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New York Whistleblower And Commercial Litigation Blog

Progressive units agree to $2 million False Claims Act settlement

A whistleblower will receive more than $600,000 after federal authorities obtained a $2 million+ settlement from Progressive Insurance in relation to alleged Medicare and Medicaid fraud. Progressive Casualty Insurance Co., of Cleveland, Ohio, and Progressive Garden State Insurance Co., of West Trenton, New Jersey, improperly submitted claims under the company's "health first" auto insurance policies.

In health insurance parlance, the insurance company that pays a claim is called the "payer." When a person has more than one insurance policy, one of those will be primarily responsible for paying specified claims. This is called the "primary payer." If the policy limit of the primary payer is reached, the second insurance policy kicks in to pay the remainder of the claim up to its policy limit. In general, the primary payer pays substantially more toward the claim than the secondary payer, so it's to the insurance company's advantage to be the secondary payer.

Whistleblower: Clinics billed Medicaid for unlicensed treatment

A whistleblower has filed suit against a chain of Massachusetts mental health care centers, claiming the company defrauded the state and federal governments of $130 million. The accusation is that the company allowed "unlicensed, unqualified, and unsupervised employees" to treat patients. Doing so would be in clear violation of Medicaid regulations and requirements, the suit says.

The alleged misconduct was apparently widespread. The lawsuit claims that over 30,000 patients per year received treatment from unqualified clinicians at South Bay Mental Health Center, Inc. The company runs 17 mental health treatment centers in the state.

New protections for VA whistleblowers

President Trump has signed into law legislation that strengthens whistleblower protections at the VA. The legislation is called the Dr. Chris Kirkpatrick Whistleblower Protection, named after a 38-year-old Wisconsin psychologist who was fired (and then committed suicide) after having revealed that the Tomah VA facility had been overprescribing opioid medications to veterans.

The new legislation does the following:

  • Requires training for federal workers so they understand their whistleblower rights
  • Increases penalties for VA superiors who retaliate against whistleblowers
  • Prevents unauthorized access to employee medical records
  • Requires outreach to employees for mental health concerns

Vitas Healthcare to pay $75 million in False Claims Act case

Vitas Healthcare and its parent company Chemed Corporation have reached a record settlement in a federal False Claims Act case. Vitas and Chemed admit no wrongdoing but have agreed to settle the case for $75 million.

"Today's resolution represents the largest amount ever recovered under the False Claims Act from a provider of hospice services," said an acting assistant attorney general for the Department of Justice's Civil Division.

Study: Aggressive production goals lead to unethical behavior

A new study published in the journal Organization Science, says that high-pressure production goals within companies often set the stage for ethics violations and misconduct.

This may not surprise you if you're aware of the scandals at Wells Fargo & Co. Whistleblowers allege that pressure to meet strict sales quotas led many Wells Fargo employees to create fraudulent accounts without customers' knowledge.

New York doctors get prison for $100 million Medicare fraud

Three New York-based doctors will receive prison time after pleading guilty to accepting bribes. Their sentences are the most recent development in a massive scandal that involved $100 million in Medicare payments to a specific diagnostic lab. An extensive investigation by the Department of Justice has led to the conviction of over 30 physicians, including two from Staten Island and one from Yonkers.

The doctors in question, George Roussis, Nicholas Roussis, and Ricky J. Sayegh, were all found to have accepted cash payments in exchange for referring their patients’ blood specimens to Biodiagnostic Laboratory Services. BLS, a Parsippany, New Jersey-based diagnostic lab, is found to have bribed dozens of physicians and personnel in exchange for blood specimens. The referrals brought in millions of dollars in business and Medicare payments for the lab.

New whistleblower protections for federal workers pass Congress

A bill strengthening whistleblower protections for federal employees has unanimously passed the House after passing the Senate in May. It now heads to President Trump's desk for signing or veto.

The bill was named after a VA psychologist named Chris Kirkpatrick. He was fired by the VA medical center he worked for after he raised concerns about certain patient medications. He committed suicide after his retaliatory dismissal.

Whistleblower Case Brought by Fischer Legal Group Settles for $13 Million

The Attorney General for the State of New York settled a New York State False Claims Act qui tam action, brought by Andrea Fischer, and handled by Andrea Fischer and Audrey Schechter of Fischer Legal Group, on behalf of its client whistleblower, against Port Authority food vendors.

Waymo offers to settle disruptive Uber lawsuit -- for a price

Alphabet Inc.'s Waymo recently made a settlement offer to Uber Technologies Inc. in its lawsuit over autonomous car technology. The lawsuit, which alleges Uber hired a former Waymo engineer who used Waymo trade secrets to Uber's benefit, has been in pretrial stages for months. No settlement talks are scheduled, according to Reuters sources, but Waymo still offered a way out for Uber.

Waymo wants at least $1 billion in damages, an independent monitor appointed to prevent further appropriation of Waymo technology, and a public apology. Uber rejected the terms as non-starters, according to Reuters.

Wells Fargo says it has hired back 1,780 employees after scandal

In prepared congressional testimony, Wells Fargo & Co. CEO Tim Sloan recently said that the company has rehired 1,780 employees who had quit or were fired after the bank's phony accounts scandal. Around 5,300 employees were fired after taking part in the creation of accounts without customers' knowledge. Wells Fargo says that many others quit or were pushed aside. Some were fired for blowing the whistle on illegal conduct.

Wells Fargo agreed to a $190 million settlement with the Consumer Financial Protection Bureau last year in which it admitted firing the 5,300 workers over allegedly "inappropriate sales conduct."

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