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DOJ Enforcement Actions

					
The  is the principal federal agency authorized to enforce the laws and defend the interests of the United States. As such, it oversees the enforcement of the False Claims Act, the foundation of the American whistleblower system, as well as numerous other laws.


The agency traces its origins to the Judiciary Act of 1789 which created the Office of the Attorney General, and the 1870 Act to Establish the Department of Justice, which established the agency as “an executive department of the government of the United States” with the Attorney General as its head.


The agency is comprised of numerous divisions with the Civil Division and in some instances, the Criminal Division, overseeing investigations and prosecutions under the False Claims Act. The  of the federal district where the False Claims Act case is filed also plays a key role in False Claims Act enforcement.


Below are summaries of recent DOJ settlements or successful resolutions under the False Claims Act as well as other successful prosecutions for fraud and misconduct. If you believe you have information about fraud which could give 聽rise to a claim for a whistleblower reward, please contact us to speak with one of our experienced whistleblower attorneys.

				

			

			
						
					
			

	
		
		

			

				
				
February 27, 2019

				 The owner and operator of a drug marketing company has pleaded guilty for his role in a $200 million scheme to defraud TRICARE in one of the largest healthcare fraud cases said to come out of Mississippi. Between 2012 and 2016, Howard Randall Thomley of Advantage Marketing Professionals allegedly recruited TRICARE beneficiaries to accept millions of dollars of medically unnecessary compounded medications by paying them a percentage of prescription revenues. The prescriptions forms 鈥� signed by medical professionals who never saw the recruited beneficiaries 鈥� were then filled by a compounding pharmacy, Advantage Pharmacy, who paid Thomley a portion of the reimbursements. For his role in the scheme, Thomley now faces a maximum sentence of 10 years in federal prison at his sentencing in July. 				 					 

						
Tagged in:
													  Compounding Pharmacy Fraud, 
													  Healthcare Fraud, 
													  Lack of Medical Necessity, 
													  Other Government Health Programs, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 27, 2019

				 Tennessee-based skilled nursing facility chain Vanguard Healthcare LLC, along with former executives William Orand and Mark Miller, have agreed to pay upward of $18 million to resolve False Claims allegations of billing Medicare and Medicaid for worthless and "grossly substandard nursing home services." According to press releases, five facilities in the Vanguard network allegedly submitted false claims for reimbursement, despite a litany of failures, including forging nurse and physician signatures, using unnecessary physical restraints on residents, failing to prevent pressure ulcers, failing to provide wound care as ordered, failing to provide standard infection control, failing to administer medications as prescribed, and failing to meet basic nutrition and hygiene requirements. The case is considered the largest case of fraud involving worthless services in state history. ; 				 					 

						
Tagged in:
													  Certifications, 
													  FCA Federal, 
													  FCA State, 
													  Healthcare Fraud, 
													  Home Health and Hospice, 
													  Medicaid, 
													  Medicare, 
													  Misrepresentations, 
													  SNF, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 25, 2019

				 PhysioHealth Inc. and its wholly owned company, Dynamic Therapy Services, LLC, have agreed to pay $2 million following a self-disclosure that Dynamic had improperly billed TRICARE for services performed at clinics in Delaware, Maryland, and Pennsylvania, between 2011 and 2017. The reported misconduct involved billing for services performed by unauthorized physical therapy assistants, using the supervising physical therapist's authorized provider number, which was in violation of TRICARE rules at the time. 				 					 

						
Tagged in:
													  Healthcare Fraud, 
													  Other Government Health Programs, 
													  Provider Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 25, 2019

				 Skyline Urology will pay $1.85 million to resolve allegations under the federal False Claims Act that it improperly billed Medicare for evaluation and management (E&M) services that did not meet the criteria for separate billing.听 Skyline allegedly used "Modifier 25" to unbundle its E&M billing even when the E&M services were provided on the same day as other billed medical services and were not significant, separately identifiable, and beyond those ordinarily involved with the associated procedure.听 A whistleblower, James M. Cesare, filed a qui tam complaint, and will receive a relator's share of approximately $323,750.听 				 					 

						
Tagged in:
													  Bundling and Unbundling, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Provider Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 25, 2019

				 A Southern California pharmacy owner has been ordered to pay $1.5 million to Medicare after her conviction for one count of healthcare fraud and two counts of wire fraud. Tamar Tatarian, the owner of Akhtamar Phamarcy, was recently convicted of submitting false claims for prescription drugs never ordered from wholesalers or dispensed to beneficiaries. 				 					 

						
Tagged in:
													  Healthcare Fraud, 
													  Medicare, 
													  Pharma Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 22, 2019

				 Marketers, doctors, lawyers, and medical service provider defendants were sentenced this week for their roles in a multi-million dollar California worker's compensation fraud scheme in the San Diego area.听 The defendants recruited patients and referred them to co-defendant attorneys to file fraudulent claims on their behalf and medical providers who performed often unnecessary and painful medical procedures for which they would then bill insurers including California Workers' Compensation.听 Ronald Grusd, a doctor who owned a diagnostic imaging company, was sentenced to 10 years in prison and ordered to forfeit $1.3 million.听 Fermin Iglesias, who worked as a patient capper, was sentenced to 5 years in prison and ordered to forfeit $1 million. Julian Garcia, who provided services to assist the referrals and kickbacks, was sentenced to three years in prison.听 Jennifer Louise White, who marketed to providers in the network, was sentenced to two years in prison.听 Sean O'Keefe, an attorney who filed fraudulent claims on behalf of patients, was sentenced to 13 months in prison and ordered to forfeit $300,000.听 Steven Rigler, a chiropractor, was sentenced to six months in prison.听 				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  Criminal Proceedings, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Other Government Health Programs, 
													  Provider Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 22, 2019

				 Pharmaceutical manufacturer Lehigh Valley Technologies, Inc. will pay $4 million to resolve claims that it caused the submission of false claims through a scheme to avoid the payment of FDA new drug application (NDA) fees.听 The FDA will waive such fees for a small business applicant submitting its first NDA, and had waived fees for Lehigh on an NDA in 2010.听 Subsequently, in an effort to avoid $2 million in fees for a later NDA, Lehigh entered into agreements with two other companies to submit the NDAs and claim the fee exemptions, while Lehigh retained undisclosed control. 				 					 

						
Tagged in:
													  FCA Federal, 
													  FDA Fraud, 
													  Pharma Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 22, 2019

				 Mark Cundiff of Macon, Georgia, was sentenced to three years in prison and ordered to pay restitution of $380,000 to the federal government.听 Cundiff, a former DOD employee at Robins Air Force Base, was responsible for soliciting bids for new contracts at the base.听 Cundiff accepted cash payments of $2,000-$8,00 monthly over the course of almost ten years from co-defendant Raymond Williams (previously sentenced to five years in prison) in exchange for drafting bid solicitation Performance Work Statements in such a way that the contracts could only be met by Williams and his companies, US Technology Corporation and US Technology Aerospace Engineering Corporation.听 The UST companies and Williams received almost $14.5 million in government contracts as a result of the bribery scheme.听 				 					 

						
Tagged in:
													  Bribery and Bid-Rigging, 
													  Criminal Proceedings, 
													  Defense Contract Fraud, 
													  Government Procurement Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 21, 2019

				 Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program.听 Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees.听 				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Provider Fraud, 
													  Upcoding, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
February 21, 2019

				 Body armor manufacturer Survival Armor, Inc., will pay $900,000 to resolve claims that it falsely claimed to qualify as a small business to secure a five-year small business set-aside contract to provide tactical body armor to the Department of Homeland Security.听 The company is, in fact, a subsidiary of a large foreign parent company, and not a small business. 聽				 					 

						
Tagged in:
													  Government Procurement Fraud, 
													  Set-Asides and Preferences, 
												
						

					
	
							
	
		
		
	


 			


											

						

								

									
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