has voluntarily disclosed to the Government the information on which allegations or transactions in a claim are based, or (2) who has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions . 31 U.S.C. Id. 1:20-CV-11927 | 2020-10-26, U.S. District Courts | Other | Menu and widgets. Martin Flanagan is a Director, National of Acute Dialysis Services at Fresenius Medical Care North America based in Waltham, Massachusetts. (Id. (Am. for money or property presented to an officer, employee, or agent of the United States. . That is not sufficient, under the case law, to state a false claim with particularity within the meaning of Rule 9(b). Co., Ltd., 842 F.3d 125, 130 (1st Cir. any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program shall be guilty of a felony. les 5 doigts de la main gestion de classe; is the armed forces vacation club legitimate; biggest drug bust in the world guyana; martin flanagan fresenius. It then alleges, in general terms, that all claims from those facilities were tainted by kickbacks and therefore constitute false claims within the meaning of the False Claims Act. . 1320a-7b, states that whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person . 119 (2010). It alleges that FMCNA courted nephrologists in multi-physician private practices with high numbers of patients to be medical directors, often offering to pay them more than $100,000 annually in exchange for patient referrals. 2013) (Duxbury II) (internal quotation marks and citations omitted). 284 (North Carolina) (All such claims . A subscription to PACER is required. v. Fresenius Medical Care [$6,000,000.00] Gonzales et al. Add to basket. 176). The CKD complaint alleged that FMCNA used joint-venture agreements as a way to provide remuneration to physicians in exchange for referrals. (Id. Relator here has not attempted to do so. Documents and certified copy of docket sheet and order of transfer received from the Clerk in the transferor district via Email. (Id. 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. . On February 5, 2021 a long-time former Fresenius Medical Care North America (Fresenius) employee, Martin Flanagan, filed a qui tam relator amended 167-69). According to the complaint, FMCNA paid inflated amounts for controlling interests in the joint venture while selling shares below fair market value to physicians who were in a position to make referrals. et al, County of Lycoming v. Purdue Pharma, L.P. et al, Lazy S Ranch Properties v. Valero Terminaling and Distribution, et al, Lester E. Cox Medical Centers d/b/a Cox Medical Centers et al v. Amneal Pharmaceuticals, LLC et al. [ ]. 232-35 (Diablo Nephrology in California); id. 3. 1999)). FMCNA is headquartered in Waltham, Massachusetts. plaintiff the benefit of all reasonable inferences therefrom. Ruiz v. Bally Total Fitness Holding Corp., 496 F.3d 1, 5 (1st Cir. Res., 162 F.3d 195, 200 (2d Cir. Martin Flanagan is a resident of Texas. 274 (North Carolina) ([E]ach of these claims was false .); id. The complaint further alleges a scheme to provide favorable leases to physician groups in order to induce referrals. And it means that relator stands to reap a reward of 15%-30% of any recovery-an amount that might well be measured in tens of billions of dollars. Sanders, 553 U.S. 662 (2008). . Ex. Currently, Sandra Martin works as a Clinical Application Specialist at Fresenius Medical Care North America. Mar 17, 2023 11:00am. The entire basis of the complaint is a theory of tainted referrals; kickbacks paid by FMCNA tainted the physician-referral process, which enabled the company to obtain, unlawfully, a larger share of referrals than it would have otherwise in a properly functioning market. But nowhere does the complaint identify a specific physician who made a specific referral as a result of a specific unlawful practice that resulted in a specific false claim. 2012). The Clerks Office nevertheless takes the position that the matter may not reassigned by their corrective action alone but requires some action of a judicial officer under the Local Rules. FMCNA decided that one of the keys to capturing new patients for its dialysis clinics was through its relationships with hospitals providing inpatient acute care. 3730(e)(4)(B). The second was that these same doctors are often provided with opportunities to rent office space that they own to Fresenius at above or at the very top of fair market value, with guaranteed long-term leases that are not commercially reasonable. (Id. 13 at 23); and that (3) If physicians and other referral sources cease referring patients to our dialysis clinics . Submission of claims to Medicaid that were ineligible for payment because of violation of the AKS are actionable under the FCA because the payments of those claims were made with federal funds. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia. v. Fresenius Medical Care [$6,000,000.00] - San Diego Sexual Harassment Attorneys, Sexual Harassment Lawyers in San Diego, CA. . 29 at 10); (2) compensation is negotiated individually [based on] local factors . We believe that the compensation of our medical directors is in line with the market (Id. UniCourt uses cookies to improve your online experience, for more information please see our Privacy Policy. Under the circumstances presented here, the Court concludes that he cannot. Winkelman v. CVS Caremark Corp., 827 F.3d 201, 208 (1st Cir. . (Id. A more recent docket listing Previously, Martin was a Senior Na tional Account Manager at QuickSTAT. It appears, therefore, that the government may have suffered little or no actual financial loss. Defendant further contends that the original complaint did not contain any allegations concerning medical-director agreements, and that all claims based on such agreements should likewise be dismissed. Moreover, referral sources were routinely permitted to own more than 40% of the joint venture investment, contrary to HHS OIG guidance. 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. This action is taken to insure the parties receive timely notice of the properly assigned presiding judge and is without prejudice to consideration by the Court as a whole whether Local Rule 40.1 should be amended in some fashion to eliminate any further misunderstanding by the Clerks Office. 308-14). Instead, those services were provided free of charge. Among other things, the complaint uses the passive voice throughout: claims were submitted, rather than FMCNA submitted claims.. 494.150; Am. Judge Douglas P. Woodlock assigned to case. . He is also a trustee and vice-Chair of the Inv Martin Flanagan's Phone Number and Email Last Update 4/3/2023 2:19 PM Contact Number (***) ***-**** Engage via Phone Mobile Number (***) ***-**** Engage via Mobile Test Drive 3730(e)(4)(A). According to the complaint, [f]or this reason, claims submitted to the state Medicaid agencies are presented to the federal government within the meaning of the [False Claims Act]. (Id.). 3729-33, provides for civil liability for anyone who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval or knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim. 31 U.S.C. 170. The portions of the claims based on those allegations will therefore be dismissed for failing to comply with the FCA's pre-suit requirements. 361 (Dallas Nephrology Associates)). (Id.). 293 (Washington state) (All such claims . Co. Ltd., 737 F.3d 116, 123 (1st Cir. (Id.). of Cunningham v. Millennium Lab'ys of Cal., Inc., 713 F.3d 662, 669-70 (1st Cir. 256-69 (IMN and other practices in Indiana); id. It alleges that although FMCNA directed that all services provided under the Bridge Program must be provided at FMV, Flanagan was never required to obtain an FMV analysis for any hospital contract or for Bridge Program services during his tenure with the company. WebFlanagan v. Fresenius Medical Care Holdings, Inc. View recent docket activity Reflects complaints, answers, motions, orders and trial notes entered from Jan. 1, 2011. Ex. Mem. According to the United States Renal Data System, there were approximately 746,557 ESRD patients in the United States at the end of 2017. . Second, the requirement for direct knowledge was replaced with the requirement that a relator's knowledge must materially add[ ] to the publicly disclosed allegations or transactions. Id. for reimbursement were submitted to the government. facetime call on chromebook; (g), I respectfully disagree with that interpretation. at 999. . 2016). A variety of hospitals, nephrologists and nephrology group practices have been specifically identified in the Complaint. Courts have therefore required relators to abide by those requirements when filing an amended complaint that is not substantially similar to the original complaint. Relator relies on the Sixth Circuit's holding in United States ex rel. The plaintiff further recounts various instances where Fresenius leadership was questioned about the fair market value of such relationships and the companys alleged failure to enforce annual contractual rate increases. Those arguments, however, are unavailing. (Id. The complaint provides a detailed account of Fresenius acute care dialysis management business and alleges that it systematically used acute care dialysis management contracts with hospitals as loss leaders to secure patient referrals for Fresenius outpatient dialysis centers in violation of the FCA and AKS. (Id. Since 1972, Medicare has been the primary payor for more than 80% of the cost of dialysis treatment for nearly 800,000 ESRD patients in the United States. (Woodlock, Douglas) (Entered: 11/02/2021), Docket(#7) NOTICE of Appearance by Abraham R. George on behalf of United States of America (George, Abraham) (Entered: 10/18/2021), Docket(#6) MOTION for Leave to Appear Pro Hac Vice for admission of James F. Bennett Filing fee: $ 100, receipt number AMADC-9005666 by Fresenius Medical Care Holdings, Inc.. (Attachments: #1 Affidavit Certification of James F. Bennett)(Durant, Maria) (Entered: 10/13/2021), Docket(#5) MOTION for Leave to Appear Pro Hac Vice for admission of Megan S. Heinsz Filing fee: $ 100, receipt number AMADC-9005610 by Fresenius Medical Care Holdings, Inc.. (Attachments: #1 Affidavit Certification of Megan S. Heinsz)(Durant, Maria) (Entered: 10/13/2021), Docket(#4) NOTICE of Appearance by Maria R. Durant on behalf of Fresenius Medical Care Holdings, Inc. (Durant, Maria) (Entered: 10/07/2021), Docket(#3) NOTICE of Appearance by William H. Kettlewell on behalf of Fresenius Medical Care Holdings, Inc. (Kettlewell, William) (Entered: 10/07/2021), Docket(#2) Case transferred in from District of Maryland; Case Number 14-cv-00665-GLR. Id. 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. they [therefore] violated the FCA's filing and service requirements. Wilson, 750 F.3d at 120. Defendant next contends that the remaining FCA claims in the amended complaint are barred by the public-disclosure bar of the statute, 31 U.S.C. According to the complaint, FMCNA budgeted for the anticipated losses in the acute programs at many of the larger hospitals. 38). (Id. (McManus, Caetlin) (Entered: 11/22/2021), Docket(#15) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #13 Motion for Leave to Appear Pro Hac Vice Added W. Scott Simmer. 1320a-7b(g); Patient Protection and Affordable Care Act, Pub. Access the Case Summary and Docket Report to access additional information about this case on the US Court's PACER system. . 343). . (Id.). Mo. There must be particularized allegations of claims for payment arising from that scheme. Paperback. Martin Flanagan has been a director and President and Chief Executive Officer of Invesco since 2005. Attorneys admitted Pro Hac Vice must have an individual PACER account, not a shared firm account, to electronically file in the District of Massachusetts. United States v. Cyberonics, Inc., 844 F.3d 26, 31 (1st Cir. See 31 U.S.C. 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. Fresenius also allegedly provided free discharge planning services and in-service training to hospitals. 3730(b)(2), (b)(4), (c)(1). 45). Arch Flanagan, Martin Flanagan. 44). (Id.). . If the government declines to intervene and the qui tam case is unsealed, further proceedings are governed by 31 U.S.C. According to the complaint, FMCNA clinics and other providers treating ESRD submit to the government one reimbursement claim bill per month for each patient, including the charges for several dialysis treatments, any separately billable laboratory services, and separately billable drugs. a. Compl. . 3729(a)(1)(A) (Count 1); making or using false records material to a false or fraudulent claim in violation of the False Claims Act, 31 U.S.C. Paperback. Id. (Am. Nor does it provide any representative or sample claims. 217). (Id. 308-20). Rather, the complaint must allege both the existence of a scheme and the making of particular false claims resulting from the scheme. Care Holdings, Civil Action 21-11627-FDS (D. Mass. Relator did comply with that requirement before filing his original complaint, which was 22 pages long and described an illegal scheme with two essential components. Evidence of an actual false claim is the sine qua non of a False Claims Act violation. Karvelas, 360 F.3d at 225. Nonetheless, the First Circuit has identified some examples of specific allegations that may suffice to state a claim with the requisite particularity. Util. no person other than the Government may intervene or bring a related action based on the facts underlying the pending action. 31 U.S.C. First, the complaint alleges in general terms that all claims for reimbursement made to Medicare require the submission of a Form UB-40 (or a substantially similar form) that contains various data, including the patient's identifying information and line items for each claim sought to be reimbursed. (Am. 97-106). (Attachments: #1 Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#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. CKD Project, LLC v. Fresenius Med. The complaint further alleges that FMCNA paid its medical directors far above fair market value. Full title:UNITED STATES ex rel. Counsel may need to link their CM/ECF account to their upgraded individual pacer account. As to the submission of false claims, it makes the following general allegations: The complaint also describes the compensation paid to a number of specific medical directors around the United States. Now, a relator may also qualify as an original source if prior to a public disclosure under subsection (e)(4)(a), [he] voluntarily disclosed to the Government the information on which allegations or transactions in a claim are based. Id. (Id. See United States ex rel. In any event, as noted, the complaint does not include a single allegation concerning a single specific false claim. It then used that data to identify physicians and practice groups to target for medical director positions and joint-venture agreements. Fresenius Medical Care Holdings, Inc., 1:14-cv-00665 Brought to you by the RECAP Initiative and Free Law Project, a non-profit dedicated to creating high quality (Id. Stevens v. Vermont Agency of Nat. (Id. Based on the allegations of the complaint, it appears that all of the patients in question would have received treatment at a facility operated by FMCNA or a competitor, and all of those treatments would have been paid by Medicare regardless. To survive a motion to dismiss, the complaint must state a claim that is plausible on its face. Care Holdings, Inc., 906 F.Supp.2d 1264, 1274 (N.D.Ga. WebMartin Flanagan (Author), Andrew Livingstone (Author), Mike McKenny (Author) Paperback $46.95 $42.25 Hardback $190.00 $171.00 Ebook (PDF) $42.25 $33.80 Ebook (Epub & Mobi) $42.25 $33.80 Quantity In stock $171.00 RRP $190.00 Website price saving $19.00 (10%) Add to basket Add to wishlist This product is usually dispatched within 1 week by. 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. Est. . Add to Family Medicine Call for an It alleged that [t]hese problematic physician relationships generally break down into two areas. (Id.). 5266, 5289). First, it added a second definition for original source. Id. Physicians who wanted to terminate the non-competition agreements were forced to negotiate onerous buyouts. As the Chair of the Local Rules Committee when the relevant rules were adopted, see generally L.R. These arrangements allegedly also used long-term non-competition covenants to lock in patient referrals for the centers; non-fair market value space leases for dialysis centers where there was a landlord physician referral source; and. (Finn, Mary) (Entered: 10/05/2021). Counsel may need to link their CM/ECF account to their upgraded individual pacer account. Nor is there any contention that any dialysis services that were paid by Medicare in fact should have been paid by a private payor. To the extent the complaint here provides any factual or statistical evidence as to the actual false claims, it does so by alleging in a handful of instances that certain types of claims associated with patients at certain facilities were false. 184-97). Under the circumstances, the Court concludes that the bar does not apply. 2005)). 359 (NANI); id. (Attachments: #1 Affidavit Certificate of Noah M. Rich in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#16) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #14 Motion for Leave to Appear Pro Hac Vice Added Jamie Bennett. 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. Duxbury v. Ortho Biotech Prods., L.P., 719 F.3d 31, 33 (1st Cir. (Id. were false.); id. The critical question is whether the complaint meets the exacting standard for FCA claims required by law. occurred; (2) said disclosure . may be available from PACER. . Martin Flanagan is a Senior National Account Manager at Quick International Courier based in Jamaica, New York. 750 F.3d at 120. WebMartin Flanagan. By contrast, here the statements in defendant's securities filings concerning medical-director agreements do not even convey the possibility that those agreements might violate the law. In any event, as to those aspects of the alleged scheme, the allegations of the submission of false claims are similarly general. 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. Employed by Penn State Health. Pilon v. Martin Marietta Corp., 60 F.3d 995, 998-99 (2d Cir. (Attachments: #1 Docket Sheet from District of Maryland, #2 Docket Entries 1-30, #3 Docket Entries 31-50, #4 Docket Entries 51-56, #5 Docket Entries 58-74) (Jones, Sherry) Modified on 10/7/2021 to correct docket text. 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. 360 (ENA); id. In response, relator filed an amended complaint. The first-to-file bar provides that [w]hen a person brings an action . Journal of Intensive Care Medicine 2011 26: 4, 237-249 Download Citation. United States v. Takeda Pharm. Dec. 2, 2022). Poteet v. Medtronic, Inc., 552 F.3d 503, 516-17 (6th Cir. As to Medicaid, the complaint alleges in general terms that state administrators of the program obtain reimbursement from the federal government by submitting a quarterly Form 64 to the Centers for Medicare and Medicaid Services at Department of Health and Human Services. The complaint alleges that FMCNA provided free discharge-planning services to hospitals, free in-service training to staff, free training to patients, and free quality assessment and improvement program data analysis. The complaint alleges that the Bridge Program was actually designed to capture all of a hospital's referrals, as about half of the company's patients came into [FMCNA] clinics via [the discharge planning process]. (Id. Search Google Scholar for this author 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. 110-11). FMCNA also inserted non-competition clauses into their JVAs in order to lock partners into referring patients to its facility. Westmoreland v. Amgen, 707 F.Supp.2d 123, 130 (D. Mass. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 233 (1st Cir. 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). 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. Why is this public record being published online? For the sake of simplicity, the Court will focus first on the Medicare claims. He did not do so, however, before filing his amended complaint, which is 147 pages long and contains a number of substantially new allegations of different components of the scheme. to purchase . #57) filed by Appellant Martin Flanagan. In summary, the amended complaint fails to state allegations of fraud under the FCA with the particularity required by Rule 9(b). (Id. It further alleges that defendant is required to submit on an annual basis a Form 265 cost report to Medicare that certifies, among other things, that the services identified in the report (that is, the dialysis services) were provided in compliance with federal law, including the Anti-Kickback Statute. 40. Ex. 18). our revenues would decrease. (Id. 3730(e)(4)(A). 14-cv-6646 (E.D.N.Y. were false .); id. Kelly v. Novartis Pharm. Thus, the statute now defines original source as an individual who. 228). And it did not allege that FMCNA provided free or below-cost practice-management services to physicians. (Am. I understand that the relevant personnel have since received training to avoid such errors in the future. (Am. Instructions on how to link CM/ECF accounts to upgraded pacer account can be found at # https://www.mad.uscourts.gov/caseinfo/nextgen-current-pacer-accounts.htm#link-account. To avoid dismissal, the complaint must therefore establish the necessary degree of particularity, if at all, through allegations of factual or statistical evidence that strengthen[ ] the inference of fraud on the government beyond a mere possibility. Duxbury I, 579 F.3d at 29. See 31 U.S.C. As the Chair of the Local Rules Committee when the relevant rules were adopted, see generally L.R. 111-148, 10104(j)(2), 124 Stat. According to the complaint, over the past two decades, the dialysis industry has become increasingly concentrated in the hands of two companies: DaVita and FMCNA. The objective of the essential facts test is to determine whether the statutorily required threshold for notifying the government of the fraud alleged in the later-filed suit has been met. Williams v. Renal Care Grp., et al., No. 167-307). The first question, for the purpose of applying the first-to-file bar, is whether the first-filed complaint contained all the essential facts of the fraud later alleged. United States v. Millenium Lab'ys, Inc., 923 F.3d 240, 252 (1st Cir. The government can intervene in a qui tam action and assume primary responsibility over it. Phone: 1.619.238.4720 Email: inquiries@hoguebelonglaw.com Home Home Gonzales et al. Martin Flanagan. Under Rule 9(b), the standard for allegations of fraud is higher than the normal pleading standard. Casetext, Inc. and Casetext are not a law firm and do not provide legal advice. Fifth, it alleges that FMCNA entered into favorable joint-venture agreements (JVAs) with physician groups to induce them to make referrals. The 2010 Patient Protection and Affordable Care Act amendment to the public-disclosure bar made two notable changes to that definition.