More than $4.7 billion in settlements and judgments from whistleblower cases involving fraud against the government were had in 2016 ending Sept. 30. Of the $4.7 billion recovered, $2.5 billion came from the health care industry, including drug companies, medical device companies, hospitals, nursing homes, laboratories, and physicians.    In many of these cases, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.

The next largest recoveries came from the financial industry in the wake of the housing and mortgage fraud crisis.  Settlements and judgments in cases alleging false claims in connection with federally insured residential mortgages totaled nearly $1.7 billion in fiscal year 2016 – the second highest annual recovery in this area.

Most false claims actions are filed under those whistleblower, or qui tam, provisions.  If the government prevails in the action, the whistleblower, also known as the relator, receives up to 30 percent of the recovery.  Whistleblowers filed 702 qui tam suits in fiscal year 2016, and the Department recovered $2.9 billion in these and earlier filed suits this past year.  The government awarded the whistleblowers $519 million during the same period.

 New York Whistleblower News

The Infosys Corporation a global outsourcing and consulting company, agreed to pay $1 million for its failure to properly compensate hundreds of workers and to pay applicable taxes. Infosys Corporation has a significant presence in New York State and provides consulting and outsourcing services to many New York-based clients in the financial sector, among other industries. The settlement resolves whistleblower claims that Infosys Corporation, in the course of providing outsourcing services, routinely brought foreign IT personnel into New York to perform work in violation of the terms of their visas.

The H-1B visa is a non-immigrant visa that allows an employer to employ a foreign national temporarily in a “specialty occupation” in the United States. These visas are difficult to obtain: the application process is highly regulated and requires a submission that describes the intended occupation and specific geographic place of employment, and certifies that the salary of the proposed employee is commensurate with similarly employed United States workers. H-1B visa holders in New York are accordingly paid pursuant to prevailing wage requirements, and state taxes are withheld on salary earned while working in the State.

Missouri Whistleblower News

Missouri Attorney General Josh Hawley filed a lawsuit today against three large drug manufacturing companies in the Circuit Court of St. Louis City. Hawley is suing Purdue Pharma, Endo Health Solutions and Janssen Pharmaceuticals. The lawsuit alleges that these companies fraudulently misrepresented the serious risks posed by the drugs they manufacture and sell. “Our state faces an urgent public-health crisis brought on by fraud. These companies have profited from the suffering of Missourians,” Hawley said. “Today, we begin to fight to put an end to this crisis as we fight for the thousands of lives endangered and lost to the opioid epidemic.”

The drug companies named in today’s suit carried out a complex, multi-year campaign in which they deliberately misrepresented the addictive risks of opioids. This resulted in thousands of patients being given unnecessary opioids prescriptions, often to treat chronic pain.

Indiana Whistleblower News

Indiana University Health Inc. (IU Health) and HealthNet Inc., have agreed to pay  $18 million to resolve allegations that they violated federal and state false claims laws by engaging in an illegal kickback scheme related to the referral of HealthNet’s OB/GYN patients to IU Health’s Methodist Hospital.  The settlement resolves a whistleblower lawsuit filed by Judith Robinson, M.D., a Board Certified Ob/Gyn and Fellow of the American College of Obsetrics and Gynecology. Dr. Robinson worked at HealthNet and from 2010 through 2012 was also the Assistant Ob/Gyn Residency Director for the Methodist Hospital campus. Dr. Robinson was represented by Jillian Estes Esq.  of Tampa Florida. The Complaint alleged that IU Health and HealthNet utilized certified nurse midwives and nurse practitioners to treat all obstetric patients regardless of risk factors that mandate the use of physicians. Indiana Medicaid plainly conditions the payment of public healthcare money for the treatment of medically high-risk pregnant women on the requirement that those women be treated only by a physician.

The Anti-Kickback Statute prohibits, among other things, the knowing and willful payment of any remuneration to induce the referral of services or items that are paid for by a federal health care program, such as Medicaid. Claims submitted to federal health care programs in violation of the Anti-Kickback Statute are also false claims under the False Claims Act. The United States alleged that from May 1, 2013 through Aug. 30, 2016, IU Health provided HealthNet with an interest-free line of credit, the balance of which consistently exceeded $10 million. United States further alleged that HealthNet was not expected to repay a substantial portion of this loan and that this financial arrangement was intended to induce HealthNet to refer its OB/GYN patients to IU Health’s Methodist Hospital.


The lease to operate the state-owned ski resort at Mount Sunapee, Och ziff has agreed to pay $413 million to resolve a case involving foreign bribes. The company agreed to pay a criminal penalty of $213 million to the Justice Department and $199 million to the Securities and Exchange Commission.The U.S. Justice Department announced that Och-Ziff and its African subsidiary had entered into an agreement to resolve criminal charges stemming from a scheme to bribe government officials in the Democratic Republic of Congo and Libya.Och-Ziff admits it paid tens of millions of dollars in bribes to Congo officials in exchange for exclusive investment opportunities involving the country’s diamond and mineral mining sectors.

The state attorney general and commissioner of Resources and Economic Development are pushing for a public meeting at which the new leaseholder, Och-Ziff Capital Management Group, can offer assurances that New Hampshire won’t see any of the conduct that resulted in more than $400 million in fines and penalties levied by the U.S. Justice Department and the Securities and Exchange Commission.

The United States Centers for Disease Control and Prevention (CDC) has issued a report based on data from 4000 hospitalizations, which concludes that one in seven infections in acute care hospitals are caused by antibiotic resistant hospital infections.According to the findings, one in seven infections in acute care hospitals, related to catheters and surgeries, are caused by antibiotic-resistant bacteria. Many of the urgent serious antibiotic-resistant bacteria threaten patients while being treated in hospitals for other conditions. Of the 15 urgent serious antibiotic-resistant infections, seven are predominantly acquired in a healthcare setting.
The report highlights the major medical dilemma that antibiotic-resistant bacteria can make infections impossible treat. Antibiotic resistant infections increase patient deaths. In the United States, approximately 2 million persons become ill each year with antibiotic-resistant infections and approximately 23,000 die. The CDC compiled data in 2014 from the National Healthcare Safety Network; taking data on specific infections from 4,000,  short-term acute care hospitals, 501 long-term acute care hospitals and 1,135 inpatient rehabilitation facilities in all 50 states.Researchers found the likelihood of a patient becoming infected by any of the six most common bacteria was 12% for in-patient rehabilitation facilities, and 29% for long term acute care hospitals.

More than half of hospitalized patients are receiving antibiotic treatment on any given day, and one-quarter of that population has a hospital acquired infection, making them more likely to contract illnesses which are resistant to common antibiotic treatment.

Health experts say there is an urgent need to engage new methods of reducing the spread of these superbugs, including finding new ways of treating infections without the use of antibiotics. The National Institute of Allergy and Infectious Diseases (NIAID) recently awarded $5 million to fund research focused on bacterial infection treatments that do not involve the use of antibiotics..  –

Genesis Healthcare Inc. (Genesis) will pay the federal government $53,639,288.04, including interest, to settle six federal lawsuits and investigations alleging that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. Genesis, headquartered in Kennett Square, Pennsylvania, owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business.

This settlement resolves four sets of allegations. First, the settlement resolves allegations that from April 1, 2010 through March 31, 2013, Skilled Healthcare Group Inc. (SKG) and its subsidiaries, Skilled Healthcare LLC (Skilled LLC) and Creekside Hospice II LLC, knowingly submitted or caused to be submitted false claims to Medicare for services performed at the Creekside Hospice facility in Las Vegas, Nevada by: (1) billing for hospice services for patients who were not terminally ill and so were not eligible for the Medicare hospice benefit and (2) billing inappropriately for certain physician evaluation management services.

Second, this settlement resolves allegations that from Jan. 1, 2005 through Dec. 31, 2013, SKG and its subsidiaries, Skilled LLC and Hallmark Rehabilitation GP LLC, knowingly submitted or caused to be submitted false claims to Medicare, TRICARE, and Medicaid at certain facilities by providing therapy to certain patients longer than medically necessary, and/or billing for more therapy minutes than the patients actually received. The settlement also resolves allegations that those companies fraudulently assigned patients a higher Resource Utilization Group (RUG) level than necessary. Medicare reimburses skilled nursing facilities based on a patient’s RUG level, which is supposed to be determined by the amount of skilled therapy required by the patient.


Three Tennessee prosecutors have filed a lawsuit accusing several drug manufacturers of deceptive marketing which they say resulted in an epidemic of addiction to painkillers. The lawsuit is also being taken by the guardian of a baby which was born dependent on opioid drugs.

According to the suit, Baby Doe spent his first days in the neonatal intensive care unit in agony as he went through detoxification. The infant boy, who is not identified, was born to an addicted mother survived after spending 14 days in a neonatal intensive care unit. The child continues to suffer from numerous health and learning disabilities.

The lawsuit was filed by three district attorneys who represent parts of the east Tennessee mountains in Appalachia. This has been the center of the prescription drug epidemic in Tennessee.


Dr. Lisa Wollman, a former anesthesiologist at Mass. General has filed a whistleblower lawsuit alleging that surgeons at the hospital who simultaneously handled two or more surgeries defrauded the government. They did so, she alleges, by submitting bills for surgeries at times they were not in the operating rooms for critical portions of the procedures by leaving the work for unsupervised residents.

Dr. Wollman’s COMPLAINT  states that she witnessed surgeons performing simultaneous surgeries between 2010-2015. They never informed the patients they were doing more than one surgery at a time. “The procedures did not merely overlap on their margins, they were instead scheduled at or about the same time, making it impossible for the teaching physician to assure that he could be physically present and ready to participate in the key or critical parts of each surgical procedure,” the Complaint states. These included high risk procedures including total shoulder replacement, cervical, lumbar and spine surgeries.

A whistleblower Patty Nixon, who worked as a sales representative for the drug manufacturer Insys, says that its major drug Subsys was prescribed for patients who never should have had it.She’s a former Insys sales rep turned whistleblower. According to the company web-sire the drug contains the massively strong medication fentanyl and it is a spray that is absorbed underneath the tongue, which results in faster absorption.

Whistleblower Nixon says her job was to contact insurance companies on behalf of the patients and the doctors to get the medication approved and paid for by their insurance company. Nixon says NBC that her supervisor told her ways to trick the insurers into believing it was “medically necessary.” The medication is approved only for cancer patients but was apparently sold to patients who did not have cancer.

Prosecutors say the company paid hundreds of thousands of dollars to doctors in exchange for prescribing Subsys. Three top prescribers have already been convicted of taking bribes from Insys. Insys has denied any responsibility and insists it shouldn’t be blamed for how doctors prescribe their products. The corporation is not facing criminal charges and is still selling Subsys — some $240 million worth of Subsys just last year.