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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.

				

			

			
						
					
			

	
		
		

			

				
				
April 14, 2021

				 The owner of a Florida-based telemarketing call center, Ivan Andre Scott, has been sentenced to 10 years in prison after being convicted of conspiracy to commit healthcare fraud in connection with a $3.3 million fraud scheme against Medicare.  According to evidence presented at trial, Scott made telemarketing calls to Medicare beneficiaries to persuade them to take expensive genetic tests, paid illegal kickbacks to telemedicine companies in exchange for doctor authorizations, and received illegal kickbacks from laboratories in exchange for providing them with the genetic tests.  				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  Criminal Proceedings, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Laboratory and IDTF, 
													  Medicare, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
April 13, 2021

				 After pleading guilty to one count of conspiracy to commit healthcare fraud, James Spina of Dolson Avenue Medical (DAM) in New York has been sentenced to 9 years in prison and ordered to pay over $9.7 million in restitution and over $9.1 million in forfeiture.  Because he did not meet legal requirements for owning and operating a medical corporation, Spina went to great lengths to conceal his role in DAM and at least four other medical corporations, which he then used to run a widespread fraud scheme against Medicare and other health insurers.  The misconduct involved submitting fraudulent claims for medically unnecessary services and services not rendered, double billing for services, fabricating medical records, and obstructing audits by Medicare and other health insurers.  				 					 

						
Tagged in:
													  Criminal Proceedings, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Medicare, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
April 8, 2021

				 South Carolina’s largest urgent care provider, Doctors Care, P.A., and its management company, UCI Medical Affiliates of South Carolina, Inc. (UCI), have agreed to pay $22.5 million and enter into a Corporate Integrity Agreement to resolve a whistleblower suit alleging violations of the False Claims Act.  From 2013 to 2018, UCI allegedly submitted false claims to Medicaid, Medicare, and TRICARE by linking services rendered by Doctors Care providers who lacked proper billing credentials—which are separate from a degree or license to practice medicine—to providers who did hold the proper credentials.  Under the Corporate Integrity Agreement, UCI will retain an independent claims reviewer for the next five years.  				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Whistleblower Case, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
April 6, 2021

				 Health Net Federal Services LLC paid over $97 million to resolve claims that it overcharged the Department of Veterans Affairs as the third-party administrator under the Patient-Centered Community Care Program.  Health Net's alleged overbilling, which included billing the VA for duplicate claims and failing to pass on provider rate savings to the VA, was discovered in an audit by the VA Office of the Inspector General.  				 					 

						
Tagged in:
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Other Government Health Programs, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
April 1, 2021

				 Pharma company Bristol-Myers Squibb will pay $75 million to settle a False Claims Act action, filed by a whistleblower, alleging that the company failed to pay amounts it owed under the Medicaid Drug Rebate Program. That program, the MDRP, requires drug manufacturers to report the Average Manufacturer Prices (AMPs) of their Medicaid-covered drugs to the government; the higher the reported AMPs, the greater the rebate owed by the pharma company to the government.  The whistleblower alleged that Bristol-Myers systematically under-reported their AMPs for a number of its drugs, including by reducing service fees it paid to wholesalers and excluding the value of price appreciation provisions in wholesale contracts. Of the total settlement, $41 million will be paid to the federal government, and the remainder to states participating in the settlement.  The government did not intervene, and the action was pursued by the whistleblower, Ronald J. Streck, who will receive an undisclosed share of the settlement.  				 					 

						
Tagged in:
													  Drug and DME Pricing, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medicaid, 
													  Pharma Fraud, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
March 26, 2021

				 David Boice, the co-founder and CEO of Trustify Inc., was sentenced to 8 years in prison and ordered to pay $18.1 million in restitution and $3.7 million in forfeiture following SEC charges that Boice misrepresented Trustify, an online marketplace purportedly designed to connect customers to a network of private investigators, as a successful business, fraudulently offering and selling over $18.5 million of securities to more than 250 individual and corporate investors.  Boice inflated company revenues in financial statements, fabricated customer relationships, forged correspondence purportedly from potential investors, and misrepresented the use of investor funds.  Trustify was placed in corporate receivership in 2019.  				 					 

						
Tagged in:
													  Criminal Proceedings, 
													  Financial and Investment Fraud, 
													  Misrepresentations, 
													  Securities Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
March 26, 2021

				 Following two whistleblower complaints, a former owner of a now-defunct diagnostic testing laboratory in North Carolina and South Carolina has agreed to pay $2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  Together with other agents of Physicians Choice Laboratory Services (PCLS), Phillip McHugh allegedly offered and provided benefits to physicians in exchange for referrals of patient samples, causing false claims to be submitted to Medicare.  A second defendant in the case, former sales representative and manager Manoj Kumar, has already paid approximately $650,000 to resolve similar claims.  				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
March 24, 2021

				 Two men in Mississippi have been sentenced to 7 years in prison and ordered to pay over $16 million in restitution to Medicare, TRICARE, and Express Scripts, as well as forfeiture of close to $1 million, for their roles in a multimillion-dollar healthcare fraud scheme.  Dempsey Bryan Levi and Jeffrey Wayne Rollins, the operators of the Gardens Pharmacy, LLC, had previously admitted to soliciting and incentivizing recruiters to obtain prescriptions for highly reimbursed compounded medications, and soliciting and incentivizing doctors to authorize those prescriptions.  				 					 

						
Tagged in:
													  Anti-Kickback and Stark, 
													  Compounding Pharmacy Fraud, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medicare, 
													  Other Government Health Programs, 
													  Pharma Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
March 23, 2021

				 The former owner of Shape of Behavior (TSOB), a Texas-based therapy service provider for children with autism, has agreed to pay $2.7 million to resolve allegations that nine of the provider’s locations submitted improper claims to TRICARE.  The misconduct was uncovered by TRICARE’s managed care support contractor, Humana Military Program Integrity, and involved claims that could not be substantiated by medical records, claims involving excessive hours by individual providers, and misrepresentations of the identities of actual rendering providers.  				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Other Government Health Programs, 
													  Provider Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
March 19, 2021

				 Humanitarian organization the International Rescue Committee, which contracted with USAID to provide humanitarian assistance for internally-displaced persons in Syria, will pay $6.9 million in a settlement resolving claims under the False Claims Act. The settlement followed an investigation by the USAID OIG into an alleged kickback and bid-rigging scheme involving IRC’s acquisition of goods and services between 2012 and 2015, which resulted in USAID paying inflated prices.  				 					 

						
Tagged in:
													  Bribery and Bid-Rigging, 
													  FCA Federal, 
													  Government Procurement Fraud, 
													  Government Programs Fraud, 
												
						

					
	
							
	
		
		
	


 			


											

						

								

									
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