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New York City Health and Hospitals Corporation and Former Program Director of the Podiatric Medicine and Surgery Residency Program at Coney Island Hospital Pay $1.25 million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

New York City Health and Hospitals Corporation and Former Program Director of the Podiatric Medicine and Surgery Residency Program at Coney Island Hospital Pay $1.25 million to Settle Whistleblower Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

Brooklyn, New York, September 24, 2020 – The New York City Health and Hospital Corporation (“HHC”) and Glenn J. Donovan, DPM (“Dr. Donovan”), former Program Director of the Podiatric Medicine and Surgery Residency Program at Coney Island Hospital (“CIH”), have agreed to pay $1.25 million under the False Claims Act (“FCA”) to settle a whistleblower case brought by a podiatrist, Irina Gelman, DPM, who alleged that HHC and Dr. Donovan knowingly violated Medicare and Medicaid program requirements in submitting claims for hospital and professional services, and in operating the PMSR program at CIH.

Dr. Gelman’s “qui tam” (whistleblower) lawsuit against HHC and Dr. Donovan was filed in 2012 in federal district court in Brooklyn. Dr. Gelman was represented by the law firms Farrell Fritz, P.C., Kaiser Law Firm, PLLC and Weiss Zarett Brofman Sonnenklar & Levy P.C.

“Dr. Gelman is a medical professional of utmost integrity who refused, at great personal cost and over the course of eight long years, to look away from what she knew were wrongful billing and operational practices inside the podiatry residency program at Coney Island Hospital,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm, PLLC. “She never once wavered in her confidence and belief.” 

The whistleblower complaint alleges that HHC and Donovan: (1) submitted or caused to be submitted claims for payment to Medicare and Medicaid, which violated Medicare and Medicaid program requirements governing payment for inpatient and outpatient hospital services for podiatry at CIH, payment for professional podiatrist services furnished by Dr. Donovan, and payment for the costs of direct and indirect graduate medical education relating to the podiatric and surgical residency program for podiatry residents at CIH; (2) violated standards and requirements established by the Council on Podiatric Medical Education governing the podiatric medicine and surgery residency program at CIH; and (3) submitted or caused to be submitted claims for payment for the costs of graduate medical education and indirect medical education, and for hospital and professional services in which certain podiatry residents at CIH participated, during periods when those podiatry residents lacked a Limited Residency Permit established pursuant to § 7008 of the New York Education Law.

Dr. Gelman served as a podiatric resident, including in the position of Chief Resident, in the PMSR program at CIH from July 2010 until in or about late 2013. As a podiatry resident, Dr. Gelman witnessed the improper billing and operational practices that compelled her to commence her whistleblower lawsuit. 

“This case highlights the importance of people being willing to step forward and expose improper conduct and billing involving federal and state funds,” said Kevin P. Mulry, a litigation partner at Farrell Fritz, “particularly where the allegations involve a troubling lack of training and supervision in one of our public hospitals.”  

“From the moment I met Dr. Gelman, I was singularly impressed by her desire to expose institutional wrongs impacting the public fisc,” notes David A. Zarett, Esq., a founding member of Weiss Zarett Brofman Sonnenklar & Levy, P.C., “and her confidence and self-determination to pursue this issue in court rather than look the other way.” 

An important aspect of the case is that Dr. Gelman and her attorneys litigated it entirely on their own to recover federal and state taxpayer money since the government declined to intervene in the qui tam lawsuit.

“The government is frequently the first to point out that a declination does not mean that a case lacks merit, since there are many reasons that the government may sometimes elect not to intervene in a whistleblower case,” Kaiser said.  “We could not be more pleased to have played a part in prosecuting this important case, and to have recovered significant proceeds for taxpayers.”

$1,030,325.00 of the settlement amount will be paid to the United States for Medicare-related conduct and the federal portion of Medicaid-related conduct. $219,675.00 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, which is what happened in Dr. Gelman’s case. 

Case citation: United States of America, et al., ex rel. Gelman vs. Glenn J. Donovan, DPM, et al., Case No. 12-CV-5142

About Farrell Fritz, P.C.

Farrell Fritz, P.C. is a full service law firm of more than 90 attorneys based in Uniondale, New York, with offices in New York City, Albany, Hauppauge and Water Mill.  The firm has earned a strong reputation in the New York business community, including within the healthcare industry.  Our attorneys work collaboratively with individuals and with the leaders of companies of every size and type – and with each other – providing clients throughout the New York metropolitan area and beyond with seamless access to in-depth legal expertise.  www.farrellfritz.com

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 Weiss Zarett Brofman Sonnenklar & Levy P.C.

Weiss Zarett Brofman Sonnenklar & Levy, P.C., is a boutique sized Long Island, New York law firm providing a wide array of legal services to the members of the health care community, including physicians, podiatrists, dentists and residents/fellows. The depth and breadth of our practice includes healthcare transactional and compliance matters, professional discipline and medical staff privileging disputes, healthcare fraud investigations before the US Attorney and Attorney General, insurance company audits, and litigation in state and federal courts or before arbitration tribunals. The Firm also represents an array of businesses in commercial and real estate transactional, lending and litigation matters. www.weisszarett.com

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

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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