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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.

				

			

			
						
					
			

	
		
		

			

				
				
July 8, 2020

				 An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE.  Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals.  USP also allegedly offered preferential investment opportunities to physicians in Texas.  As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma.  				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 7, 2020

				 After being found guilty of eighteen fraud-related felonies, Todd Michael Ficeto, a former Beverly Hills stockbroker, has been sentenced to 6 years in prison and ordered to pay nearly $216 million in restitution to investor victims for his role in a massive penny stock fraud scheme.  From 2004 to 2007, Ficeto and co-conspirators fraudulently manipulated penny stocks to exaggerate the reported profits of a co-conspirator’s hedge fund, Absolute Funds.  When the scheme unraveled, Ficeto attempted to conceal the fraud by lying to investigators from the Securities Exchange Commission and Financial Industry Regulatory Authority.  One of his alleged co-conspirators—hedge fund owner Florian Wilhelm Jürgen Homm—has fled to Germany as a fugitive from justice.  				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 7, 2020

				 Florida Cancer Specialists & Research Institute, LLC (FCS) has agreed to return more than $2.3 million in overcharges to the VA after a successful qui tam action by a former Claims Resolution Specialist with FCS, Marianne Parker.  Parker’s complaint instigated a government investigation that found that an error in the VA’s billing system had led the agency to pay the full amount billed by FCS for certain physician-administered drugs provided to veterans, rather than at the Medicare rate mandated by the Code of Federal Regulations.  For alerting the government to the discrepancies, Parker will receive a 20% share of the funds.  				 					 

						
Tagged in:
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Medicare, 
													  Other Government Health Programs, 
													  Whistleblower Case, 
													  Whistleblower Rewards, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 1, 2020

				 Novartis Pharmaceuticals Corporation will pay a total of $678 million to resolve a case brought by a whistleblower, Oswald Bilotta, alleging that between 2002 and 2011 the pharmaceutical company violated the Anti-Kickback Statute and False Claims Act by providing doctors with cash payments and luxury travel and meals to induce them to prescribe Novartis cardiovascular and diabetes drugs reimbursed by federal healthcare programs.  The total settlement consists of $591.4 million as federal FCA damages, $48.2 million as state FCA damages for Medicaid false claims submitted to 28 states and the District of Columbia, and $38.4 million as forfeiture under the Anti-Kickback Statute.  The whistleblower award has not yet been determined.  In addition to the monetary settlement, Novartis entered into a Corporate Integrity Agreement obligating the company to, among other things, significantly reduce its volume and spending on paid speaker programs.  ; ; ; ; 				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 1, 2020

				 Novartis Pharmaceuticals Corporation will pay $51.25 million to resolve claims that it unlawfully funneled money to three different foundations – The Assistance Fund, the National Organization for Rare Disorders, and the Chronic Disease Fund – so that those organizations could fund co-payments owed by Medicare beneficiary patients prescribed the Novartis drugs Gilenya (for multiple sclerosis) and Afinitor (for renal cell carcinoma and certain pancreatic cancers).  The payments were alleged to be in violation of the Anti-Kickback Statute and False Claims Act.  ; 				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 1, 2020

				 Leonard J. Cipolla of Richmond, Virginia, was sentenced to ten years in prison for bilking more than $7 million in investor funds from customers of his Tate Street Trading, Inc..  Cipolla falsely told the investors that he was a successful commodities trader and could guarantee them a fixed rate of return.  In fact, Cipolla diverted the investor funds that he did not lose through speculative trading, and provided his customers with false account statements.  (Restitution order)				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 1, 2020

				 Raeann Gibson of Palm City, Florida, was sentenced to ten years in prison based on her role in an investment fraud conspiracy.  Gibson served as the Chief Operating Officer of Dominion Investment Group, which defrauded elderly investors of over $25 million by diverting investment funds to the personal use of Gibson and co-defendant Daryl Bank.  Gibson created numerous shell companies, laundered investment funds through multiple accounts, and spoke with investors.  				 					 

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

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
July 1, 2020

				 Genetic testing company Agendia, Inc., which offers the MammaPrint test analyzing genes within breast cancer tumors to predict recurrence, will pay $8.25 million to resolve claims of Medicare fraud in a case brought by a whistleblower under the False Claims Act.  Agendia was alleged to have conspired with hospitals to delay the performance of MammaPrint tests for patients discharged from those hospitals.  Under the Medicare 14-Day Rule in effect during the relevant time period, Agendia was allowed to bill Medicare directly for the test if it was performed more than 14 days after the patient was discharged from the hospital; if the test was performed within 14 days of discharge, then it would be billed through the hospital.  If Agendia received a physician’s order for a Medicare patient within 14 days of the patient’s discharge, it would either cancel the order and require the physician to resubmit it, or otherwise improperly delay the test and claim it was ordered and performed on a later date.  The whistleblower was a former employee of a Kentucky hospital, Mercy Health- Lourdes, which worked with Agendia to allow it to separately bill Medicare for the test, including by holding tissue specimens for 14 days or longer after patients were discharged. The hospital previously paid $211,039 to settle its liability.  No reward amount for the whistleblower was made public.  

 				 					 

						
Tagged in:
													  Bundling and Unbundling, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Laboratory and IDTF, 
													  Medical Billing Fraud, 
													  Whistleblower Case, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
June 30, 2020

				 Clifford P. Shomake and Kimberly Clyde “Casey” Conner, the owners of Guam Medical Transport, were sentenced to 6 years and 5.25 years, respectively, following their guilty pleas to charges arising from their conspiracy to defraud Medicare and TRICARE by submitting claims for reimbursement for medically unnecessary ambulance services that GMT provided to patients with end stage renal disease, despite knowing that the individuals did not qualify for ambulance transport under applicable regulations.  Defendants admitted that the conspiracy resulted in improper payments to GMT of approximately $10.8 million, and restitution in that amount was also ordered.  				 					 

						
Tagged in:
													  Ambulance, 
													  Criminal Proceedings, 
													  Healthcare Fraud, 
												
						

					
	
							
	
		
		
	


 			




	
		
		

			

				
				
June 30, 2020

				 Ophthalmic Consultants, P.A. and its principal Robert K. Snyder have agreed to pay $4.8 million to resolve claims that they unlawfully billed federal healthcare programs for the drugs ranibizumab (Lucentis®) and aflipercept (Eylea®).  While the drugs are sold in single-use vials, defendants used single vials to provide doses to multiple patients, allowing them to obtain excessive reimbursement from Medicare, TRICARE, and the Federal Employees Health Benefits Program.  				 					 

						
Tagged in:
													  Dosage Fraud, 
													  FCA Federal, 
													  Healthcare Fraud, 
													  Medical Billing Fraud, 
													  Pharma Fraud, 
													  Provider Fraud, 
												
						

					
	
							
	
		
		
	


 			


											

						

								

									
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