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Articles by Eva Gunasekera
Coded for Fraud: Whistleblower Takes Home 16.5% of Medical Device Billing Fraud Settlement
The Department of Justice settled a qui tam whistleblower lawsuit with THD America Inc. along with its parent company, THD SpA of Italy. The medical device manufacturer will pay $700,000 for an alleged incorrect billing code scheme which caused Medicare and State Medicaid programs to pay false claims. The whistleblower, a former employee of the medical device manufacturer, will receive $115,500 or 16.5% of the settlement.
From Prescription Pad to Prison: Physician’s Opioid Scheme Leads to $4.7 Million Judgment
Kickbacks and writing prescriptions without a medical need formed the basis of the United States’ complaint against a Sandusky, Ohio-area physician who was recently ordered to pay $4.7 million for violations of the False Claims Act and the Controlled Substances Act. The recent civil case in the U.S. District Court for the Northern District of Ohio against Dr. Gregory Gerber serves as a significant reminder of the ethical and legal responsibilities healthcare providers must uphold.
Unraveling Fraud Like a Double Helix: Two Whistleblowers Receive Over $860,000 for Reporting Genetic Testing Kickbacks
In a recent development that underscores the importance of compliance with the Anti-Kickback Statute, Admera Health LLC has agreed to pay over $5.5 million to settle allegations of False Claims Act violations. This settlement serves as a crucial reminder for healthcare providers about the severe consequences of violating the Anti-Kickback Statute (AKS)—and the power of whistleblowers to speak up.
The Good, The Bad And The Ugly Of Healthcare's PE Boom
By Eva Gunasekera and Jaclyn Tayabji (July 18, 2024, 5:21 PM EDT) -- Over the past decade, private equity firms' interest and investment in domestic healthcare has quadrupled. From 2010 to 2021, private equity acquisitions of healthcare entities rose from an estimated annual deal value of $41.5 billion to more than $200 billion.[1]... Law360 is on it, so you are, too.
The Good, The Bad And The Ugly Of Healthcare's PE Boom
ADVERTISEMENT Don't want ads? Subscribe or login now. By Eva Gunasekera and Jaclyn Tayabji (July 18, 2024, 5:21 PM EDT) -- Over the past decade, private equity firms' interest and investment in domestic healthcare has quadrupled. From 2010 to 2021, private equity acquisitions of healthcare entities rose from an estimated annual deal value of $41.5 billion to more than $200 billion.[1]...
Grafts Graft: Major Healthcare Fraud Takedown in Arizona Highlights Fraud Schemes Targeting Substance Abuse Patients, Elderly
In a blockbuster enforcement action, The Justice Department has charged nearly 200 people in a nationwide crackdown on health care fraud schemes, with false claims amounting to $2.7 billion. Among the accused are doctors, nurse practitioners, and others involved in various scams, including a $900 million scheme in Arizona targeting dying patients.
No ‘Passing Grade’ for Fraud: Government Steps in on Student Recruiting Scheme
The U.S. Department of Justice announced its intervention in a qui tam False Claims Act (FCA) complaint filed against Study Across the Pond LLC (SATP) and its principal, John Borhaug, in the District of Massachusetts. The complaint asserts that SATP and Borhaug induced U.K. schools to file false claims for federal student aid to the Department of Education.
No Time for Fraud: Government Contractor to Pay $18.4 Million for False Timecard Submissions
Consolidated Nuclear Security LLC (CNS), a Delaware company with its main operations in Tennessee, will pay the United States $18.4 million to settle False Claims Act violations. From July 2014 through June 2020, CNS knowingly submitted doctored timesheets to the National Nuclear Security Administration (NNSA) for employees working at NNSA’s Pantex Site. The Pantex Site is the United States’ main facility for nuclear weapons production.
Crude Consequences: Switzerland-Based Company to Pay $126 Million Criminal Fine for Oil Bribery Scheme
The United States announced that Swiss international commodities trading company, Trafigura Beheer B.V. (Trafigura), pled guilty to violations of the Foreign Corrupt Practices Act (FCPA) and will pay over $126 million to resolve the investigation. The allegations stem from Trafigura’s bribes to Brazilian government officials in return for access to business with Brazil’s state-owned oil company, Petróleo Brasileiro S.S. – Petrobras (Petrobras).
DOJ Files Second Qui Tam Lawsuit Against Regeneron Pharmaceuticals
The United States announced that it has intervened in a False Claims Act case against New York-based Regeneron Pharmaceuticals Inc. (Regeneron). The suit, brought by two whistleblowers, alleges that Regeneron improperly inflated Medicare reimbursement rates and submitted doctored sales reports to Medicare and Medicaid.
Wait for it: CFTC Awards $1.25 Million to Whistleblower Under New 120-Day Safe Harbor Provision
The Commodity Futures Trading Commission (CFTC) announced that they are awarding $1.25 million to a whistleblower who worked within the offending entity’s auditing and compliance branch. This is the first award given under the CFTC’s 120-day safe harbor provision, which requires a whistleblower who works in those functionalities to raise concerns internally and wait at least 120 days and see no meaningful changes before contacting the CFTC.
The U.S. Intervenes in False Claims Act Qui Tam Cybersecurity Fraud Case Against Government Contractor Georgia Tech
The United States has intervened in a False Claims Act qui tam case against Georgia Tech Research Corporation, Georgia Institute of Technology, and Georgia Tech Research Institute (Collectively “Georgia Tech”) for violations of NIST 800-171 for failing to protect Controlled Unclassified Information (CUI).
CMS ISSUES ITS 2025 FINAL RULE: Aligning with the FCC, CMS Requires TPMOs to Obtain Beneficiary’s Prior Express Written Consent Prior to Sharing Personal Data with Other TPMOs – Even if “Manually” Dialing!
Well, this shouldn’t come as a surprise to anyone due to the recent increase in marketing regulations imposed on TPMOs. Today the Centers for Medicare and Medicaid Services (“CMS”) issued its 2025 Medicare Advantage and Part D Final Rule where amongst other new rules, it issued heightened marketing rules that align with the FCC’s Second Report and Order requiring “one to one” prior express written consent to transfer personal data to marketing partners.
Anti-Kickbacks, Pro Patients: Whistleblower Exposes Oncology Practice’s Kickback Scheme
Oncology San Antonio, PA and its affiliated physicians will pay $1.3 million, and CorePath Laboratories, PA (CorePath) will pay over $2.7 million, plus interest, to the United States and Texas to resolve False Claims Act violations. The lawsuit was brought by a whistleblower, who will receive a reward for his efforts. According to the allegations, in August 2016, Oncology San Antonio conspired with CorePath, a diagnostic reference laboratory, to create a kickback scheme.
Time to Pay Up: Doctors and Marketers Pay $1.5 Million Settlement for Medicare Referral Kickback Scheme
In a recent striking example of the paramount role whistleblowers play in safeguarding the integrity of healthcare systems, a False Claims Act settlement has spotlighted the dark underbelly of laboratory kickback schemes in the United States.
An Institutional Relator Brought COVID Fraud Allegations to DOJ and Received Relator Share
NOVEMBER 7, 2023. Feast American Diners LLC and Dawood “David” Beshay, the corporate owner and managing member of multiple Denny’s restaurants in both Arizona and New York, have agreed to pay $2 million to resolve allegations that Beshay took advantage of the Restaurant Revitalization Fund (RRF) by certifying that Feast American Diners was eligible for a RRF grant despite knowing that his company had too many locations to qualify.
Twitter Cybersecurity Whistleblower Calls Out Company for Allegedly Deceiving Regulators and the Public
Big Tech is having another day of reckoning. Peiter “Mudge” Zatko, Twitter’s former head of cybersecurity, filed a complaint with the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), and the Department of Justice (DOJ), alleging the company’s poor internal security controls leave users’ data potentially unprotected and available to malicious actors.
All that Glitters: $70.7 Million False Claims Act Settlements for Golden State Medicaid Fraud
August 23, 2022. The United States Department of Justice settled three cases against a California county organized health system and three healthcare providers for alleged submission of false claims to California’s Medicaid program (Medi-Cal). Under the terms of the settlements, the county organized health system (COHS), an integrated health care system, a non-profit hospital system, and another non-profit healthcare organization paid a combined total of approximately $70 million.
Nursing Home Whistleblowers are the Canaries in the Coal Mine: $5.5 Million Nursing Home Operator Settlement
A whistleblower reported Medicare fraud happening at an Indiana-based senior citizen residential healthcare company, and the Department of Justice settled with the company for $5.5 million. The whistleblower was a former employee of a hospice services company working with skilled nursing and long-term care services provider, American Senior Communities, L.L.C. (ASC).
Coveralls Don’t Cover Up Govcon Fraud: Apparel Manufacturer Settles SDVOSB GovCon Fraud Allegations
Thursday, August 11, 2022 August 11, 2022. The United States Department of Justice settled a case against an apparel manufacturer for falsely claiming to be a service-disabled, veteran-owned small business (SDVOSB) in order to win contracts with the U.S. Department of Agriculture and the U.S. Defense Logistics Agency. Under the terms of the settlement, the contractors and company owners paid almost $8 million.
Pushing Back on Kickbacks: $900 Million Settlement in Biotech False Claims Act Case
28 July 2022. On the eve of a trial with a former employee turned whistleblower, biotechnology company Biogen agreed to pay $900 million to settle allegations of lavishly overpaying doctors to prescribe their drugs to Multiple Sclerosis (MS) patients. The whistleblower was a sales representative for the biotechnology company who claimed he was demoted when he blew the whistle on the sham speaker program. He will be entitled to 25-30 percent of the $900 million settlement, or at least $225 million.
Who is Most Likely to Become a Whistleblower and Why Do They Speak Up? [VIDEO]
The False Claims Act is a commonly misunderstood law, but one that offers powerful protections and financial incentives to those who leverage it to report government fraud. To help demystify the process for becoming a whistleblower and the benefits of speaking up, whistleblower attorneys and Tycko & Zavareei LLP partners Renée Brooker and Eva Gunasekera answered commonly asked questions about the False Claims Act, government program fraud, and more during a recent office hours webinar.
Rocket Fuel for Cyber-Fraud Initiative: Whistleblower Receives 29% of False Claims Act Settlement in Cyber-Fraud Case
July 12, 2022. The Department of Justice has announced the final settlement in the Aerojet Rocketdyne cyber-fraud False Claims Act case, including a relator payday of $2.61 million. Under the terms of the settlement, the rocket propulsion and power systems manufacturer paid $9 million to settle allegations of cyber-fraud. The whistleblower was a former senior director of cybersecurity, compliance, and controls of Aerojet Rocketdyne.
What is Cyber Fraud Under DOJ's New Cyber Fraud Initiative? Original
The Department of Justice’s Civil Cyber-Fraud Initiative One thing that we think is really interesting is the Department of Justice’s [DOJ] new Civil Cyber-Fraud Initiative. What we think is so interesting about it is that DOJ often has initiatives.
Recognizing World Whistleblower Day 2022
June 23, 2022. Today is World Whistleblower Day, which focuses on whistleblowing in Europe, the United Kingdom, and abroad. Various international foundations highlight the importance of whistleblowers on the global stage, particularly in international organizations such as the United Nations and the European Union. Despite the prominence and protections of the United States False Claims Act, it is one of many whistleblower and anti-corruption laws worldwide.
Court Affirmed Admitting A Codicil To Probate As The Testator Had Mental Capacity And Was Not Unduly Influenced And Discussed Expert Testimony Issues
In Dillon v. King, one sister contested their father’s will and codicil and also asserted other claims against her sister. No. 05-20-00215-CV, 2022 Tex. App. LEXIS 2991 (Tex. App.—Dallas May 4, 2022, no pet. history). In 2010, the father executed a will leaving everything equally to his two daughters. Thereafter, he moved to Texas to be near the contestant. The contestant then accessed the father’s bank account.
Rise of Telehealth Fraud and Abuse: How it Happens and How You Can Report it
In the few years since COVID-19 first reached the United States, the rate of telehealth appointments has soared to help bridge the gap between stay-at-home measures and the need for healthcare. While telemedicine has been enormously helpful for many, some bad actors have also used it as an opportunity to take advantage of situation to overcharge, defraud, and otherwise scam and skim off more than their fair share of public funds.
What Sussmann Acquittal Means for False Statement Prosecutions
On May 31, former Hillary Clinton campaign attorney Michael Sussmann was found not guilty in connection with his provision of information to the Federal Bureau of Investigation. Sussman’s acquittal provides insight into the applicability of a favored prosecution tool, 18 U.S.C. § 1001(a)(2) (“Section 1001”), which prohibits “knowingly and willfully . . . mak[ing] any materially false, fictitious, or fraudulent statement or representation” in a government investigation.
EPA Extends Comment Period for Proposed Rule to Ban Ongoing Uses of Asbestos
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66,000 Prescriptions in 3 Years: Pharmacy Owners Convicted for Multimillion-Dollar Telemedicine Fraud Scheme
May 24, 2022. Telemedicine for prescribing pharmaceuticals is supposed to bring convenient care to patients, not be a new way to deal drugs. A multi-year investigation concluded in a criminal trial, with two leaders of a multimillion-dollar telemedicine pharmacy fraud scheme paying approximately $50 million in restitution and facing 17 years in prison.
FDA and EPA Collaborated on Agricultural Water Efficacy Protocol
As previously reported, on July 30, 2020, FDA worked with EPA to release a protocol to evaluate the efficacy of antimicrobial pesticides in agricultural water. The protocol established an agricultural water panel assay that companies could use to test the capability of their water treatment processes to combat strains of Listeria, Salmonella and E. coli frequently responsible for foodborne illnesses.
FDA Releases Guidance on Infant Formula Enforcement Discretion Policy
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FDA Expresses Displeasure with Consumer Products Containing Trendy Cannabis Ingredient Delta-8 THC
On May 4, 2022, the U.S. Food and Drug Administration (FDA) for the first time issued warning letters related to products containing delta-8 tetrahydrocannabinol (delta-8 THC). FDA has previously sent warning letters to other companies illegally selling unapproved and misbranded cannabidiol (CBD) products that claimed to treat illness in violation of the Federal Food, Drug, and Cosmetic Act (FD&C Act), as we have discussed in prior posts (one example here).
Construction Company Settles False Claims Act Allegations Relating to Small Business Subcontracting for $2.8 Million
On May 12, the U.S. Department of Justice announced a $2,804,110 settlement with Hensel Phelps Construction Company to resolve allegations that it violated the False Claims Act (FCA) by circumventing federal regulations designed to encourage contract awards to service-disabled veteran owned small businesses (SDVOSBs).
EPA Shares 2020 Chemical Data Report for Public Knowledge
On May 12, 2022, the U.S. Environmental Protection Agency (EPA) announced the publication of information collected during the 2020 Chemical Data Reporting (CDR) cycle to increase public awareness of chemicals being manufactured in communities and to enable citizen and stakeholder access and use of the reported information.
Department of Justice Takes Historic Action to Prioritize Environmental Justice in Enforcement: What Does it All Mean and What is Ahead?
On May 5, 2022, Attorney General Merrick Garland announced key developments that would elevate environmental justice (EJ) as a key priority for the nation’s largest and most powerful enforcement agency.
U.S. Supreme Court Decides Important Regulatory Taking Case In Favor of Property Owners
Property owners won a significant victory in the recent case of Pakdel v. San Francisco, in which the U.S. Supreme Court rejected a restrictive view of the “finality requirement,” which generally requires a government decision to be final before the property owner can file suit to challenge that decision. In Pakdel, a married couple partially owned a multi-unit residential building in San Francisco as “tenants-in-common” with all the other owners of the building.
Whistleblower Receives $130,000 for Reporting Behavioral Health Fraud
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EPA Research Team Develops Framework to Determine What Products to Classify and Evaluate as Nanopesticides
According to a May 9, 2022, news item published by the U.S. Environmental Protection Agency (EPA), “Advancing EPA’s Understanding of the Next Generation of Pesticides,” over the past decade, EPA “has received an increasing number of pesticide product applications that potentially contain nanomaterials.” The article notes that EPA’s current pesticide review method was not designed for nanomaterials, so each product is reviewed on a case-by-case basis.
Navigating the Data Privacy Landscape for Autonomous and Connected Vehicles: Documenting Collected Data
This is the second part in a series of advisories on data privacy best practices for autonomous and connected vehicles. To read the first advisory, please visit Navigating the Data Privacy Landscape for Autonomous and Connected Vehicles: Best Practices. Autonomous vehicles require a vast amount of data to operate safely, some of which could answer questions like: Where is the car right now, and what direction is it heading? What other vehicles, landmarks or pedestrians are nearby?
No Whistleblower: Hearing Aid Company Settles Allegations of FEHBP Fraud for $34.37 Million
The United States Department of Justice settled a case against hearing aid distributor Eargo Inc. (Eargo) for allegedly submitting false claims to the Federal Employees Health Benefits Program (FEHBP). Under the terms of the settlement, the medical device distributor paid $34.37 million.
Revisiting the Infrastructure Bill for Earth Day: Whistleblowers Keep Clean Energy Efforts Clean
The 2022 theme for Earth Day was “Invest In Our Planet.” The 2021 bipartisan Infrastructure Bill included billions of dollars to invest in remediating how the United States’ transportation infrastructure impacts the planet. Government contractors are bidding for these funds in order to accomplish these projects to reduce dependence on fossil fuels and thereby benefit the environment.
Cooking Up Trouble: Record $48.5 Million Settlement in Foodservice Equipment Government Contracting Fraud Case
Improperly obtaining contracts that are meant for service-disabled, veteran-owned businesses—and concealing it—is not a recipe for success in government contracting. The United States Department of Justice settled a case against a foodservice and restaurant equipment supplier. Under the terms of the settlement, the contractor paid $48.5 million, the “largest-ever False Claims Act recovery based on allegations of small business fraud,” of which $21.6 million is restitution.
“Over-Operated” – Whistleblower Receives Over $4.1 Million for Reporting Medically Unnecessary Neurosurgery Procedures Fraudulently Billed to Federal Healthcare Programs
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Whistleblower Receives $5 Million of $20 Million Settlement in Impermissible Medicaid Donations False Claims Act Case
Legal Disclaimer You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on www.NatLawReview.com are intended for general information purposes only.
Bipartisan Cybercrime Bill Highlights Cybersecurity Breach Reporting
Legal Disclaimer You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on www.NatLawReview.com are intended for general information purposes only.
With Russian Hackers on the Rise, Need for Cybersecurity Whistleblowers is More Urgent than Ever
Legal Disclaimer You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on www.NatLawReview.com are intended for general information purposes only.
$870,000 Home Healthcare Patient Recruiter Shell Game Cracked
Legal Disclaimer You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on www.NatLawReview.com are intended for general information purposes only.
Remembering Bill Jenkins, Whistleblower and Epidemiologist
February 22, 2022 Reform Bill Proposal to Article 8 of The Federal Law of... by: Luis C. Schmidt TCPA Regulatory Update — FCC Enforcement Bureau Sends More Cease-And-... by: Russell H. Fox and Jonathan P. Garvin When Board Conflict Crosses the Line… by: Gretchen E. Moore FERC's Updated Certificate Policy and Interim GHG Mitigation... by: Michael R. Pincus and Michael Diamond CNIL Recommends Using US Analytics Tools Only for Anonymous... by: Liisa M. Thomas and Julia K.
Whistleblower Pulls Stop Request Cord: Bus Company Settles False Claims Act Allegations for $25 Million
Legal Disclaimer You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on www.NatLawReview.com are intended for general information purposes only.
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