Quick View. were false .); id. It then provides a table of patients and patient treatments for the same facilities over the same time period. According to the complaint, FMCNA pitched medical-director positions to nephrologists as a way to earn a considerable income for little or no investment of time. (Id. United States ex rel. . Counsel may need to link their CM/ECF account to their upgraded individual pacer account. Accordingly, the public-disclosure bar does not preclude the claims concerning unlawful medical-director agreements. 223). As to Diablo Nephrology, the complaint alleges the following: As to Balboa Nephrology Medical Group, it alleges the following: As to NANI, the complaint provides a table of Medicare and Medicaid revenue for a period of five years at seventeen dialysis centers in the Chicago area. See 31 U.S.C. WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. 29). Here, the motion to dismiss presents three sets of issues, all arising from the strict requirements for pleading such claims. (Id. Hardback. Relator relies on the Sixth Circuit's holding in United States ex rel. To strike a balance between encouraging whistle-blowing and discouraging opportunistic behavior, the FCA contains a public-disclosure bar. Id. Another six described a scheme involving improper remuneration relationships with physicians who serve as medical directors at Fresenius clinics. (Id. Flanagan v. Fresenius Medical Care Holdings, Inc. - Law360 Second, defendant contends that a complaint alleging medical-director fraud filed in Missouri in 2005 against two different companies-both of which were later acquired by FMCNA-qualified as a public disclosure barring the current allegations. 4:05-cv-985 (E.D. No published case in the First Circuit, however, has ever gone so far. Save US$5.33. I understand that the relevant personnel have since received training to avoid such errors in the future. Whistleblower Lawsuit Against Fresenius Alleges First, it alleges that FMCNA offered remuneration to hospitals in two ways: by entering into contracts that provided no-cost and/or below-cost inpatient dialysis services, and by providing significant free services, including free dischargeplanning services, free in-service training to staff, free training to patients, and free quality assessment and improvement data analysis to hospitals. According to the complaint, FMCNA budgeted for the anticipated losses in the acute programs at many of the larger hospitals. Under the circumstances, the Court concludes that the bar does not apply. In an FCA case, these may include details concerning the dates of the claims, the content of the forms or bills submitted, their identification numbers, the amount of money charged to the government, the particular goods or services for which the government was billed, the individuals involved in the billing, and the length of time between the alleged fraudulent practices and the submission of claims based on those practices. U.S. ex rel. As the Chair of the Local Rules Committee when the relevant rules were adopted, see generally L.R. The following is a relevant excerpt from an SEC filing cited by the court in CKD: That excerpt discloses that the joint ventures do not qualify for safe-harbor protection and identifies the penalties that might be imposed should the company be found to be in violation of the relevant statutes. 85). Beginning in approximately 2007, FMCNA allegedly realized that the company's organic growth (that is, growth from adding new patients and not through acquisitions) was almost nonexistent. 3730(e)(4); (3) the claims concerning joint-venture agreements are barred by the FCA's first-to-file bar, 31 U.S.C. (Id.). (Id. (Id.). 111-148, 10104(j)(2), 124 Stat. Williams v. Renal Care Grp., et al., No. Martin Flanagan The government can intervene in a qui tam action and assume primary responsibility over it. 25). Compl. 247-48). FMCNA tracked the referrals recorded as part of the Bridge Program. 15). Internal spreadsheets from the Western Business Unit show that FMCNA recorded losses on its contracts with hospitals, often in excess of the budgeted losses. However, even assuming compliance with those requirements, the claims concerning joint-venture agreements would be barred in any event. (Id.). (Attachments: #1 Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), Docket(#13) MOTION for Leave to Appear Pro Hac Vice for admission of W Scott Simmer Filing fee: $ 100, receipt number AMADC-9065559 by Martin Flanagan. Relator Martin Flanagan has brought suit against defendant Fresenius Medical Care Holdings, Inc., d/b/a Fresenius Medical Care North America (FMCNA), alleging that FMCNA improperly provided free or below-cost services to hospitals and physicians, and made various types of improper payments to physicians, in exchange for referrals to its dialysis clinics. at 253. Fifth, it alleges that FMCNA entered into favorable joint-venture agreements (JVAs) with physician groups to induce them to make referrals. A subscription to PACER is required. (Id. Rather than spend time at this point disputing and, if necessary clarifying rule language, however, I have simply consulted with the Chief Judge and under L.R. 304 (Washington state) (All such claims . (Id. If relator is correct, that means that the entire government-payor business of FMCNA-which appears to amount to more than $10 billion in revenue per year-is based on fraud. The original complaint referred to joint-venture agreements between FMCNA and physicians, but only in order to contrast such agreements (which it referred to as a product of arms-length negotiations) with the higher compensation paid to medical directors in the absence of such agreements. Relator here has not attempted to do so. Finally, one place to get all the court documents we need. For example, in United States ex rel. 3730(b)(2); (2) the claims are barred by the FCA publicdisclosure bar, 31 U.S.C. 257 (Indiana) (All such claims . Rather, the complaint must allege both the existence of a scheme and the making of particular false claims resulting from the scheme. The initial complaint has since been amended to add 125 pages of allegations, including multiple new claims. 360 (ENA); id. 91, 93). Moreover, the CKD complaint alleged that the scheme was nationwide. In substance, the complaint alleged that FMCNA engaged in a scheme to pay kickbacks to physicians with whom it had entered into joint-venture agreements. 3730(b)(5). 228). At most, relator merely adds detail or color to previously disclosed elements of an alleged scheme [which] is not materially adding to the public disclosures. United States ex rel. This is a qui tam action alleging violations of the Anti-Kickback Statute, 42 U.S.C. The CKD complaint therefore contained the essential facts alleged here, thus barring the allegations contained in the amended complaint. The complaint does not allege, even in general terms, how claims are submitted under the CHAMPUS/TRICARE or CHAMPVA programs. 2005)). If the government declines to intervene and the qui tam case is unsealed, further proceedings are governed by 31 U.S.C. Id. Ge v. Takeda Pharm. Under Rule 9(b), the standard for allegations of fraud is higher than the normal pleading standard. 274 (North Carolina) ([E]ach of these claims was false .); id. Connect via Twitter or email . See Ge, 737 F.3d at 124 (stating that the court reject[s][the] approach sought by the relator, which was a per se rule that if sufficient allegations of misconduct are made, it necessarily follows that false claims and/or material false information were filed). Martin Flanagan | Book Depository See Wilson, 2011 WL 2462469, at *7. He was employed by Fresenius for 29 years. United States v. Takeda Pharm. Cancellation and Refund Policy, Privacy Policy, and 361 (Dallas Nephrology Associates)). . 2:22-CV-01807 | 2022-10-21, U.S. District Courts | Personal Injury | 41 (The fact that medical director compensation is lower where the physician actually shares the cost of his or her compensation through his or her joint venture (ownership) agreement shows that where there are arms-length negotiations between two more or less equal parties, a lower compensation rate results.)). In other words, an AKS violation that results in a federal health care payment is a per se false claim under the FCA. Guilfoile v. Shields, 913 F.3d 178, 190 (1st Cir. (Id. Therefore, the court may consider any public disclosures made prior to 2021 for purposes of determining whether the claims are prohibited by the public-disclosure bar. SALTER, GARY vs. FRESENIUS MEDICAL CARE HOLDINGS INC, Instituto Mexicano del Seguro Social v. Fresenius Medical Care AG & Co. KGaA. Martin Flanagan CHAMPVA, which is administered by the United States Department of Veterans Affairs, is a health-care program for families of veterans with 100% service-connected disabilities and provides ESRD benefits to covered beneficiaries. Attorneys admitted Pro Hac Vice must have an individual upgraded PACER account, not a shared firm account, to electronically file in the District of Massachusetts. . free or discounted physician practice alignment services, including providing dedicated chronic kidney disease educator services, financial coordination services for patients beginning dialysis, vascular access development services and assistance with physician recruiting through Fresenius online recruiting platform. at 999. In many states, Medicaid pays for treatment costs for ESRD patients who do not qualify for Medicare and/or pays for the 20% of treatment costs not covered by Medicare. Employed by Penn State Health. . Appearance form, Docketing Statement, and Transcript Report/Order form due 04/19/2023. Judge Douglas P. Woodlock assigned to case. The qui tam provisions of the FCA permit relators, in some instances, to reap huge financial windfalls. The Anti-Kickback Statute, 42 U.S.C. Id. MARTIN FLANAGAN, Plaintiff-Relator, v. FRESENIUS, Court:United States District Court, D. Massachusetts. 242-55 (NANI in Illinois); id. As is often the case with qui tam actions, the issue is not whether the complaint alleges an unlawful scheme-it does, in considerable detail-but whether it actually pleads a violation of the False Claims Act. 332-75). (McManus, Caetlin) (Entered: 11/02/2021), Docket(#9) ELECTRONIC NOTICE of Case Reassignment. Courts have therefore required relators to abide by those requirements when filing an amended complaint that is not substantially similar to the original complaint. . Here, the allegations are substantially similar to those in CKD and are thus based upon the public disclosures. . (Id. 353, 357 (Balboa); id. 217). Previously, Martin was a Senior Na tional Account Manager at QuickSTAT. 308-20). The description of the alleged scheme consisted of 25 paragraphs. 90). 131). Rather than spend time at this point disputing and, if necessary clarifying rule language, however, I have simply consulted with the Chief Judge and under L.R. FMCNA has moved to dismiss the complaint for failure to state a claim upon which relief can be granted pursuant to Fed.R.Civ.P. In substance, it is a dressed-up version of a generalized allegation: it essentially alleges that if a practice benefited financially from a relationship with FMCNA, and if it administered 104,000 treatments, and 93% of those were to patients who were beneficiaries of government-sponsored healthcare programs, then it submitted 96,720 false claims. It also provides a very limited amount of statistical evidence to attempt to bolster those allegations. to purchase . The complaint also alleges that Fresenius regularly entered into a variety of problematic arrangements with nephrologists and nephrology group practices intended to secure patient referrals for Fresenius wholly-owned and joint venture outpatient dialysis centers, including: Many of the allegations contained in the Complaint of inappropriate physician arrangements are similar, in many regards, to the allegations contained in whistleblower David Barbettas complaint filed against DaVita in federal district court in 2009.
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