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Ghanshyam Bhambhani and New York Cardiology, P.C. Pay $2 Million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

Ghanshyam Bhambhani and New York Cardiology, P.C. Pay $2 Million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

August 20, 2020 – Former Cardiologist Ghanshyam Bhambhani and his former medical practice New York Cardiology, P.C. have agreed to pay $2 million under the False Claims Act (“FCA”) and to settle a whistleblower case brought by a Relator who alleged that Bhambhani and New York Cardiology violated the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (“AKS”) through an unlawful rental arrangement with referring physicians and generated false claims for cardiac procedures using fraudulent documentation, thereby defrauding the Medicare and Medicaid programs.

The “qui tam” (whistleblower) lawsuit against Bhambhani and New York Cardiology was filed in 2014 in federal district court in Brooklyn and remained pending during a parallel criminal investigation and prosecution of Bhambhani by the Eastern District U.S. Attorney’s Office. In 2018, Bhambhani was convicted on a guilty plea of one count of conspiracy to pay healthcare kickbacks and sentenced to 34 months in prison and three years of supervised release.

In agreeing to the settlement, Bhambhani and New York Cardiology admitted that they falsified records to justify cardiac procedures and provided compensation to certain physicians, disguised as rent, which was actually compensation for referrals of patients.

The Relator who brought the lawsuit against Bhambhani and New York Cardiology under the FCA was represented by Kaiser Law Firm, PLLC.

“This case reflects the importance of using all the tools in the government’s arsenal, both civil and criminal, to hold unscrupulous medical providers accountable,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm, PLLC, “especially where, as here, Bhambhani not only defrauded Medicare and Medicaid through violations of the anti-kickback statute, but also jeopardized public health by generating claims for medically unnecessary cardiac procedures using fraudulent documentation.”

$1,370,294.50 of the settlement amount will be paid to the United States for Medicare-related conduct and the federal portion of Medicaid-related conduct.

$629,705.50 will be paid to New York State for the state portion of Medicaid- related conduct covered under the settlement agreement.

The federal False Claims Act and similar state laws offer whistleblowers (frequently called “Relators”) protections and rewards to encourage them to file qui tam lawsuits against individuals and entities that are stealing from the government through Medicare fraud and other types of fraud. The laws also allow whistleblowers and their counsel to independently pursue FCA claims on behalf of the government when the government declines to join a qui tam lawsuit.

Case citation: United States of America, et al., ex rel. FNU-LNU LLC vs. New York Cardiology, P.C. and Ghanshyam Bhambhani, Case No. 14-CV-4581

About Kaiser Law Firm, PLLC

Kaiser Law Firm, PLLC is a boutique law firm dedicated to providing experienced representation for whistleblowers reporting fraud against the government. Founded by Geoffrey R. Kaiser, a former federal prosecutor in both the Southern and Eastern Districts of New York, Kaiser Law Firm, PLLC has notable expertise in health care fraud and other financial fraud against the government, as well as complex fraud investigations. The firm’s Whistleblower Practice focuses on the representation of individuals and entities bringing claims under fraud and abuse laws, including federal and state False Claims Acts. www.kaiserfirm.com

New York Cardiology to Pay $2 Million False Claims Settlement

NEW YORK CARDIOLOGY TO PAY $2 MILLION FALSE CLAIMS SETTLEMENT

  • Defendants accused of violating FCA in patient referral scheme
  • Using false records to justify procedures also alleged

New York Cardiology PC and a former physician will pay $2 million to the U.S. and New York to resolve claims they defrauded Medicare and Medicaid in violation of the False Claims Act by engaging in an unlawful rent payment arrangement to get patient referrals, according to a filing in a New York federal court.

The defendants, who were also accused of falsifying records to justify medical procedures, admit they engaged in the alleged conduct, a settlement agreement filed Wednesday with the U.S. District Court for the Eastern District of New York said.

The physician, Ghanshyam Bhambhani, pleaded guilty in 2018 to one count of conspiracy to pay healthcare kickbacks, and sentenced to 34 months in prison with three years of supervised release, the settlement said.

“This case reflects the importance of using all the tools in the government’s arsenal, both civil and criminal, to hold unscrupulous medical providers accountable,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm PLLC, in a press release.

Kaiser represented whistleblower FNU-LLC, which filed the false claims suit in 2014.

Judge Carol Bagley Amon presided over the case.

The case is United States ex rel. FNU-LNU LLC v. N.Y. Cardiology PC , E.D.N.Y., No. 14-4581, settlement agreement 8/19/20 .

To contact the reporter on this story: Daniel Seiden in Washington at dseiden@bloomberglaw.com

To contact the editors responsible for this story: Rob Tricchinelli at rtricchinelli@bloomberglaw.com; Nicholas Datlowe at ndatlowe@bloomberglaw.com

MJHS Hospice and Palliative Care, Inc. Pays $5.225 Million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

MJHS Hospice and Palliative Care, Inc. Pays $5.225 Million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

August 20, 2020 – MJHS Hospice and Palliative Care, Inc. (“MJHS Hospice”) has agreed to pay $5.225 million under the False Claims Act (“FCA”) to settle a whistleblower case brought by a former nurse employee, Ellyn D. Ward, who alleged that MJHS Hospice (1) violated the False Claims Act (“FCA”) by, among other things, presenting claims to Medicare and Medicaid for hospice services at medically unnecessary levels of care; and (2) retaliated against her for protesting these practices by taking adverse employment actions.

Ms. Ward’s “qui tam” (whistleblower) lawsuit against MJHS Hospice was filed in 2014 in federal district court in Brooklyn. Ms. Ward was represented by Kaiser Law Firm, PLLC and Kaiser Saurborn & Mair, P.C.

“Ms. Ward’s deep moral integrity and respect for the rule of law compelled her to bring this lawsuit, at great personal cost, because she could not stay silent in the face of what she knew were improper billing practices at MJHS,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm, PLLC. “We are pleased that this matter has been concluded successfully and that substantial insurance proceeds that were wrongfully taken from the Medicare and Medicaid programs have been recovered for taxpayers.”

Under the Medicare and Medicaid programs, a hospice provider may seek payment for several levels of care, including heightened levels known as “CHC” (continuous home care services) and “GIP” (general inpatient services). To receive reimbursement for CHC, a hospice provider must show that a patient is experiencing acute medical symptoms, and to receive reimbursement for GIP, a patient must need pain control, or acute or chronic symptom management, which must be managed in a hospital.

The government’s investigation determined that MJHS Hospice: (a) from January 1, 2011 to December 31, 2015, submitted or caused to be submitted to Medicare claims for the CHC level of care for patients who did not qualify for this heightened level of care; (b) from January 1, 2012 to December 31, 2012, submitted or caused to be submitted to Medicare claims for the GIP level of care

for patients who did not qualify for this heightened level of care; and (c) from January 1, 2011 to December 31, 2015, submitted or caused to be submitted false claims to the New York Medicaid Program for the CHC level of care for patients who did not qualify for this heightened level of care.

$4,850,000 of the settlement amount will be paid to the United States for Medicare-related conduct and the federal portion of Medicaid-related conduct. $375,000 will be paid to New York State for the state portion of Medicaid-related conduct covered under the settlement agreement.

The federal False Claims Act and similar state laws offer whistleblowers (frequently called “Relators”) protections and rewards to encourage them to file qui tam lawsuits against individuals and entities that are stealing from the government through Medicare fraud and other types of fraud. The laws also allow whistleblowers and their counsel to independently pursue FCA claims on behalf of the government when the government declines to join a qui tam lawsuit.

Case citation: United States of America, et al., ex rel. Ellyn D. Ward vs. MJHS Hospice and Palliative Care, Inc., et al., Case No. 14-CV-4201

About Kaiser Law Firm, PLLC

Kaiser Law Firm, PLLC is a boutique law firm dedicated to providing experienced representation for whistleblowers reporting fraud against the government. Founded by Geoffrey R. Kaiser, a former federal prosecutor in both the Southern and Eastern Districts of New York, Kaiser Law Firm, PLLC has notable expertise in health care fraud and other financial fraud against the government, as well as complex fraud investigations. The firm’s Whistleblower Practice focuses on the representation of individuals and entities bringing claims under fraud and abuse laws, including federal and state False Claims Acts. www.kaiserfirm.com

About Kaiser Saurborn & Mair PC

Kaiser Saurborn & Mair, PC is a leading employee whistleblower law firm representing employees and executives across all sectors of business, finance, academia and professional firms. The firm is widely recognized for its use of dynamic and innovative litigation strategies to expand the scope of legal protections for its clients. www.ksmlaw.com

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