreement, under which they will be closely monitored, so that they can continue to participate in federal healthcare programs.

Whistleblower Lawsuit over Healthcare Fraud Settles for $145 Million Tue, 08 Nov 2016 19:57:10 +0000

At the end of October, Life Care Centers of America, Inc., a private nursing home company owned by Forrest L. Preston, settled a qui tam lawsuit by agreeing to pay $145 million to the government and the whistleblowers in the case. Life Care Centers, which is based in Cleveland, TN, owns over 260 residential care and nursing home facilities in 28 states and offers multiple types of care, from short-term post-operative care to longer term dementia care. This settlement came out of a consolidated lawsuit initially brought under the False Claims Act as two separate qui tam lawsuits that originated with a therapist and a registered nurse who used to work for Life Care. The consolidated suit alleged that, from January 2006 until February 2013, Life Care committed health care fraud by billing Medicare and TRICARE (the government’s health care program for the military and their dependents) for therapy that was given to patients who didn’t need it or were otherwise ineligible to receive it. The therapist and the nurse who came forward with these allegations were eventually joined by the Department of Justice in pursuing the case.

Although healthcare fraud is unfortunately not particularly unusual, the industry has watched this lawsuit unfold more closely because it has set a precedent by allowing the use of statistical sampling to prove the fraud. That is, instead of forcing the case to drag on by reviewing over 150,000 individual claims from 54,000 admissions, only 400 randomly selected admissions were reviewed, and the total number of false claims filed was calculated from the findings within that 400. In this case, the results indicated that Life Care was able to defraud Medicare and TRICARE of so much money because it required its therapists to meet goals for doing certain types of therapies, causing the therapists to feel pressured to give patients unneeded or potentially harmful therapies and causing Life Care to bill Medicare at the highest billing level possible for years.

Another lawsuit has been filed against Preston, who benefited the most from the fraud as the sole owner of Life Care.

Qui Tam Case Against Novartis Settles for Over $35 Million Thu, 20 Oct 2016 17:59:36 +0000

Elidel, Novartis Pharmaceuticals Corporation’s medication for eczema, was recently at the center of a qui tam lawsuit alleging that the company pushed off-label uses of the drug for patients under two years old. Because studies conducted in animals indicated that Elidel might result in skin cancer and non-Hodgkin’s lymphoma, the Food and Drug Administration (FDA) didn’t grant Novartis approval to market it as an eczema treatment for infants. However, most eczema happens in that age group, and so Novartis encouraged their pharmaceutical sales reps to tell physicians that Elidel was a safe alternative to the typical treatment for infants, topical corticosteroids.

Donald Galmines, who used to be a Novartis sales rep, was the whistleblower in this qui tam lawsuit, brought under the False Claims Act. He said that while he worked for the company, they not only falsely stated that Elidel could safely go on up to 80 percent of a baby’s body, but they also provided kickbacks to doctors in the form of dinners and conferences at which the uses of Elidel were frequently discussed. In 2005, the FDA issued its strongest warning, a Black Box warning, against using Elidel on anyone under the age of 24 months. Galmines and his attorneys subsequently pursued his case despite the fact that the government chose not to intervene because the False Claims Act states that whistleblowers may move forward on their cases on the government’s behalf without the government’s direct involvement. In the end, because Galmines’s case settled successfully for over $35 million, he has received about 29 percent of the total recovery, with the rest going to the government as a reimbursement for the fraud.

Qui Tam Lawsuit Against Vibra Healthcare Settles for $32.7 Million Tue, 11 Oct 2016 18:10:45 +0000

A group of hospitals nationwide owned and operated by Vibra Healthcare LLC settled a qui tam lawsuit at the end of September for $32.7 million plus interest. During the course of an investigation, it was found that Vibra defrauded the U.S. government by billing Medicare for unnecessary services between 2006 and 2013. The fraud allegedly took place when Vibra sent patients to five of its long-term care hospitals and one of its inpatient rehabilitation facilities without those patients exhibiting any reasons to be admitted. Vibra also kept patients in the hospital longer than medically necessary so that it could continue to bill Medicare for its services.

The whistleblower in this case, Sylvia Daniel, used to work for Vibra Hospital of Southeastern Michigan as a health information coder. It was in this capacity that she noticed the fraud and filed the lawsuit. For her work in bringing the suit on behalf of the government, Daniel will receive $4 million of the recovered funds.

As Benjamin C. Mizer, head of the Justice Department’s Civil Division and the principal deputy assistant attorney general, said, “Medicare beneficiaries are entitled to receive care that is determined by their clinical needs and not the financial interests of healthcare providers.” The outcome of this case serves as an important reminder of that, and of the high costs of healthcare fraud.

A Brief History of the Federal False Claims Act Tue, 04 Oct 2016 17:49:14 +0000

The False Claims Act, which is also known as Lincoln’s Law thanks to the president who signed it 150 years ago, is crucial legislation that protects the government from fraud and waste. But in its long history, it hasn’t always been the powerful law that it is today. When Abraham Lincoln signed the act into law during the Civil War, it was because of the amount of corruption he noticed during the conflict. Profiteers saw and seized the opportunity to defraud the government in wartime, and they did so often enough that Lincoln and Congress decided to set a new legal precedent by allowing plaintiffs to sue on the government’s behalf. For the first time in American legal history, the plaintiff did not have to be injured directly in order to bring a suit. The second new thing that the False Claims Act permitted was what’s known as a qui tam provision, in which the person who brings the suit (known as the relator or whistleblower) receives a portion of the monetary award; initially, it was 50 percent of the total amount recovered. The tradition behind qui tam predates the False Claims Act, but it hadn’t been a part of any specific law before Lincoln’s. Both the monetary compensation and a person’s ability to sue on the government’s behalf were intended to make it easier for ordinary citizens to speak up if they saw other people or companies cheating the government.

Although the law worked well, for a period of time from the early ‘40s until the mid ‘80s, it was rendered almost useless due to alterations made by Francis Biddle, the attorney general, in 1943. Biddle’s changes to the False Claims Act made it both more difficult for whistleblowers to file a suit and less lucrative for them if the suit won. Then in 1986, President Ronald Reagan repealed many of these changes and reinvigorated the act with amendments sponsored by Senator Charles Grassley, an Iowa Republican, and Representative Howard Berman, a California Democrat. Ever since, whistleblowers have been eligible for awards of between 15 and 30 percent of the total amount of money recovered. President Barack Obama has also signed amendments supporting the law, and it has been all to the good of the government, which has been able to recover billions of dollars per year from companies in industries such as healthcare and defense, which unfortunately see a greater than average share of fraud cases each year. As over 9,200 qui tam cases have been brought on the government’s behalf since 1986, it’s clear that Lincoln’s Law continues to have a tremendous impact on the finances of the government as well as on justice.

$2.2 Billion Settlement in Risperdal Qui Tam Case Tue, 27 Sep 2016 17:01:54 +0000

Johnson & Johnson to Pay More Than $2.2 Billion to Resolve Federal Fraud Allegations

(Allegations include Off Label Marketing And Kick-Backs to Doctors and Pharmacists)

PHILADELPHIA, PA, Nov. 4, 2013 — Global healthcare giant Johnson & Johnson has agreed for its subsidiary Janssen Pharmaceuticals to plead guilty to criminal charges and Johnson & Johnson will pay $2.2 Billion to resolve criminal and civil liability arising from their unlawful promotion of certain prescription drugs, the Justice Department announced today. The global resolution is one of the largest health care fraud settlements in U.S. history, including criminal fines and forfeiture totaling $485 million and civil settlements with the federal government and states totaling $1.72 Billion.

Johnson & Johnson subsidiary, Janssen Pharmaceuticals, Inc., has agreed to plead guilty to two counts of introducing a misbranded drug, Risperdal, into interstate commerce in violation of the Food, Drug, and Cosmetic Act. The criminal plea agreement also includes certain non-monetary compliance commitments that the federal government will enforce through a Corporate Integrity Agreement entered into between it and Johnson & Johnson.

Johnson & Johnson and Janssen will also pay $1.273 billion to resolve it civil liabilities with the federal government under the False Claims Act, as well as the states. The civil settlement resolves claims relating to the Johnson & Johnson/Janssen drugs Risperdal, Invega, and Natrecor.

The government’s case against Johnson & Johnson and Janssen was based partly on a qui tam lawsuit filed by attorney Thomas W. Sheridan of the law firm of Sheridan and Murray, LLC 1600 Market St., Suite 2500 Philadelphia PA 19103 (2159779500) on behalf of a former marketing manager at Janssen. The federal whistle-blower law, entitled the False Claims Act was enacted in 1863 and was originally designed to restrict war profiteering following the American Civil War. The false claims act prohibits people or businesses from defrauding the government and provides incentives for individuals who suspect wrongdoing to come forward. The qui tam lawsuit filed by Sheridan provided the government with information relating to a range of improper marketing practices on the part of Johnson & Johnson/Janssen relating to the drug Risperdal from 1999 through 2005 and the drug Invega from 2007 through 2009.

Johnson & Johnson/Janssen promoted the sale and use of its drug Risperdal for individuals and specific conditions for which it was not approved as safe and effective by the FDA. Johnson & Johnson/Janssen improperly promoted the sale and use of Risperdal for behavioral disturbances in elderly dementia patients. Johnson & Johnson/Janssen improperly promoted the sale and use of Risperdal for treatment of children and adolescents under the age of 18 suffering from conduct disorders and attention deficit hyperactivity disorders. Johnson & Johnson/Janssen improperly promoted the sale and use of Risperdal to treat conduct disorders in individuals with mental retardation and developmental disabilities.

The lawsuit filed by Sheridan provided information that Johnson & Johnson/Janssen were improperly marketing and promoting the sale and use of Risperdal to highly vulnerable patients including elderly dementia patients, children and adolescents and a significant number of Americans suffering from developmental disabilities and mental retardation. The lawsuit filed by Mr. Sheridan also provided information regarding Johnson & Johnson/Janssen’s illegal payments to health care professionals and long-term pharmacy care providers to improperly promote and prescribe Risperdal in violation of the Federal Anti-Kickback Statute.

For more information, please contact Thomas W. Sheridan, Esq. Sheridan & Murray LLC, 1600 Market St., Suite 2500, Philadelphia PA 19103, Tel 2159779500 email:

DOJ documents can be located at the below links:

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