Efficient and Effective Legal Representation

Our Whistleblower Litigation Case Results

Below are samples of results obtained in False Claims Act cases filed by Cross Law Firm, S.C. on behalf of the firm’s qui tam clients as primary or as co-counsel in forums throughout the United States. In some cases, the resolution was sealed permanently by the court or the settlement was entered into with a confidentiality agreement, so the parties cannot be listed or no mention can be made at all. Often settlement includes nonmonetary items for employee whistleblowers who have suffered retaliation such as employment continuation, backpay and special damages. Qui tam settlements may also involve or be in conjunction with a guilty plea to criminal charges against the fraudster; restitution wages paid to defrauded employees; or mandatory monitoring and employee training and/or a Corporate Integrity Agreement to prevent future fraud, all in addition to the government’s monetary recovery in the case.

The following are settled allegations only:

Whistleblower Litigation

$38 Million

Forest Pharmaceuticals, Inc., et al.

Kickback Fraud By Drug Company Sales Representatives

Attorney Nola Hitchcock Cross represented the whistleblower who filed a False Claims Act lawsuit against Forest Pharmaceuticals, Inc., in April 2012, resulting in a $38 million settlement in 2016. The settlement resolved allegations that Forest Pharmaceuticals violated the Anti-Kickback Statute, which prohibits the payment of remuneration to induce referrals of items or services covered by federal health care programs, by providing payments and meals to certain physicians in connection with bogus speaker programs about Bystolic®, Savella®, or Namenda® between Jan. 1, 2008 and Dec. 31, 2011.

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Whistleblower Litigation

$31.5 Million

PharMerica Corp.

Wholesale Long Term Care Pharmacy Prescription & Dispensing Fraud

Our firm represented a whistleblower in an FCA case against Pharmerica Corp. that resulted in the first nation-wide recovery in an FCA case predicated on the Controlled Substance Act and also the first nation-wide FCA case predicated on Medicare Part D. The case alleged that PharMerica violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription.

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Whistleblower Litigation

$25 Million

Gentiva subsidiary
Odyssey Health Care, Inc.

Hospice Fraud in Eligibility and Continuous Care Benefit

Our firm represented Relators who filed a False Claims Act qui tam action in 2012 against Odyssey Health Care, Inc. for hospice care fraud. Specific allegations included that Odyssey submitted false claims to the Medicare program for continuous home care services that were unnecessary or not performed in accordance with Medicare requirements. This resulted in a $25 million settlement. Continuous Care is an important, but highly compensated benefit for dying Medicare Beneficiaries.

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Whistleblower Litigation

$12.9 Million

Odyssey Healthcare, Inc.

Patient Eligibility Hospice Fraud

In the first case of its kind in the nation to obtain recovery, our firm represented a former vice president of Odyssey, who exposed hospice care fraud involving billing Medicare for hospice care services for patients who were not terminally ill including one enrolled in tap dance lessons and another taking a foreign language. This resulted in a $12.9 million settlement in 2006.

The settlement, which covers a period from 2001 to 2005, also resolves charges originally brought against Odyssey HealthCare by a former regional vice president, JoAnne Russell. As part of the settlement, Cross Law Firm’s client received $2,326,500 for bringing the matter to the attention of the government.

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Whistleblower Litigation

$10 Million

Agnesian Healthcare, Inc., and Fond Du Lac Regional Clinic, S.C.

Kickback & Stark Act Fraud

Our firm was local co-counsel in a lawsuit against Fond du Lac medical giant Agnesian Healthcare. The lawsuit accused Agnesian of paying doctors to steer Medicare and Medicaid patients to their facilities. This resulted in a $10 million settlement.

The complaint alleged Agnesian’s compensation plan for doctors violated the Stark Law and the Anti-Kickback Statute by rewarding and offering incentives to its network of affiliated doctors to refer Medicare and Medicaid patients exclusively to Agnesian doctors and facilities. The company denied the allegations.

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Whistleblower Litigation

$4.8 Million

Abri Health Plan, Inc.

Medicare Plan Sales Misrepresentation

Our firm’s clients alleged that Abri Health Plan, Inc. misrepresented Medicare Part C coverage plans. According to the whistleblowers, Abri’s salespeople would mislead customers about the scope of the Medicare Part C coverage plan in violation of Medicare regulations and would even sign-up customers for the plan without their consent.  Additionally, Abri allegedly paid doctors for referrals and paid customers to sign up for the Medicare Part C coverage plan.

As their share of the recovery, CLF’s clients received more than $900,000 of the $4.8 million recovered.

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Whistleblower Litigation

$4 Million

RehabAuthority, LLC, et al.

Physical Therapy Fraud

Our firm was co-counsel in representing a whistleblower who brought a claim under the qui tam provisions of the False Claims Act against RehabAuthority. In 2021, the company agreed to pay $4 million to resolve allegations that the company billed the government for direct, one-one-one care with physical therapists, but did not provide individual care when it overbooked government beneficiaries for certain outpatient physical therapy services. When Taxpayers pay for individual physical therapy, but therapists actual run between multiple patient rooms or treat multiple patients in one room simultaneously, both Taxpayers and Patient Beneficiaries are cheated.

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Whistleblower Litigation

$3.74 Million

Deaconess Home Health, Inc.

Personal Care Workers Medical Necessity Fraud

Our firm represented one of three Relators who filed separate FCA lawsuits. Notably, Deaconess and its owner also faced criminal charges for allegedly committing health care fraud. The cases also resulted in a civil settlement agreement for $3.74 million in 2015.

Allegations included that the defendants engaged in schemes to defraud the Medicaid program by (1) intentionally recruiting patients without regard to medical necessity; (2) instructing nurses to routinely inflate the assessment of the patient for  Medicaid benefits; (3) failing to conduct required supervisory visits to ensure that services were being provided, that they were medically necessary and appropriate for the patient’s needs; and (4) hiring physicians to act as medical directors to sign plans of care for patients on whom they had not completed a physical examination.

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Whistleblower Litigation

$2.75 Million

AlixaRx LLC et al.

Pharmacy Prescription Fraud

Our firm represented a former pharmacist at the Atlanta hub of AlixaRx. AlixaRx, LLC, agreed to pay $2.75 million in 2021, resolving allegations of improperly dispensing opioids and other controlled substances without valid prescriptions at long-term care facilities via their vending-machine like drug dispensing units.

“AlixaRx LLC spun a web of deception when it engaged in unlawful dispensing practices by abusing the emergency prescription provisions of the Controlled Substances Act,” Robert J. Murphy, special agent in charge of the DEA Atlanta Field Division, said in a statement.

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Whistleblower Litigation

$2.05 Million

Hayat Pharmacy, LLC, et al.

Compounding & Prescription Pharmacy Fraud

Our firm represented a whistleblower whose case obtained False Claims Act recovery against Milwaukee pharmacy chain Hayat Pharmacy. In January 2022, the company agreed to pay $2,050,000 due to allegations that the company submitted fraudulent claims for two prescription medications: a multi-vitamin called Azesco and a cream used to treat skin infections.

In addition to the monetary recovery, we obtained on-going and mandatory training to prevent future fraud.

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Whistleblower Litigation

$1.6 Million & Felony Conviction

Watry Homes, LLC

Construction Fraud

Our firm represented a relator in 2015 who exposed a New Berlin, WI contractor for underpaying wages on federally funded housing projects in violation of the David Bacon Act. This resulted in a $1.6 million settlement.

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Whistleblower Litigation

$1 Million

Advanced Pain Mgmt., et al.

Incentive Stock & Bogus Medical Director Kickback Fraud

Our firm represented a whistleblower whose False Claims Act complaint alleged that Advanced Pain Management Holdings, Inc. (APMH) improperly gifted shares of incentive stock to non-employee Advanced Pain Management S.C. (APMSC) physicians who performed pain management procedures at APMH’s ambulatory surgical centers and paid non-employee APMSC physicians to serve as medical directors in a manner that was tied to the volume of procedures at the ambulatory surgery centers. APMH agreed to pay $1 million in 2020.

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Whistleblower Litigation

$1 Million

TMJ & Orofacial Pain Treatment Centers of Wisconsin

Dental Appliance Billing Fraud

Our firm represented a whistleblower who filed a False Claims Act lawsuit against TMJ & Orofacial Pain Treatment Centers of Wisconsin. In 2020, the company agreed to pay $1 million, resolving allegations that TMJ & Orofacial Pain Treatment Centers of Wisconsin falsely billed Medicare and TRICARE for oral appliances under billing codes applicable to expensive prosthetic devices fabricated by surgeons, rather than other lower paying billing codes applicable to appliances fabricated by an outside laboratory.

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Whistleblower Litigation

$500,000

Permanently Sealed Case

Nursing Supervision Fraud

Our firm represented two RNs who complained that in a chain of women’s clinics, nurses’ aides were performing unsupervised work which was both unsafe and fraudulently billed as nursing services. In 2005, the Government settled the case which remained permanently sealed after $500,000 recovery.

Whistleblower Litigation

Employment Whistleblower Results

In some cases, a False Claims Act case is not possible, timely, or otherwise pursued to recovery for a variety of reasons, which may include a client’s decision not to proceed with a qui tam action. In such cases, it is essential to be working with a firm, such as Cross Law Firm, that has also litigated employment matters. We have recovered substantial sums for clients who pursued FCA whistleblower retaliation employment claims only, depending of course on the amount of the damages they respectively sustained, such as Military Contract Fraud, $300,000; Nursing Supervision Fraud, $250,000; Higher Education Fraud, $52,000; Government Construction Contract Fraud, $150,000; Pharmacy Dispensing Fraud, $175,000; Stark Act and Anti-Kickback Act Fraud, $125,000.