By the Constantine CannonĚýWhistleblower Team

On May 16, U.S. Attorney Michael DiGiacomo announced that Catholic Health System, Inc. (CHS) agreed to pay $3,293,122.66 to settle False Claims Act allegations that it knowingly submitted or caused the submission of false claims to the Medicare program by engaging in improper financial relationships with physicians in violation of the Stark Law¹.

About The Stark Law

The Stark Law prohibits hospitals or other healthcare providers from billing Medicare for services referred by physicians with whom they have a financial relationship, unless those relationships meet strict exceptions. Under the Stark Law, “referrals” are limited to specific types of medical services, such as lab testing, hospital services, prescription drugs, and durable medical equipment, defined as “designated health services.” The Stark Law aims to ensure physician referrals are based on patient need and prevent financial incentives from tainting medical judgment.

CHS Allegedly Entered into Improper Financial Relationships

Here, the government alleges that CHS and its affiliates maintained financial relationships with non-employee physicians who referred patients for hospital services, medical supplies, and laboratory testing. CHS then billed Medicare for the referred services. The government alleged that these physician compensation agreements did not meet narrow exceptions to the Stark Law.

The Whistleblower In This Case

The settlement resolves claims brought by whistleblower Gary Tucker under the qui tam (or whistleblower provisions) of the False Claims Act. Private parties can file lawsuits on behalf of the government and receive up to 30% of any monetary recovery. In this case, Tucker will receive an undisclosed portion of the settlement.

U.S. Attorney DiGiacomo commented: “The Stark Law is designed to protect Medicare by ensuring that physician referrals are not influenced by financial interest. This office is committed to holding health care providers accountable who engage in such conduct.”

Healthcare fraud enforcement remains a top government priority. The DOJ’s 2024 annual roundupĚýof False Claims Act successes showed that of the $2.9 billion the government and whistleblowers recovered during the last fiscal year, over $1.67 billion (58%) came from matters involving healthcare fraud. Four out of 2024’s top 10 healthcare fraud recoveries involved Anti-Kickback Statute violations.

Our Firm Helps Anti-Kickback Statute and Stark Law Whistleblowers

Whistleblowers play a key role in exposing Kickback schemes and Stark Law violations. As whistleblower partner Marlene Koury commented: “Healthcare fraud schemes involving kickback and improper referrals are unfortunately widespread throughout the industry. From hospitals to specialty pharmacies, we have seen creative attempts to circumvent the law at all levels of patient care.”

Common schemes include:

• Hospitals, nursing homes, labs, dialysis centers, drug or DME companies offering referring doctors the opportunity to buy into businesses or other opportunities on favorable financial terms
• Hospitals offering physicians below-market-rate rent for office space
• Drug companies paying kickbacks to pharmacies (retail or specialty) to induce them to switch patients’ prescriptions
• Medical device manufacturers offering incentives to physicians who use their products – just to name a few.

If you would like to learn what it means to be a whistleblower, believe you have information relating to Stark Law violations or healthcare fraud, pleaseĚýcontact usĚýso we can connect you with a member of the 91pornwhistleblower lawyerĚýteamĚýfor a free and confidential consultation.

Speak Confidentially With Our Whistleblower Attorneys

Sources

¹ See

Read Catholic Health Pays Over $3M to Resolve False Claims Act Allegations at constantinecannon.com

By the 91pornWhistleblower Team

Last week (May 19), the Department of Justice (DOJ) released a memo describing the details of its new Civil Rights Fraud Initiative, which will use the False Claims Act to push the Trump Administration’s DEI agenda.¹Ěý In announcing the initiative,² Attorney General Pam Bondi made clear that enforcing Trump’s crusade against DEI is a top DOJ priority:

“Institutions that take federal money only to allow anti-Semitism and promote divisive DEI policies are putting their access to federal funds at risk.Ěý This Department of Justice will not tolerate these violations of civil rights – inaction is not an option.”

THE FALSE CLAIMS ACT WILL BE CENTRAL TO ENFORCING TRUMP’S ANTI-DEI CAMPAIGN

The False Claims Act has become the Government’s primary fraud-fighting tool to go after those who engage in fraud or misconduct that causes financial harm to the Government or otherwise violates a fundamental Government program or policy.

Here, the Government is holding out Civil Rights as the fundamental policy at risk.Ěý According to the DOJ memo, the new Initiative takes aim at federal contractors or recipients of federal funds that “knowingly violate civil rights laws — including but not limited to Title IV, Title VI, and Title IX, of the Civil Rights Act of 1964 — and falsely certifies compliance with such laws.”Ěý DOJ identifies two specific constituencies it will be targeting with the Initiative:

• • Universities. According to DOJ, “A university that accepts federal funds could violate the False Claims Act when it encourages antisemitism, refuses to protect Jewish students, allows men to intrude into women’s bathrooms, or requires women to compete against men in athletic competitions.”

• • Government Contractors. DOJ similarly cautioned that the “False Claims Act is also implicated whenever federal-funding recipients or contractors certify compliance with civil rights laws while knowingly engaging in racist preferences, mandates, policies, programs, and activities, including through [DEI] programs that assign benefits or burdens on race, ethnicity, or national origin.”

CONNECTION TO SUPREME COURT RULING AND HARVARD INVESTIGATION

In creating the Initiative, DOJ cites the Supreme Court’s 2023 decision in Students for Fair Admissions, Inc. v. President & Fellows of Harv. Coll., 600 U.S. 181, where the High Court struck down certain admissions practices at Harvard, finding them racially discriminatory.Ěý Apparently, the Trump Administration believes too many companies and schools are ignoring that decision and employing what DOJ describes as “racist policies and preferences — albeit camouflaged with cosmetic changes that disguise their discriminatory nature.”

According to the New York Times, DOJ is already off to the races with this new Initiative, adding the threat of False Claims Act enforcement to its ever-widening stream of attacks against Harvard.³Ěý According to the Times, DOJ recently served Harvard with a 14-page demand for “a trove of documents and . . . written answers to a list of detailed questions” relating to Harvard’s DEI programs.Ěý The DOJ’s demand also seeks to have a school official testify under oath about the school’s admissions policies and how they may have changed since the Supreme Court’s 2023 ruling.

DOJ IS CALLING OUT FOR WHISTLEBLOWERS TO HELP

The DOJ does not plan to act alone in using the False Claims Act to enforce the Trump Administration’s anti-DEI campaign.Ěý It is actively seeking the help of whistleblowers to bring violators to light through the qui tam provisions of the statute.Ěý One of the notable features of the False Claims Act is that it authorizes private persons to bring actions on the Government’s behalf and if successful, receive up to 30% of any Government recovery.Ěý The vast majority of False Claims Act lawsuits are brought by whistleblowers under these provisions.

The DOJ stressed in both its press release and memo its call for whistleblowers to come forward with potential DEI violations and the promise of potential rewards if they do: “The Department recognizes that it alone cannot identify every instance of civil rights fraud.Ěý Congress likewise has recognized as much and, as a result, has authorized private parties to protect the public interest by filing lawsuits and litigating claims under the False Claims Act and, if successful, sharing in any monetary recovery.Ěý The Department strongly encourages these lawsuits.”

POTENTIAL CHALLENGES TO DOJ’S DEI ENFORCEMENT PLAN

91pornwhistleblower partner Gordon Schnell sees several potential challenges the Government will face in bringing DEI-based False Claims Act cases.Ěý Chief among them are proving intentional fraud and materiality, two of the key elements that must be satisfied in any False Claims Act case.

According to Schnell, “The Government would have to show a company or university intentionally engaged in DEI practices it knew violated the law and purposely concealed those violations from the Government, which is no easy task given the current legal landscape and uncertainties in this area.”Ěý Schnell added, “The Government also would have to show that any such violations were so significant they would have materially impacted the Government’s decision to contract with or fund the offending company or university in the first place.”

Separately, Schnell notes the Initiative “is another good example of the Trump Administration’s continued commitment to the False Claims Act as a key fraud enforcement tool.”Ěý Even more importantly, Schnell highlighted how, regardless of where you stand on the merits of the new Initiative, “it demonstrates the Administration’s continued recognition of the critical role whistleblowers play in helping the Government go after fraud and misconduct.”

CONSTANTINE CANNON REPRESENTS FALSE CLAIMS ACT WHISTLEBLOWERS

91pornhas substantial experience and success representing whistleblowers under the False Claims Act.Ěý If you would like to learn more about the statute and what it means to be a whistleblower, please do not hesitate to contact us.Ěý We will connect you with an experienced member of our whistleblower team for a free and confidential consultation.

Speak Confidentially With Our Whistleblower Attorneys

Sources

¹ See

² See

³ See .

Read DOJ to Use False Claims Act to Enforce Anti-DEI Crusade at constantinecannon.com

By the 91pornWhistleblowerĚýTeamĚý

On May 9, the government announced that Assertio Therapeutics Inc., (formerly Depomed Inc.) (“Assertio”), agreed to pay $3.6 million to resolve False Claims Act allegations stemming from its marketing of Lazanda, its transmucosal immediate-release fentanyl (TIRF) drug. This case was initiated by whistleblowers.¹

Lazanda is a nasal spray solely approved by the FDA for patients with breakthrough cancer pain who are receiving and are tolerant to opioid therapy. Assertio allegedly geared its marketing toward pain specialists who were prescribing high volumes of TIRF products. Several of these pain specialists were flagged or later indicted.

The government alleged that Assertio caused the submission of false claims to the Medicare and TRICARE programs for patients who did not meet the prescription requirements. The government further alleged that Assertio placed high-volume TIRF prescribers on its speakers’ bureau and advisory boards and developed a program to ensure Lazanda prescriptions would be approved by insurance companies.

Deputy Inspector General Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) commented: “Violations of the False Claims Act such as the illegal prescribing practicesĚýalleged in this settlement are especially egregious considering the opioid epidemic. HHS-OIG will continue to work with our law enforcement partners to ensure health care providers and corporations involved in schemes that threaten patient safety are held accountable.”

False Claims Act Whistleblowers

The settlement resolves claims under the qui tam, or whistleblower provisions, of the False Claims Act, allowing private parties to file lawsuits on behalf of the United States for false claims and share up to 30% of any monetary recovery.

The whistleblowers in this case are Noelle Webb and Nicole Novellino, who previously worked as sales representatives at Assertio. They will receive a $657,000 share of the total settlement.

Whistleblower partner Marlene Koury explained: “Whistleblowers who expose improper opioid marketing protect public health and taxpayer dollars. This Ěýcase demonstrates that the FCA remains one of the most powerful tools to hold accountable those who attempt to profit from pain and undermine a system meant to heal.”

Our Firm Helps False Claims Act Whistleblowers

If you would like more information onĚýwhat it meansĚýto be a whistleblower, believe you have information relating toĚýFalse Claims ActĚýviolations orĚýhealthcare fraud, pleaseĚýcontact usĚýso we can connect you with a member of the experienced 91pornwhistleblower lawyerĚýteamĚýfor a free and confidential consultation.

Speak Confidentially With Our Whistleblower Attorneys

Sources

Read Assertio to Pay $3.6M in False Claims Act Settlement over Fentanyl Marketing 91porn at constantinecannon.com

By the 91pornWhistleblowerĚýTeam

On May 5, the government announced that the restaurant chain CoreLife Eatery, LLC admitted to misrepresenting its eligibility for pandemic relief funds. The business, which operates locations in Illinois, Kentucky, Ohio, Pennsylvania, and New York, agreed to pay $7,809,373 to resolve allegations that it violated the False Claims Act by falsely certifying its eligibility for a Restaurant Revitalization Fund (RRF) grant as part of the government’s COVID-19 emergency relief programs.

United States Attorney John A. Sarcone III explained: “The RRF was created to support certain small businesses facing the economic hardships of the COVID-19 pandemic. By submitting false information about its size to obtain a grant, CoreLife not only diverted funds from eligible recipients but also eroded public trust in critical relief efforts. Our office remains committed to enforcing the False Claims Act and holding accountable those who misrepresent their eligibility for federal funding.”

COVID-19 Emergency Relief Programs

In March 2021, Congress enacted the American Rescue Plan Act, part of the government’s emergency relief programs to aid American businesses economically suffering from the pandemic’s effects. From this Act, the RRF was allocated $28.6 billion, enabling the United States Small Business Association to award grants to qualifying entities.

Pandemic Relief Program Eligibility

The program had many requirements including that restaurants, and affiliated entities with over 20 locations as of March 13, 2020, were ineligible for RRF funding. The application process asked applicants how many locations each business owned and operated.

CoreLife now admits that they had 29 restaurant locations as of March 13, 2020.[1] During the application process, it falsely responded “no” to the question about owning more than 20 locations. Next to this question, the application stated that the applicant would be ineligible if they answered “yes.” The chain knew, or should have known, that it had too many locations to qualify.

COVID-19 Related Fraud and the Role of Whistleblowers

As with many recent pandemic fraud cases, this complaint was originated by a whistleblower under the qui tam (or whistleblower provision) of the False Claims Act, allowing private parties to file lawsuits on behalf of the government for false claims and receive a portion of any monetary recovery. The relator (or whistleblower) in this case will receive $1,171,405.96.

Whistleblowers are vital to speaking out against misconduct and sharing information about matters such as defrauding the government. Such frauds can include falsely certifying requirements when applying for COVID-19 loans, unauthorized use of funds, payment of kickbacksĚýto obtain government contracts related to the COVID-19 pandemic response, and more.

Whistleblower attorney Ginger Buck commented: “It is gratifying to see the government taking action against business owners and operators who falsely certify their eligibility for emergency government assistance programs. We applaud and assist whistleblowers who share information about potential cases.”

Our Firm Helps COVID-19 Fraud Whistleblowers

If you would like to learn more about our work representing whistleblowers or think you have information on potential violations, please contactĚýus.ĚýWe will connect you with an experienced member of our whistleblowerĚýteam.

Speak Confidentially With Our Whistleblower Attorneys

[1] See

Read CoreLife Eatery Admits to Pandemic Relief Fraud in Whistleblower Initiated Case, Will Pay $7.8M at constantinecannon.com

By the 91pornWhistleblower Team

On April 23, the government announced that Genexe LLC, its marketing company Immerge, Inc., and two of its owners, Jason Green and Jason Gross, will pay $6 million to settle allegations that they violated the False Claims ActĚýand Anti-Kickback Statute.

The now-defunct Genexe once billed itself as a “one-stop-shop” for genetic and pharmacogenetic profiling, marketing itself as “involved in every aspect of the patient screening process, from the collection of samples to laboratory processing.” In reality, the company operated a high-volume kickback scheme bilking Medicare out of millions of dollars.

According to the government, Genexe allegedly targeted Medicare beneficiaries for unnecessary genetic testing, hiring untrained independent contractors to collect patient information and DNA samples at malls, churches, and senior centers. To drive referrals, they paid kickbacks to incentivize doctors to order medically unnecessary genetic and pharmacogenetic tests. Genexe then sent the samples to labs, which in turn paid Genexe kickbacks of up to $2,000 per sample.

This case was brought by four whistleblowers under the qui tam provisions of the False Claims Act, allowing private parties (or relators) to file lawsuits on behalf of the government and receive up to 30% of any recovery. As part of this settlement, the relators will receive $1.32 million altogether, roughly 22% of the recovery.

U.S. Attorney Metcalf stated: “Genetic testing fraud preys on the fears of patients, and it wastes taxpayer dollars by spending limited funds on medically unnecessary or nonexistent tests. This settlement shows we will work with our law enforcement partners to investigate fraud, waste, and abuse in federal healthcare programs and will use every tool available to recover improperly paid taxpayer funds.”

Healthcare Fraud and Kickback Schemes

Healthcare fraud and kickback schemes remain a threat to government funded programs. These schemes occur at all levels of the healthcare system from individual medical facilities to executive offices of global pharmaceutical companies.

Kickback schemes take many forms, such as a drug company paying kickbacks to pharmacies to get them to switch patients’ prescriptions, and diagnostic labs like Genexe incentivizing doctors to order unnecessary tests. Violations of the Anti-Kickback Statute and Stark Law can be reported by whistleblowers under the False Claims Act.

What Role do Whistleblowers Play in Uncovering Medicare Fraud and Kickback Schemes?

Whistleblower partner Marlene Koury highlighted the importance of whistleblowers in uncovering fraud: “Whistleblowers help maintain the integrity of the system, protect patients, and save taxpayers’ money. The United States enforces Medicare fraud and violations of the Anti-Kickback and Stark laws to prevent waste of government funded programs.”

Whistleblowers are instrumental in identifying and sharing any knowledge they might have of fraud. One example of an insider-turned-whistleblower could be an employee becoming aware of doctors knowingly, willfully receiving, offering, or paying for referring individuals under a federal healthcare program that violates the Anti-Kickback Statute.

If you would like more information onĚýwhat it meansĚýto be a whistleblower, believe you have information relating toĚýFalse Claims ActĚýviolations orĚýhealthcare fraud, pleaseĚýcontact usĚýso we can connect you with a member of the experienced 91pornwhistleblower lawyerĚýteamĚýfor a free and confidential consultation.

Speak Confidentially With Our Whistleblower Attorneys

Read Genexe and Its Entities Will Pay $6M to Settle False Claims Act Allegations, Case Brought by Four Whistleblowers at constantinecannon.com

By the 91pornWhistleblower Team

On May 1, the Department of Justice (DOJ) settled its latest cybersecurity enforcement action, showing the Government’s continued commitment to using the False Claims Act to go after cybersecurity fraud.Ěý Under the settlement, RTX subsidiary Raytheon Company and Nightwing Group agreed to pay $8.4 million to settle charges of violating key cybersecurity requirements in various Department of Defense (DoD) contracts. ĚýEven though the contracts were with Raytheon, DOJ swept Nightwing into the action because it acquired RTX’s cybersecurity business in March 2024.

GOVERNMENT CONTRACTORS MUST ENSURE STRICT CYBERSECURITY CONTROLS

Under the Federal Acquisition Regulations that govern defense contracts, Government contractors must provide adequate security for information systems that process or store sensitive defense information.Ěý According to the Government, Raytheon failed to comply with these cybersecurity requirements on 29 DoD contracts and subcontracts.

In announcing the settlement, a chorus of Government enforcers stressed the critical need to maintain proper cybersecurity controls and the Government’s commitment to go after contractors that fall short:

• • • “Cyber threats have grown in size and reach in recent years, leaving no room for complacency among those in the public sector, private sector, or even among private citizens. Government contractors must comply with the cybersecurity rules that govern their performance and be candid about their compliance. ĚýThis settlement reflects the Government’s commitment to pursue contractors that fail to live up to those expectations.”Ěý [DC US Attorney Edward Martin, Jr.]

• • • “As cyber threats continue to evolve, it is critical that defense contractors take the required steps to protect sensitive government information from bad actors. We will continue our efforts to hold contractors accountable when they fail to honor their DoD cybersecurity commitments.”Ěý [Acting Assistant AG Yaakov Roth]

• • • “[We] will continue to protect our service members and military technological edge by ensuring defense contractors strictly adhere to their cyber security contractual obligations.” [DoD Special Agent Kenneth DeChellis]

• • • “Failure to implement cybersecurity requirements can have devastating consequences, leaving sensitive DoD data vulnerable to cyber threats and malicious actors. [We] will continue to combat fraud affecting the Department of the Air Force and hold those accountable that fail to properly safeguard sensitive defense information.”Ěý [Air Force Special Agent William Richards]

• • • “Strict compliance with contractual cybersecurity requirements is of dire importance to adequately safeguard sensitive information from sophisticated adversaries, assure the safety of our warfighters, and maintain our military’s competitive edge. [We] remain committed to investigating entities that do not responsibly protect critical information entrusted to them.”Ěý [Navy Special Agent Greg Gross]

CYBERSECURITY FRAUD REMAINS A TOP ENFORCEMENT PRIORITY FOR THE TRUMP ADMINISTRATION

This settlement follows a string of recent cybersecurity settlements the Government has extracted from federal contractors for failing to protect confidential information.Ěý Most recently in March, Massachusetts-based MORSECORP agreed to pay $4.6 million to settle DOJ charges of failing to comply with cybersecurity requirements in its Army and Air Force contracts.Ěý And two weeks before that, California-based Health Net Federal Services agreed to pay $11.3 million to settle similar charges relating to certain DoD contracts.

In its 2024 False Claims Act Roundup, cybersecurity failures was one of the primary areas of fraud enforcement to which DOJ pointed.Ěý It has been that way for years since the agency’s 2021 launch of theĚýĚý“to promote cybersecurity compliance by government contractors and grantees by holding them accountable when they knowingly violate applicable cybersecurity requirements.”

With these recent settlements, there seems little doubt the Trump Administration is committed to cracking down on contractors who fail in their cybersecurity obligations.Ěý This is particularly reassuring given what many have viewed as the Administration’s lackadaisical response to the Signal fiasco where high-level Government officials inadvertently shared sensitive military plans with a journalist.

In an article he wrote last year for Washington Technology, 91pornwhistleblower partner Gordon Schnell highlighted what he described as DOJ’s crusade against cybersecurity fraud and thatĚý“those doing business with the government would be wise to get their data protection systems in order or they may find themselves next up on DOJ’s cybersecurity hit list.”

With the Raytheon settlement, Schnell sees no slowing down in the Government’s focus on cybersecurity fraud.

WHISTLEBLOWERS ARE CRITICAL TO UNCOVERING CYBERSECURITY FRAUD

Like most False Claims Act cases, the Raytheon action originated with a whistleblower lawsuit under the qui tam provisions of the statute, which allow private parties to bring lawsuits on behalf of the Government against those that commit fraud against the Government.Ěý In return, successful whistleblower can receive up to 30% of the Government’s recovery.

The whistleblower here was Branson Kenneth Fowler, Sr., a former Raytheon Director of Engineering.Ěý He will receive an award of roughly $1.5 million from the proceeds of the Government’s recovery.Ěý Over the past 30 years, whistleblowers have received almost $10 billion in whistleblower awards under the False Claims Act.Ěý Whistleblowers are especially important in uncovering cybersecurity fraud given the lack of visibility into the cybersecurity protocols in which most companies engage.

CONSTANTINE CANNON REPRESENTS CYBERSECURITY WHISTLEBLOWERS

91pornhas substantial experience representing cybersecurity whistleblowers under the False Claims Act.Ěý Indeed, the firm represented the whistleblower in the first successful cybersecurity case ever brought under the False Claims Act.Ěý That case resulted in Cisco Systems agreeing to pay $8.6 million to settle charges of selling the Government noncompliant video surveillance software vulnerable to unauthorized access and manipulation.Ěý Our client received a whistleblower award of 20% of the government’s recovery.

If you would like more information about that case and our other work representing cybersecurity whistleblowers, or would like to learn more about what it means to be a whistleblower under the False Claims Act, please don’t hesitate to contact us.Ěý We will connect you with an experienced member of the 91pornWhistleblower Team for a free and confidential consult.

91pornSuccesses

Read Trump Administration Signals Strong Commitment to Stopping Cybersecurity Fraud at constantinecannon.com

By the 91pornWhistleblower Team

On April 29, the Department of Justice (DOJ) announced that California-based pharmaceutical giant Gilead Sciences agreed to pay $202 million to settle charges of violating the False Claims Act and Anti-Kickback Statute.Ěý Specifically, the government alleged Gilead provided financial inducements to physicians to speak at or attend sham medical conferences to induce them to prescribe various Gilead HIV drugs.Ěý This is the latest in a string of False Claims Act cases the government has brought targeting kickbacks designed to influence medical decision making.

Gilead Paid Physicians to Prescribe Gilead HIV Drugs

The Anti-Kickback Statute prohibits paying or receiving kickbacks in exchange for patient referrals covered by Medicare/Medicaid or other government healthcare programs.Ěý It is designed to prevent tainted medical decisions, unnecessary medical treatment, overutilization of medical services, increased program costs, and unfair competition.Ěý It covers virtually any form of consideration in exchange for referrals and broadly applies across the healthcare industry.Ěý It can even apply to inducements to patients (such a co-pay waivers) to influence their medical choices.Ěý Anti-Kickback Statute violations are typically treated as automatic False Claims Act violations.

The Gilead settlement involved very expensive HIV drugs with Medicare typically paying more than $1,000 for a one-month supply.Ěý To promote and maximize the sales of these pricey drugs, Gilead held regular “HIV Speaker Programs” where healthcare providers who treat HIV gathered to discuss Gilead’s HIV drugs and other HIV-related subjects.Ěý While Gilead held these programs out as educational in nature, they were really designed as a vehicle to provide kickbacks to the participating physicians to induce them to prescribe Gilead’s HIV drugs.

According to the Government, Gilead’s scheme resulted in Medicare and other Government healthcare programs paying out millions of dollars in reimbursement for tainted prescriptions.Ěý Here are some of the key facts Gilead admitted to as part of the settlement:

• • • Gilead paid many high-volume prescribers hundreds of thousands of dollars in honoraria to prepare and present as HIV speakers.

• • • Gilead paid travel costs for programs regularly held at desirable destinations like Hawaii, Miami, and New Orleans, sometimes selected by the speakers.

• • • Gilead held many of the programs at high-end restaurants across the country.

• • • Gilead repeatedly invited physicians and other healthcare providers to attend the same HIV program, covering the exact same topic, often within a short period of time.Ěý In fact, more than 250 heavy prescribers of Gilead HIV drugs attended Gilead programs on the sameĚýtopic at least three times within a six-month period.

• • • Many of Gilead’s speakers also attended Gilead’s HIV dinner programs on the same topic, often within a short time after speaking and with the same group of doctors.

Stopping Illegal Kickbacks Remains a DOJ Priority

Strictly enforcing the Anti-Kickback statute has consistently been a top DOJ enforcement priority.Ěý As DOJ stressed in its 2024 False Claims Act Roundup, illegal kickbacks “undermine the integrity of federal health care programs by tainting medical decision-making, increasing health care costs, and adversely affecting competition.”

While there has been a definite change in priorities in the heavily influenced Trump DOJ, it seems apparent that the Government’s commitment to go after healthcare kickbacks remains strong.Ěý The Government made this clear in announcing the Gilead settlement, holding it out as a warning to other companies to stay away from engaging in similar misconduct:

“For years, Gilead unlawfully sought to increase sales of its HIV drugs, by using its speaker programs to funnel kickbacks to doctors.Ěý As alleged, Gilead spent tens of millions of dollars on these programs, including over $20 million in speaking fees and millions more in exorbitant meals, alcohol and travel, all in an effort to induce doctors to prescribe Gilead’s HIV drugs and drive up sales.Ěý With this settlement, Gilead has taken responsibility for its conduct and agreed to pay a significant financial penalty.Ěý The message is clear, companies that illegally drain taxpayer dollars from federal healthcare programs will be held accountable.”

Notably, only two days after the settlement, DOJ announced (on May 1) another major False Claims Act kickback case.Ěý This one against three of the nation’s largest health insurance companies – Aetna, Elevance Health, and Humana – for allegedly paying hundreds of millions of dollars in illegal kickbacks in exchange for Medicare Advantage enrollments.Ěý In announcing the action, Deputy Assistant Attorney General repeated the Government’s anti-kickback mantra: “Health care companies that attempt to profit from kickbacks will be held accountable.”

Whistleblowers Are Critical to Uncovering Illegal Kickbacks

Both this newly filed action and the Gilead action were originated by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties to bring lawsuits on behalf of the government against those that defraud the government.Ěý In return, successful whistleblower can receive up to 30% of the Government’s recovery.Ěý Over the past thirty years, whistleblowers have received close to $10 billion in awards under the statute and have been responsible for originating the majority of False Claims Act cases.

The role of whistleblowers in helping the Government uncover illegal kickback schemes is particularly important given the sophisticated means healthcare providers and physicians use to conceal these schemes.Ěý 91pornwhistleblower partner Gordon Schnell notes why whistleblowers are so important in this enforcement area.

“With heavy Government enforcement in this area, healthcare companies are taking to ever-more sophisticated schemes to disguise their improper financial inducements.Ěý Without those on the inside with first-hand knowledge of these schemes, the Government has no easy way to identify and take action against them.”

According to Schnell, that is why virtually all False Claims Act kickback cases these days are originated by whistleblowers.

91pornRepresents Kickback Whistleblowers

91pornhas substantial experience representing kickback whistleblowers under the False Claims Act.Ěý Most recently, we represented the whistleblower who helped DOJ secure a $34 million settlement against dialysis giant DaVita for allegedly paying physicians for referring patients to DaVita’s dialysis centers.Ěý Our client received an award of roughly 18.5% of the Government’s recovery.

If you would like to learn more about our work representing kickback whistleblowers or think you have information on potential kickback violations, please don’t hesitate to contact us.Ěý We will connect you with an experienced member of our whistleblower team.

91pornSuccesses

What It Means to Be a Whistleblower

Read Gilead Pays $202M to Settle False Claims Act Kickback Charges at constantinecannon.com

On April 30, a New Jersey-based drug and alcohol rehabilitation facility, Summit BHC New Jersey, LLC, d/b/a Seabrook, agreed to pay $19.75 million to resolve allegations that it violated the False Claims Act by billing for services it was not authorized to provide. This case was initiated by a former Seabrook employee who filed suit under the whistleblower or qui tam provisions of the False Claims Act.

According to the government, Seabrook submitted claims to the Community Care Program of Veterans Health Administration and New Jersey’s Medicaid program for short-term residential treatment and partial hospitalization care, services it was not licensed or contracted to provide. Seabrook also allegedly misrepresented its ability to provide this care to state inspectors.

The government also alleged that, between 2022 and 2024, Seabrook failed to employ enough properly credentialed clinicians and billed for “specialized” veteran care that was no different from what other patients received. The government further alleged that Seabrook maintained false or incomplete records of patient care.

US Attorney Alina Habba stated that this case “demonstrates…[our] commitment to ensure that America’s veterans receive the care they deserve and for which the government has paid. Veterans and Medicaid recipients must receive care from fully qualified, licensed providers in facilities that meet state law in all respects.ĚýWe stand ready to enforce these standards and protect the Americans who need this care.”Ěý

The Role Whistleblowers Play in False Claims Act Cases

As the Department of Justice reported in itsĚýannual roundupĚýof False Claims Act successes, out of the $2.9 billion the government and whistleblowers recovered in 2024, more than $1.67 billion (58% of the total) came from healthcare fraud cases.

Like many False Claims Act case, this one was initiated under the qui tam or whistleblower provisions of the False Claims Act. Under these provisions, private parties (or relators) can file an action on behalf of the government and receive a share of up to 30% of any recovery. The relator in this case will receive an award of more than $3.5 million.

Whistleblower partner Marlene Koury commented: “The government is committed to holding healthcare providers accountable to ensure vulnerable populations get the proper care they need at facilities that comply with the law. Whistleblowers who speak up play a key role in protecting government funded healthcare programs.”

Fraud in Government Healthcare Programs

Government healthcare program fraud can occur in a wide range of government-funded programs, including Medicare, Medicaid, CHAMPVA (a program funded by the Veterans Administration), and TRICARE/CHAMPUS (a health care program for individuals and dependents affiliated with the armed forces). When providers bill for unqualified services or misrepresent the level of care they deliver, they not only break the law, they put patients at risk.

Our Firm Helps Whistleblowers

91pornhas extensive experience representing whistleblowers under the statute, with numerous record-settingĚýsuccesses.Ěý If you would like to learn more about healthcare fraud, what it means to be a whistleblowerĚýunder the False Claims Act, or believe you have information relating to a potential case, please contactĚýus. We will connect you with an experienced member of the 91pornwhistleblowerĚýteam.

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Read NJ Rehab Center Will Pay $19.75M to Resolve False Claims Act Allegations at constantinecannon.com

By the 91pornWhistleblowerĚýTeam

The government continues to prioritize healthcare fraud enforcement. As we detailed in our round-up of top healthcare-related False Claims Act recoveries from 2024, more than $1.67 billion (58% of all FCA recoveries that year) came from healthcare fraud cases alone. With several settlements already announced this year, 2025 is shaping up to be another active year in healthcare enforcement.

On April 21, the government announced that two operators of New Jersey’s Empire Pain Center Holdings LLC (“Empire”) were sentenced to prison for their roles in a $127 million healthcare fraud and kickback scheme. Eric Karlewicz a/k/a “Anthony Mazza,” 46, of Rockland County, New York, and Nicco Romanowski, 33, of Roswell, Georgia, pled guilty to the charges. They also agreed to settle related False Claims Act allegations.

According to prosecutors, from June 2017 and May 2019, Karlewicz and Romanowski orchestrated a wide-ranging conspiracy involving durable medical equipment (“DME”) companies, telemedicine providers, and doctors. As part of the scheme, Empire directed its employees to pressure Medicare and TRICARE beneficiaries into accepting unnecessary DME items, such as body braces. Empire paid its employees commissions and bonuses to incentivize them to convince as many beneficiaries as possible to accept DME, regardless of medical necessity.

Empire also paid kickbacks to telemedicine companies, which then paid kickbacks to doctors for DME prescriptions. The national DME suppliers likewise had kickback arrangements with Empire in exchange for patient referrals, generating over $63 million for Empire. In total, Karlewicz and Romanowski caused the submission of over $127 million in false claims to federal healthcare programs for DME.

As part of the criminal case, Karlewicz was sentenced to 51 months in prison and ordered to forfeit over $63 million. Romanowski was sentenced to 80 months in prison and ordered to forfeit over $5.5 million.

To settle the civil charges, Karlewicz and Romanowski admitted to violating the False Claims Act and agreed to the entry of a consent judgment against them in the amount of $63.8 million.

This case was brought by a whistleblower Robert Jackson Tyler Jr., who filed suit under the qui tam, or the whistleblower provision of the False Claims Act. ĚýUnder the FCA, private parties (or relators) can file lawsuits on behalf of the United States and share a percentage of the government’s recovery. In successful cases, whistleblowers may receive up to 30% of the government’s recovery. Tyler’s award has not yet been disclosed.

What Role Do Whistleblowers Play in Exposing Healthcare Fraud?

Whistleblower attorney Ginger Buck commented: “Whistleblowers, such as the relator in this case, are often the only ones who can expose healthcare fraud schemes from the inside. Their willingness to come forward is critical to uncovering healthcare fraud, safeguarding public funding, and strengthening trust in our healthcare system.”

Fraud affects healthcare programs funded by the United States and individual states. Individuals can blow the whistle on bad actors attempting to defraud Medicare, Medicaid, TRICARE/CHAMPUS (a health care program for individuals and dependents affiliated with the armed forces), and other types of misconduct such as kickback schemes.

Our Firm Helps Healthcare Fraud Whistleblowers

Whistleblowers are key in uncovering fraud and helping ensure the integrity of government healthcare programs. If you would like more information onĚýwhat it meansĚýto be a whistleblower, believe you have information relating toĚýFalse Claims ActĚýviolations orĚýhealthcare fraud, pleaseĚýcontact usĚýso we can connect you with a member of the experienced 91pornwhistleblower lawyerĚýteamĚýfor a free and confidential consultation.

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Read $127M Health Care Fraud and Kickback Scheme: Business Operators Sentenced, Settle False Claim Act Allegations at constantinecannon.com

By the 91pornWhistleblower Team

As the Trump Administration continues to reshape U.S. trade policy through aggressive new tariffs, the stakes for importers have never been higher. With tariffs impacting trade with China, Canada, Mexico, and others, companies may be tempted to cut corners to avoid rising costs.

When companies cheat on tariffs, they risk potential False Claims Act liability. Whistleblowers can play a key role in uncovering tariff fraud and triggering customs law enforcement. Whistleblowers can be former employees, insiders, customers, and importers – just to name a few categories of individuals who may have knowledge and actionable evidence of customs fraud.

The False Claims Act is a powerful tool used to hold companies accountable when they defraud the government.ĚýUnder the qui tam (or the whistleblower provision) of the False Claims Act, private parties (or relators) can file lawsuits on the government’s behalf and may receive between 15 and 30 percent of any monetary recovery.

When goods enter the United States, an importer must declare the country of origin, the value, whether the goods are subject to duties, and number of duties owed. Tariff fraud typically arises when an importer or company misclassifies goods, undervalues imported items, or otherwise evades customs duties.

Recent False Claims Act enforcement actions highlight the risks of cheating on tariffs. On April 18, the government a complaint against Barco Uniforms and its suppliers for allegedly underpaying customs duties owed on imported apparel manufactured abroad. The government alleged Barco knowingly conspired to undervalue imported garments it purchased from foreign suppliers, despite warnings from a third-party auditor advising them of risks and recommended they “double-check” duty calculations.

This case was brought under the False Claims Act’s qui tam provisions by whistleblower Toni Lee, the former director of product commercialization at Barco Uniforms. If the case is successful, Mr. Lee will receive an award of up to 30 percent of the government’s recovery.

Similarly, on March 25, the government announced that Evolutions Flooring Inc. and its owners $8.1 million to settle False Claims Act allegations that they evaded customs duties from 2019-2022 when importing multilayered wood flooring from the People’s Republic of China. The government alleged the company provided false information regarding the identity of the manufacturers and country of origin of the flooring.

This suit was brought by Urban Global LLC under the whistleblower provision of the False Claims Act. The relator will receive an award of approximately $1,215,000.

Acting U.S. Attorney Joseph McNally for the Central District of California stated thatĚý“fraud in international commerce deprives the United States of vital revenue and creates an unfair advantage over businesses that operate legitimately. The settlement sends a message that we will not stand aside when companies try to cheat the system.”

91pornwhistleblower partner Alysia Solow commented: “Vigilance in identifying tariff fraud is crucial to the protection of United States revenues. It’s also about upholding fairness in global trade and ensuring players compete by the same rules. Whistleblowers are essential to uncovering these violations and jumpstarting government enforcement actions.”

Our Firm Helps False Claims Act Whistleblowers

91pornhas extensive experience representing False Claims Act whistleblowers. Please contact us if you believe you have a case.ĚýWe will connect you with an experienced member of the 91pornwhistleblowerĚýteam for a free and confidential consultation.

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Read What Role Can Whistleblowers Play in Fighting Tariff Fraud? at constantinecannon.com