Id. 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. 228). (Id. By law, all outpatient dialysis clinics must have a qualified medical director to be responsible for the delivery of patient care and outcomes in the facility. 42 C.F.R. A subscription to PACER is required. It employs more than 40,000 employees and treats nearly 190,000 patients at approximately 2,400 outpatient clinics in the United States, including 39 in Massachusetts. In that role, he was responsible for, among other duties, negotiating contracts under which FMCNA provided dialysis treatment to hospital inpatients. 2019) (cleaned up). (McManus, Caetlin) (Entered: 11/22/2021), Docket(#14) MOTION for Leave to Appear Pro Hac Vice for admission of Jamie Bennett Filing fee: $ 100, receipt number AMADC-9065597 by Martin Flanagan. 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. 2009) to support the contention that when a first-filed complaint is dismissed on jurisdictional grounds, it cannot bar a later-filed complaint. were false.); id. Under Rule 9(b), the standard for allegations of fraud is higher than the normal pleading standard. Please contact one of the authors below or a member of theBenesch Healthcare+ Practice Groupif you have questions regarding information contained in this Client Alert. (Danieli, Chris) (Entered: 11/02/2021), (#8) Judge Douglas P. Woodlock: ELECTRONIC ORDER FOR TRANSFER entered. . 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.)). Full title:UNITED STATES ex rel. To register for a PACER account, go the Pacer website at # https://pacer.uscourts.gov/register-account.Pro Hac Vice Admission Request Instructions # https://www.mad.uscourts.gov/caseinfo/nextgen-pro-hac-vice.htm.A Notice of Appearance must be entered on the docket by the newly admitted attorney. Fresenius fired lawyer for reporting embezzlement, misconduct Feb. 25, 2013), the mere publication of compensation information, without an allegation of fraud or misrepresentation, is not sufficient to trigger the bar. It then used that data to identify physicians and practice groups to target for medical director positions and joint-venture agreements. Furthermore, the defendants in that case were entities that at the time were not affiliated with FMCNA. Martin Flanagan worked for Fresenius Medical Care North America (FMCNA) for 29 years. Martin Flanagan and United States of America: Defendant: FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North It might also be entirely rational to shift the burden to the defendant: that is, once a relator has established the existence of a kickback scheme, arguably the burden should be shifted to the defendant to prove that certain referrals were not caused by payment of kickbacks. There are 100+ professionals named "Martin Flanagan", who use LinkedIn to exchange information, ideas, and opportunities. (Id. Michael D. Flanagan, MD | Main Line Health Conrad v. Abbott Lab'ys, Inc., No. 2013) (quoting Duxbury I, 579 F.3d at 21). Judge Douglas P. Woodlock assigned to case. Accordingly, even if relator had complied with the pre-suit requirements of the False Claims Act, the public-disclosure bar would preclude the claims concerning joint-venture agreements. 2007) (citing Rogan v. Menino, 175 F.3d 75, 77 (1st Cir. DaVita settled that case in October 2014 by entering into a Corporate Integrity Agreement ("CIA") with the Office of Counsel to the Inspector General of the Department of Health and Human Services. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 233 (1st Cir. 353, 357 (Balboa); id. 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. See East Bay Mun. 332-75). 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. For present purposes, the Court must assume that it did. 119 (2010). WebDr. (Attachments: #1 Affidavit Certificate of W. Scott Simmer in Support of Motion for Admission Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#11) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #6 Motion for Leave to Appear Pro Hac Vice Added James F. Bennett. 3729(a)(1)(B) (Count 2); and conspiring to present false claims and making or using false records material to a false or fraudulent claim in violation of the False Claims Act, 31 U.S.C. 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. #57) filed by Appellant Martin Flanagan. (Id. However, the First Circuit has rejected the holding in Poteet, explaining that earlier-filed complaints must provide only the essential facts to give the government sufficient notice to initiate an investigation into allegedly fraudulent practices and emphasizing that Section 3730(b)(5) contains no exceptions. United States ex rel. (Id. (Id. While it is true that it did not use the term medical director agreements, its allegations concerning improper remuneration to physicians in the form of compensation above fair-market value and favorable leases are nonetheless substantially similar to those in the amended complaint. June 11, 2014). Access this case on the Massachusetts District Court's Electronic Court Filings (ECF) System. According to ZoomInfo records, Sandra Martins professional experience began in 1986. Ge v. Takeda Pharm. Rule 9(b) requires that a relator plausibly allege that specific payments concerning specific patients were caused by the AKS violation-that is, that they were part of the 25% of the claims that resulted from a violation, not the 75% that were not. But whatever the merits of that argument may be, the law requires more. Michael D. Flanagan is a Internist in Bryn Mawr, PA. Find Dr. Flanagan's phone number, address, insurance information, hospital affiliations and more. 6:22-CV-03192 | 2022-07-28. In 2014, a qui tam action was filed in the Eastern District of New York alleging that on FMCNA acquired controlling interests in dialysis clinics and paid physician owners above market value for their clinics and that this excess constituted payment to induce the doctors to refer patients back to these clinics. U.S. ex rel. (Id. The complaint further alleges that FMCNA would typically pay high-performing physicians 10 to 12% of the clinic's topline revenue, whereas it would pay lower-performing physicians up to 6% of topline revenue. 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. To begin, it appears-although the complaint is ambiguous at times-that the Medicare claims at issue were submitted to the federal government by FMCNA itself, and that the Medicaid claims were submitted by various state government agencies based on claims that FMCNA submitted to those agencies.As to the Medicare claims, therefore, the complaint must be evaluated according to the ordinary standard applicable in False Claims Act cases, not the more flexible standard applicable where the defendant allegedly caused a third party to submit false claims. 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. 2012). 2008) (quoting Centro Medico del Turabo, Inc. v. Feliciano de Melecio, 406 F.3d 1, 6 (1st Cir. . 3729 et seq., by a company that provides dialysis services to patients with kidney failure. Kelly v. Novartis Pharm. Compl. 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. The public-disclosure bar provides as follows: The public-disclosure bar of 3730(e)(4)(A) applies when (1) a public disclosure of the allegations or transactions in a relator's complaint . Learn more about the survey. (Id. This is the same scheme with the same methodology as alleged here. First, defendant contends that the salaries paid to all of its medical directors is a matter of public record and is available on the website of the Center for Medicare and Medicaid Services (CMS). 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. Here, the allegations are substantially similar to those in CKD and are thus based upon the public disclosures. That is, [f]actual allegations must be enough to raise a right to relief above the speculative level . WebMichael D. Flanagan, MD, specializes in Obstetrics / Gynecology and Maternity Care, Geriatrics and sees patients in Bryn Mawr. To be clear, the dispositive question is not whether FMCNA engaged in an illegal and pervasive scheme to pay kickbacks for referrals. To survive a motion to dismiss, a complaint alleging fraud must state with particularity the circumstances constituting fraud. Fed.R.Civ.P. The question here is whether the complaint has met that standard. See Pub. 128). The remaining six paragraphs describing the alleged scheme consisted of an introductory paragraph (Compl. And it further alleges that Flanagan was instructed not to enforce escalator clauses, which called for annual fee increases of up to 4.0%. The qui tam action at issue was United States ex rel. . (Woodlock, Douglas) (Entered: 11/02/2021), (#7) NOTICE of Appearance by Abraham R. George on behalf of United States of America (George, Abraham) (Entered: 10/18/2021), (#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), (#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), (#2) Case transferred in from District of Maryland; Case Number 14-cv-00665-GLR. Bonuses and performance evaluations for mid-level managers were tied, in part, to patient growth and the increase in number of treatments at individual clinics. (McManus, Caetlin) (Entered: 11/22/2021), (#17) MOTION for Leave to Appear Pro Hac Vice for admission of Noah M. Rich Filing fee: $ 100, receipt number AMADC-9065658 by Martin Flanagan. 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.
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