DALLAS – DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay a total of $63.7 million to resolve False Claims Act allegations relating to improper billing practices and unlawful financial inducements to federal healthcare program beneficiaries, the Justice Department announced today. DaVita Rx is based in Coppell, Texas.
The settlement resolves allegations that DaVita Rx billed federal healthcare programs for prescription medications that were never shipped, that were shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. In addition, the settlement also resolves allegations that DaVita paid financial inducements to Federal healthcare program beneficiaries in violation of the Anti-Kickback Statute. Specifically, DaVita Rx allegedly accepted manufacturer copayment discount cards in lieu of collecting copayments from Medicare beneficiaries, routinely wrote off unpaid beneficiary debt, and extended discounts to beneficiaries who paid for their medications by credit card. These allegations relating to improper billing and unlawful financial inducements were the subject of self-disclosures by DaVita Rx and a subsequently filed whistleblower lawsuit.
“Providers should not make patient care decisions based upon improper financial incentives or encourage their patients to do the same,” said U.S. Attorney Erin Nealy Cox for the Northern District of Texas. “The U.S. Attorney’s Office has and will continue to work cooperatively with providers that bring such issues to light to redress the losses the federal healthcare system has incurred.”
DaVita Rx has agreed to pay a total of $63.7 million to resolve the allegations in its self-disclosures and the whistleblower lawsuit. DaVita Rx repaid approximately $22.2 million to federal healthcare programs following its self-disclosure and will pay an additional $38.3 million to the United States as part of the settlement agreement. In addition, $3.2 million has been allocated to cover Medicaid program claims by states that elect to participate in the settlement. The Medicaid program is jointly funded by the federal and state governments.
“Improper billing practices and unlawful financial inducements to health program beneficiaries can drive up our nation’s health care costs,” said Civil Division Acting Assistant Attorney General Chad Readler. “The settlement announced today reflects not only our commitment to protect the integrity of the healthcare system, but also our willingness to work with providers who review their own practices and make appropriate self-disclosures.”
“The conduct being resolved in this matter presents serious program integrity concerns” said CJ Porter, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services, “DaVita Rx’s cooperation in the investigation of this matter was necessary and appropriate to reach this resolution.”
The lawsuit resolved by the settlement was filed by two former DaVita Rx employees, Patsy Gallian and Monique Jones, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they discover evidence that defendants have submitted false claims for government funds and to receive a share of any recovery. The case is captioned United States ex rel. Gallian v. DaVita Rx, LLC, No. 3:16-cv-0943-B (N.D. Tex.). The relators will receive roughly $2.1 million from the federal recovery.
The settlement of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). HHS also offers several programs for health care providers to self-report potential fraud. More information on self-disclosure processes can be found on the HHS-OIG website.
The investigation was conducted by HHS-OIG, the Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office for the Northern District of Texas. The claims asserted by the government are allegations only and there has been no determination of liability.
Assistant U.S. Attorney Lisa-Beth C. Meletta handled this matter for the U.S. Attorney’s Office.
Read the original article from the Department of Justice
Have You Been Discriminated Against at Work?
It is one thing to convince yourself that it was unjust that you lost your job. Self-justification is one of the strongest human drives. It is tough thing to admit that maybe your performance was not up to par. It is another thing to think that an employer fired you for illegal reasons such as discrimination.
A team of New York discrimination attorneys point out that if you were fired for illegal reasons, you may be able to sue the employer for compensation, for other related losses and to prevent them from doing this to other employees. These same New York discrimination attorneys say that employees need to learn their rights.
Know Your Rights
Under federal law and, as New York discrimination attorneys will inform you, under New York law, you cannot be terminated or suffer any adverse employment action because of race discrimination, pregnancy discrimination, disability discrimination, age discrimination, discrimination due to sexual orientation, discrimination due to gender or discrimination due to membership in any protected group. If you believe that you have been fired, demoted or overlooked for a promotion as a result of discrimination and you are in the area, contact New York discrimination attorneys to discuss you options.
Employer Retaliation
Employers have been known to fire employees for simply mentioning perceived discrimination or complaining about discrimination. If an employer has done any of this, they have broken the law. Complaining about discrimination in the workplace is your right and should be able to talk about it without fear of being terminated.
Whistleblower Revenge
If you have reported discrimination, threatening behavior or illegal behavior by your employer and have been fired or retaliated against, you may want to explore your legal options. If you are in the area, call you New York discrimination attorneys to schedule a consultation.
Should I Hire an Attorney?
If you believe your employer illegally discriminated against you as an employee, you can proceed to bring charges against the employer without an attorney. The process is very involved. It can be confusing and quite overwhelming. You can be reasonably certain that when you bring charges, you will be confronted by the employer’s attorneys. Since the U. S. Equal Employment Opportunity Commission (EEOC) enforces the job discrimination laws, sometimes the person who brings the charge is under the mistaken impression that the EEOC is in their corner and will help them with their case. In fact, the EEOC’s job is to investigate the charge and be neutral in their finding of facts. It is wise to seek council. If you are in the area, contact your New York discrimination attorneys who can help you in drafting and submitting your discrimination charge.
Whistleblower Qui Tam and the Housing Market
False Claims Reform Act
Price gouging by military contractors triggered the drafting and passing of the False Claims Reform Act. This was in 1986. The legislation provided the federal government more power and tools to recover losses due to fraud against the government. The False Claims Reform Act amended the Qui Tam and provides greater financial incentives and legal protection to private citizens who, with the help of discrimination attorneys, bring suits on behalf of the government. These private individuals are commonly referred to as “whistleblowers”.
A Potential Area of Abuse
A recent trend in qui tam is in the area of mortgage and financial fraud. The stage for fraud is set when you combine the recent downturn in the economy with the deep involvement of the government in the mortgage and financial markets. We are seeing an increase in mortgage fraud and financial fraud.
The government saw the need to rescue the economy. In response, the government has invested in a number of high cost strategies. These strategies included the buying up of troubled assets from financial institutions. These assets added up to billions. The Federal Housing Administration (FHA) provides mortgage insurance to lenders for more than 30% of all home mortgages. For the lender, mortgage insurance takes the risk out of the homeowner defaulting on their mortgage. As a result, some lenders have behaved badly.
A Response to the Abuse
In 2009, The Fraud Enforcement and Recovery Act expands the ability to report and recover fraud to the mortgage industry and housing industry. The scope of the mortgage and housing fraud is broad. Some examples of fraudulent behavior include falsification of loan documents, false appraisals and sham transactions using straw purchasers. The number of whistleblowers who have went to discrimination attorneys to report fraud in these areas has been on the rise. With increasing foreclosure rates, along with government involvement and money, potential fraud involving government funds is high. This is bound to result in continued increases in Qui Tam litigation.
What Can I Do?
As any New York discrimination attorney will tell you, under Federal law you and your job are protected for reporting fraud. You can also help hardworking taxpayers from being ripped off by corporate greed and dishonest business practices.
Your discrimination attorneys may also tell you that if you are aware of large scale fraud against the government, your reward could be in the millions of dollars. By law, you could collect between 15% and 30% of the total amount of the fraud. To date, the amount rewarded to whistleblowers has exceeded three billion dollars.