| 3. |
U.S. ex rel. Montagano v. Midway Hospital Medical Center, Inc., OrNada Healthcorp and Summit Health Ltd., (CD CA CV95-4948-TJH) |
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| OrNda agreed to pay $12.65 million in an action concerning illegal contracts and kickbacks, including alleged financial relationships with physicians and payment for referrals of Medicare patients. This qui tam action was brought on by a former chief of surgery at Midway Hospital, in Los Angeles. |
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| 4. |
U.S. ex rel. Penizotto v. Bates East Corporation and Cynthia Bates (CD CA VC 96-5824-KMW) |
| |
| Multiple Defendants agreed to pay $5 million to settle two qui tam lawsuits; involved false medical information submitted to Medicare in order to qualify Medicare beneficiaries for home oxygen equipment. The consolidated qui tam actions were filed by a former franchisee of Home Americair, a respiratory therapist and a sales representative. |
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| 5. |
U.S. ex rel. Crannage, Chinn, and Green and State of Illinois ex rel. Crannage, Chinn, and Green v. Omnicare, Inc., Home Pharmacy Services, et al. (SD IL No. 97-973-PER) |
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| Defendant, Home Pharmacy Services, Inc. settled a qui tam lawsuit in the amount of $5.3 million arising out of alleged failure to properly credit the Illinois Department of Public Aide for returned medicines. The suit was brought by three former employees. |
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| 6. |
U.S. ex rel. Ready v. The University of Texas Health Science Center at San Antonio and the University of Texas Medical School at San Antonio (WD TX No. SA96CAA0123) |
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| Defendant, University of Texas Health Science Center at San Antonio agreed to pay $17.2 million to settle a qui tam suit concerning the alleged submission of claims for services which were falsely billed as personally provided by faculty physicians. The suit was filed in 1996 by the former executive director of UTHSCSA's Medical Service Research and Development Plan, the practice plan of faculty physicians. |
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| 7. |
U.S. ex rel. Alderman v. Weiss et al. (CD CA CV97-6734-RSWL) |
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| Defendants agreed to settle a qui tam lawsuit for $1.7 million arising out of allegations of improper marketing of incontinence supplies for elderly patients. The suit was brought by a former employee of Nissim Institutional Provider, Inc. |
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| 8. |
U.S. ex rel. Heyrman v. Fulton DeKalb Hospital Authority d/b/a Grady Memorial Hospital (ND GA NO.___________) |
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| Defendant, Grady Memorial Hospital agreed to pay $4.3 million to settle this qui tam lawsuit. The lawsuit alleged that the hospital submitted false prescription claims for Medicaid patients. The suit was filed by a former pharmacy reimbursement manager at the hospital. |
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| 9. |
U.S. ex rel. Knoob v. Health Care Service Corporationl (SD IL No. 95-4071-JLF) |
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| Defendant, Health Care Service Corporation, the Medicare contractor for Illinois and Michigan agreed to pay $140 million. The qui tam lawsuit alleged that the Defendant shredded claims and otherwise concealed evidence of substandard performance in processing Medicare claims. The suit was filed by a former HCSC supervisor. |
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| 10. |
U.S. ex rel. Mettevelis and Rowan v. Charter Hospital St. Louis, Inc. et al
(MD FL No. 94-1170-CV-ORL-22) |
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| This lawsuit involved allegations of the hospital fraudulently admitting and extending the length of stay of elderly Medicare beneficiaries, including medically unnecessary and inappropriate psychiatric treatment. Defendants agreed to pay the government $4.7 million arising out of the qui tam lawsuit, filed in 1994 by two former Charter Hospital employees. |
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| 11. |
U.S. ex rel. Howell v. Pennsylvania Blue Shield (MD PA no. 97-CV-0518) |
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| Defendant's corporate successor agreed to pay $38.5 million to settle multiple qui tam lawsuits arising out of its duties as a Medicare carrier. The allegations involved the Defendant's failure to properly process Medicare claims and obstructions of government audits of its performance. The suits were filed by both former and current Blue Shield employees. |
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| 12. |
U.S. ex rel. Prendergast and Silveira v. Meris Laboratories, Inc. et al (ND CA No. C-93-20549 JW) |
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| Defendant agreed to pay $5.2 million arising from qui tam lawsuit allegations of improperly billing for various laboratory tests, including routinely adding medically unnecessary HDL cholesterol and serum iron tests to automated panels, routinely billing for additional CVC indices that were neither ordered by physicians nor medically necessary. |
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| 13. |
U.S. ex rel. Spear, Dowden and Berkley Community Law Center v. SmithKline Beecham Clinical Laboratories (ED PA No. 95-6551) |
| |
| This case involved three qui tam lawsuits alleging that Defendant engaged in false claims by add-on tests, tests not performed, code jamming, kickbacks, and additional indices. Defendant agreed to pay a total of $325 million. This suit was filed by a former SBCL employee with a responsibility for systems and data management who had access to all billing data. |
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| 14. |
U.S. ex rel. Piacentile v. Wolk, Advanced Care Associates, Inc. et al (ED PA No.93-CV-5773) |
| |
| This case involved allegations of alteration of CMN's, including forgery of CMN's, misrepresenting to beneficiaries that there would be no charge for equipment, and the delivery of used equipment instead of new. The Defendant and its former owners agreed to pay the government $4.03 million to settle the qui tam lawsuit. |
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| 15. |
U.S. ex rel. Spear and Dowden v. MetPath Inc., Corning Inc., and Unilab Corp. (D NJ no. 95-2379) |
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| Defendant laboratories agreed to settle a qui tam lawsuit for $11 million for allegedly billing for certain blood indices that were not ordered or medically necessary. This suit was filed in 1995 by two former employees of MetWest, Inc., a former subsidiary of MetPath. |
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| 16. |
U.S. v. Cohen (Civil Action No. 93-6482) (consent decree 12/16/93, E.D. Pa.) |
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| Involved billing in excess of Medicare allowed amount plus permitted balance, or billing for uncovered services with knowledge they are not covered. |
| |
| 17. |
U.S. ex rel. Roy v. Anthony. 1994 WL 376271 (S.D. Ohio 1994); U.S. v. Kensington Hospital, 760 F.Supp. 1120 (E.D. Pa. 1991) |
| |
| Involved claims induced by illegal kickback. |
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| 18. |
U.S. v. Curative Technologies and Ultramed,Inc. (D.C. Wis. No. 93C-0435) |
| |
| Involved claims for product code (lymphodema pump) which was supplied but did not meet Medicare standards for product. |
| |
| 19. |
U.S. v. Shiley and Pfizer, Inc. (July 1994 settlements) |
| |
| Involved claims for Medicare payments for product (heart valve) which obtained FDA approval based upon false statements; also failure to disclose negative information. |
| |
| 20. |
U.S. v. Rubbermaid Commercial Products (1995 settlement); U.S. v. Westinghouse (1994 settlement) |
| |
| Involved claims for goods where supplier failed to disclose discounts given to other purchasers or sales to other purchasers. |
| |
| 21. |
U.S. v. Metpath (1993 settlement); U.S. v. Allied (1995 settlement); U.S v. National Health Labs (1993 settlement) |
| |
| Involved settlements of cases against laboratories who added additional tests to standard battery and encouraged physicians to order new battery. |
| |
| 22. |
U.S. v. National Medical Enterprises |
| |
| 1994 - $379 million settlement of case against chain hospital for provision of unnecessary psychiatric care. |
| |
| 23. |
U.S. v. Northwestern Institute |
| |
| 1994 settlement involving unnecessary psychiatric care. |
| |
| 24. |
U.S. v. Metpath |
| |
| 1995 settlement of qui tam case D. Md. - ($8.6 million) billing for tests not performed or performed inadequately - company official discovered information about improper billing in May 1992, but took no action until December 1993. $1.2 million paid to relator. |
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| 25. |
U.S. v. CHR Associates (d/b/a/ Claridge House) |
| |
| Third party billing agent reviewed nursing home files, prepared claims for medical supplies used in treatment of patients, such surgical dressings. Products were not provided, or do not qualify for reimbursement. $414,911 settlement with nursing home. |
| |
| 26. |
U.S. v. CHS (Clinical Health Systems - Washington)($675,000); U.S. v. Pay Less ($1 million); U.S. v. McKesson Corp. ($765,000) All District of Oregon - 1995 settlements) |
| |
| These three cases involve override of Oregon Medicaid's dispense generic substitute requirement, misrepresenting brands as medically necessary in the opinion of the treating physician. CHS also involved allegations of mislabeling of National Drug Code (NDC) numbers showing the size of the container, resulting in billing for smaller, more expensive containers. |
| |
| 27. |
U.S. v. Blue Cross/Blue Shield of Michigan (1995 settlement - District of Maryland) |
| |
| Michigan Blues paid $2.76 million to settle qui tam allegations that it altered documents related to review by HCFA of its cost report audits. The relator received $5.5 million. |
| |
| 28. |
U.S. v. Crescent City EMS (June 1994 settlement for $1.8 million) |
| |
| Involved allegations of falsely representing ambulatory ambulance patients as bedridden. |
| |
| 29. |
U.S. v. Hospitals Project (Middle District of Pennsylvania) |
| |
| Involved charging hospitals with false claims for billing DRG-covered services as outpatient ambulatory. |
| |
| 30. |
U.S. v. Arbor Drugs (E.D. Michigan) |
| |
| $7.5 million settlement in June 1994 - defendant allegedly inflated acquisition costs of drugs under Medicaid program by failure to disclose rebates. |
| |
| 31. |
U.S. ex rel. Milan v. University of Texas |
| |
| Involved alleged false statements in application for research grants by cancer center. |
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