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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  rise to a claim for a whistleblower reward, please contact us to speak with one of our experienced whistleblower attorneys.

				

			

			
						
					
			

	
		
		

			

				
				
December 12, 2018

				 Finance of America Mortgage LLC has agreed to pay $14.5 million to the United States to resolve its liability under the False Claims Act in connection with deficient mortgage loans originated by a company it acquired. The acquired company, Gateway Funding Diversified Mortgage Services, L.P. (Gateway), had participated in the Federal Housing Administration's insurance program as a direct endorsement lender (DEL), which gave it the authority to originate, underwrite, and endorse mortgages with minimal oversight from the FHA. However, as reported by a former Gateway employee in a qui tam complaint, the company failed to comply with the stricter procedures required of DELs, including failing to conduct audits on early-payment default loans, repeatedly failing to correct high rates of default, and failing to self-report deficient loans to the FHA. For exposing the fraud, the unnamed relator will receive a share of $2,392,500. 				 					 

						
Tagged in:
													  FCA Federal, 
													  Housing and Mortgage Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 11, 2018

				 A New York-based audiology practice has agreed to pay $566,263.08 in connection with alleged violations of the False Claims Act and Anti-Kickback Statute. According to an unnamed whistleblower, Oviatt Hearing and Balance, LLC improperly billed Medicare and TRICARE for services rendered by unlicensed and unsupervised employees, as well as provided inappropriate inducements in the form of free iPads, Butterball turkeys, and gift cards, to Medicare and TRICARE beneficiaries to get them to choose Oviatt over other providers. For their role in exposing the fraud, the whistleblower stands to receive a relator's share of $120,000. 				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Improper Medical Personnel, 
													  Medicare, 
													  Other Government Health Programs, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 11, 2018

				 Following qui tam complaints filed by two former employees, Western Medical Group and owners Benjamin George and Jody Rookstool have agreed to pay a total of $1,634,844 to settle allegations that the company violated the False Claims Act in submissions to Medicare. The two complaints, filed in December 2013 and February 2014, alleged that Western Medical violated Medicare's reimbursement rules by using a telemarketing company to solicit sales of knee and back braces from eligible Medicare beneficiaries. 				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medicare, 
													  Whistleblower Case, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 11, 2018

				 Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act in claims submitted to Medicare, Medicaid, and federal employee health insurers. From 2007 until 2014, under DiIorio's direction, Coordinated Health allegedly exploited a billing code called Modifier 59 in order to separately bill for orthopedic surgery charges that, properly billed, instead fall under a single "global" payment for each surgery. Even after outside consultants warned company executives about the improper practice in 2011 and 2013 and provided on-site training on the proper use of Modifier 59, Coordinated Health continued making false claims, causing federal healthcare payers to overpay by millions of dollars. As part of the settlement, the company has signed a Corporate Integrity Agreement for additional government oversight into its billing practices over the next five years. 				 					 

						
Tagged in:
													  Bundling and Unbundling, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medicaid, 
													  Medical Billing Fraud, 
													  Medicare, 
													  Other Government Health Programs, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 11, 2018

				 Aurora Health Care, Inc. has agreed to pay $12 million to settle allegations of defrauding Medicare and Wisconsin's Medicaid program in certain reimbursement claims filed between 2008 to 2012. According to the United States and State of Wisconsin, the healthcare provider and two physicians entered into improper financial relationships in violation of the federal and state False Claims Acts as well as the Stark Law. As a result, some of the claims that Aurora submitted to the government health programs were improper. Despite alerting the government to the illegal arrangement, a qui tam complaint filed by unnamed whistleblowers alleged different claims. Although the whistleblowers will still receive a share of the recovery, the government did not intervene in their lawsuit, which will be dismissed as part of the settlement. 				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  FCA Federal, 
													  FCA State, 
													  Healthcare Fraud, 
													  Medicaid, 
													  Medicare, 
													  Whistleblower Case, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 10, 2018

				 Steven Pagartanis pled guilty to conspiring to commit mail and wire fraud for orchestrating a Ponzi scheme that ran for 18 years. Pagartanis solicited elderly victims by guaranteeing a fixed return of 4.5 to 8 percent annually in real estate-related investments. Pagartanis directed his victims to make checks payable to an entity he secretly controlled and then utilized a network of bank accounts to launder the stolen funds, which he used to pay for exorbitant personal expenses and to cover purported “interest” payments. Pagartanis’ scheme resulted in actual losses of over $9 million and many of his victims lost substantial portions of their life savings. A civil case against Pagartanis has also been filed by the SEC. 				 					 

						
Tagged in:
													  Financial and Investment Fraud, 
													  Misrepresentations, 
													  Ponzi Schemes, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 6, 2018

				 Actelion Pharmaceuticals US, Inc., will pay $360 million to settle claims that it violated the False Claims Act by means of illegally using a foundation as a channel through which it paid the copays of thousands of Medicare patients who were taking Actelion’s pulmonary arterial hypertension drugs to induce patients to purchase the medications. Actelion collected data from the foundation on its spending for patients and used this information to calculate its donations to the foundation, ensuring that its contributions were adequate to cover the copays of patients taking the subject drugs. The company continued these practices despite allegedly receiving warnings from the foundation.   

 				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  Drug and DME Pricing, 
													  FCA Federal, 
													  Pharma Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 4, 2018

				 In connection with their work for the "Panama Papers" law firm of Mossack Fonseca & Co. and its affiliates, Ramses Owens, Dirk Brauer, Richard Gaffey, and Harald Joachim Von Der Goltz have been indicted for actions related to the firm's efforts to circumvent U.S. tax laws on behalf of their clients through the use of offshore accounts and shell companies which Mossack Fonseca created.  The defendants then used an alleged “playbook” to repatriate un-taxed money into the U.S. banking system. The defendants are charged with wire fraud, tax fraud, and money laundering, among other offenses. In the last two months, three of the defendants have been arrested; Ramses Owens remains at large.  				 					 

						
Tagged in:
													  Abusive Tax Shelters, 
													  Money Laundering, 
													  Tax Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 4, 2018

				 In connection with fraud involving two medical devices, Covidien and ev3 Inc. have agreed to pay a total of $31 million to resolve allegations of violating the False Claims Act. According to whistleblower and former employee of Covidien, Jeffrey Faatz, sister company ev3 Inc.'s Onyx Liquid Embolic System was only FDA approved for use within the brain, but was allegedly being marketed to surgeons for use outside the brain. Furthermore, ev3 reportedly incentivized its sales representatives to sell the device for unapproved purposes by setting up sales quotas and bonuses, and did so even as FDA officials expressed safety concerns to the company's executives. Separately, Covidien was accused of paying kickbacks to hospitals to induce use of its Solitaire mechanical thrombectomy device, causing false claims to be submitted to Medicare and Medicaid. For blowing the whistle on this case, Faatz will receive a relator's share of $2 million. ; ; ; 				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  FCA Federal, 
													  Medical Devices and DME, 
													  Off-Label and Unapproved Use, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
December 4, 2018

				 Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. 				 					 

						
Tagged in:
													  FCA Federal, 
													  FCA State, 
													  Improper Medical Personnel, 
													  Medicaid, 
													  Medicare, 
													  Other Government Health Programs, 
													  Provider Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			


											

						

								

									
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