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Home - Whistleblower Attorneys

Since the time of our <a href="https://www.whistleblowersattorneys.com/successes.html">Landmark Victory</a>, 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.

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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:

False Claims Act Successes

In a significant achievement, the Department of Justice (DOJ) has intervened in a lawsuit initiated by GK on behalf of the former Director of Strategic Growth of BAYADA Home Health Care, Inc. This legal action addresses BAYADA&#8217;s alleged illegal acquisition of patient referrals by purchasing two home health agencies from a retirement operator in Arizona. This purchase is reported to have violated both the Federal False Claims Act and the Medicare and Medicaid Anti-Kickback Statute. The outcome of this effort is a resounding victory, with BAYADA agreeing to pay a substantial $17 million to settle these allegations. This success underscores GK&#8217;s prowess in handling False Claims Act cases, earning them awards and recognition. For further details, please refer to the DOJ press release and GK&#8217;s <a href="https://www.whistleblowersattorneys.com/newsroom-news-nj_based_home_health_firm_bayada_pays_7_million_to_settle_whistleblower_lawsuit.html">press release</a>.

BAYADA Home Health Care, Inc.

GK is currently representing two former employees of Kaiser who claim to have witnessed fraudulent activities within the Medicare Advantage program during their tenure at the company. The lawsuit asserts that Kaiser and its affiliates engaged in Medicare fraud by submitting unsupported diagnosis codes, leading to inaccurate inflation of Kaiser&#8217;s risk adjustment payments from the government. The United States has taken action by intervening and consolidating GK&#8217;s lawsuit with other similar cases filed by whistleblowers. The case remains ongoing and is being closely monitored. For additional details, please consult GK&#8217;s <a href="https://www.whistleblowersattorneys.com/newsroom-news-us_doj_intervenes_in_fca_lawsuits_against_kaiser_including_case_filed_by_gk.html">press release</a>.

Kaiser Permanente

GK successfully represented former employees of Community Health Systems, Inc. (CHS) in a qui tam lawsuit that accused the company of purposefully billing government health care programs for unnecessary ER admissions and inpatient services. This alleged misconduct spanned across 119 of CHS&#8217;s hospitals, where services that should have been classified as outpatient or observation were billed otherwise. The Department of Justice (DOJ) intervened in GK&#8217;s lawsuit and combined it with seven related cases from other districts brought forward by whistleblowers. The DOJ claimed that CHS had orchestrated a corporate-driven strategy to increase inpatient admissions, even when medical necessity was lacking, affecting Medicare, Medicaid, and the Department of Defense&#8217;s TRICARE program beneficiaries. In resolution, CHS agreed to pay a significant $98.15 million to settle these allegations. Additionally, subsidiary Health Management Associates, LLC faced criminal charges and Medicare fraud accusations resulting from this initial suit, culminating in a separate settlement of $260 million. To access further details about these settlements and associated criminal proceedings, refer to the DOJ press releases <a href="https://www.justice.gov/opa/pr/community-health-systems-inc-pay-9815-million-resolve-false-claims-act-allegations">here</a> and <a href="https://www.justice.gov/opa/pr/hospital-chain-will-pay-over-260-million-resolve-false-billing-and-kickback-allegations-one">here</a>, along with the firm&#8217;s press releases <a href="https://www.whistleblowersattorneys.com/newsroom-news-146.html">here</a> and <a href="https://www.goldbergkohn.com/newsroom-news-1323.html">here</a>.

Community Health Systems, Inc.

In a notable development, the Department of Justice (DOJ) and the State of Illinois have jointly intervened in a qui tam lawsuit, originally initiated by GK, on behalf of a mental health professional with prior involvement in providing services to children and adolescents at Laynie Foundation. The lawsuit&#8217;s core allegation revolves around Laynie Foundation&#8217;s purported receipt of around $6.3 million in unjustified Medicaid reimbursements spanning four years. The foundation is accused of submitting false claims for payment to the Illinois Department of Healthcare and Family Services. These claims encompass services that were ineligible, unnecessary, or entirely nonexistent. The case is ongoing, and for comprehensive details, please consult GK&#8217;s <a href="https://www.goldbergkohn.com/newsroom-news-1281.html">press release</a>.

Laynie Foundation, Inc.

Allergan, Inc. is said to have engaged in offering illicit kickbacks to ophthalmologists in a bid to encourage the prescription of its eye care products. In a resolution to these claims, Allergan has committed to paying $13 million to both the federal government and 19 states. The lawsuit was a collaborative effort between GK and the Philadelphia-based law firm Pietragallo Gordon Alfano Bosick &amp; Raspanti. For additional insights, refer to GK&#8217;s <a href="https://www.whistleblowersattorneys.com/newsroom-news-177.html">press release</a>.

Allergan, Inc.

GK achieved a significant victory in 2015 as a federal judge mandated continued Medicaid payments to providers treating Cook County children, even during a budget impasse. This decision was grounded in an October 2005 consent decree from Judge Lefkow, stemming from a trial where GK acted as counsel. This trial established the state&#8217;s obligation to provide health care services as guaranteed under the federal Medicaid Act to children. Joining forces with GK in this case were the Sargent Shriver National Center on Poverty Law and AIDS Legal Council of Chicago. In 2017, GK and its co-counsel returned to court amid an extended state budget crisis to ensure proper Medicaid funding. Consequently, Judge Lefkow issued an order compelling the state Comptroller to augment payments to the Medicaid system. For more details, consult GK&#8217;s <a href="https://www.whistleblowersattorneys.com/newsroom-news-176.html">press releases</a> linked above.

Illinois Medicaid

GK championed a physician who formerly worked for IPC in a qui tam lawsuit, contending that IPC orchestrated an extensive &#8220;upcoding&#8221; scheme. This scheme involved incentivizing physicians to bill at the highest possible levels regardless of actual services rendered, at times even surpassing feasible service levels within a single day. Following IPC&#8217;s acquisition by Team Health Holdings, Inc. in 2015, a $60 million settlement was reached to resolve these allegations. The case was collaboratively pursued by GK attorneys in conjunction with government attorneys from the DOJ and the United States Attorney&#8217;s Office. Further insights can be found in the DOJ <a href="https://www.justice.gov/opa/pr/healthcare-service-provider-pay-60-million-settle-medicare-and-medicaid-false-claims-act">press release</a> and GK&#8217;s <a href="https://www.goldbergkohn.com/newsroom-news-1262.html">press release</a>. Coverage of the case was also featured in a Chicago Daily Law Bulletin <a href="https://www.chicagolawbulletin.com/archives/2017/02/07/60m-health-care-fraud-2-7-17?utm_source=subscriber&amp;utm_medium=CDLBemail&amp;utm_content=1Afree&amp;utm_campaign=headlines">article</a>.

IPC The Hospitalist Company, Inc.

GK&#8217;s client initiated legal action against the Allen School of Health Sciences, a for-profit institution, and its former COO, alleging violations of the incentive compensation ban and breach of the school&#8217;s Program Participation Agreement. The government intervened and took charge of the litigation, culminating in settlements amounting to $4.29 million. Comprehensive details can be found in the DOJ <a href="https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-announces-settlements-totaling-429-million-profit-school-and-its">press release</a> and GK&#8217;s press releases available <a href="https://www.whistleblowersattorneys.com/newsroom-news-163.html">here</a> and <a href="https://www.whistleblowersattorneys.com/blogs-whistleblowerblog%2Cfederal-ban-on-higher-education-incentive-compensation">here</a>.

Allen School of Health Sciences

Education Management Corp. (EDMC), a for-profit college company, faced allegations of falsely certifying compliance with Title IV of the Higher Education Act and corresponding state statutes, with the aim of securing federal and state grants along with loan funds. In resolution, EDMC agreed to a $95.5 million settlement, taking into account its financial capability despite the suit&#8217;s assertion of billions in damages. Co-leading as counsel to the whistleblowers who instigated the case, GK played a pivotal role. The case drew involvement from the DOJ and the states of California, Florida, Illinois, and Indiana, all of whom partnered in the lawsuit. This collective effort merged with three additional cases filed in Pennsylvania and Tennessee. Detailed information can be accessed through the DOJ <a href="https://www.justice.gov/opa/pr/profit-college-company-pay-955-million-settle-claims-illegal-recruiting-consumer-fraud-and">press release</a>. Furthermore, the case garnered coverage in a <a href="https://www.nytimes.com/2011/08/09/education/09forprofit.html">New York Times article</a>.

Education Management Corp.

GK acted on behalf of three clients who accused Shire Pharmaceuticals of promoting uses and advantages of multiple drugs, like Adderall XR, to prescribers without sufficient clinical evidence. With the intervention of the DOJ, the case led to a settlement of $56.5 million to address these allegations. Further details can be found in both the DOJ <a href="http://www.justice.gov/opa/pr/shire-pharmaceuticals-llc-pay-565-million-resolve-false-claims-act-allegations-relating-drug">press release</a> and GK&#8217;s own <a href="https://www.whistleblowersattorneys.com/newsroom-news-148.html">press release</a>. Additionally, the case received coverage in a <a href="https://www.thetimes.co.uk/article/scientists-sleepless-nights-over-shire-drugs-xjvsp79p8b9">London Times article</a>.

Shire Pharmaceuticals LLC 

GK advocated for a former employee of Total Pharmacy in a qui tam lawsuit asserting that Omnicare&#8217;s acquisition of Total Pharmacy, valued at $32 million, involved a substantial kickback. This kickback was aimed at securing enduring pharmacy contracts with over two dozen nursing homes under the ownership of Morris and Philip Esformes, who also possessed Total Pharmacy. To resolve the ongoing lawsuit, Omnicare agreed to a $17.2 million settlement with the government, while the implicated individuals subsequently settled for $5 million. Refer to GK&#8217;s <a href="https://www.goldbergkohn.com/newsroom-news-1178.html">press release</a> for comprehensive information. This case&#8217;s significance was covered in a <a href="https://www.chicagotribune.com/news/ct-xpm-2013-08-06-ct-met-esformes-settlement-20130807-story.html">Chicago Tribune article</a> as well.

Omnicare, Inc.; Morris and Philip Esformes

GK represented two former employees in a qui tam lawsuit against Rush University Medical Center (Rush), asserting that false claims were submitted to Medicare between 2000 and 2007. These claims stemmed from leasing arrangements for office space with individual physicians and physician practice groups, in violation of the Stark Law. Rush subsequently settled these allegations for $1.5 million. Additional unresolved matters from the first settlement included allegations of Medicare billing improprieties within Rush&#8217;s orthopedic practice. Initially dismissed by the District Court for the Northern District of Illinois, the case was successfully appealed by GK. The U.S. Seventh Circuit Court of Appeals overturned the dismissal, leading to a $5 million settlement. For comprehensive details, please refer to the DOJ&#8217;s <a href="http://www.justice.gov/opa/pr/chicago-hospital-pay-more-15-million-resolve-medicare-false-claims-act-allegations">press release</a>.