In summary, because the new allegations concerning (1) joint-venture agreements, (2) free services to hospitals and patients, and (3) free practice-management services to physicians are not substantially similar to the allegations in the initial complaint, that portion of the complaint will be dismissed for failure to comply with the filing and service requirements of the FCA. . Martin Flanagan is a journalist and author who writes on sport, Australian culture and the relationship between indigenous and non-indigenous Australia. Because the False Claims Act is a statute directed at fraudulent conduct, Rule 9(b) requires both that the circumstances of the alleged fraud and the claims themselves be alleged with particularity. Lawton ex rel. 2023-03-21, U.S. Courts Of Appeals | Other | 3730(e)(4)(A). (Id. FMCNA has moved to dismiss the complaint for failure to state a claim upon which relief can be granted pursuant to Fed.R.Civ.P. 360 (ENA); id. Flanagan v. Fresenius Medical Care Holdings, Inc. (Id. were false.); id. United States ex rel. Flanagan v. Fresenius Med. Care The question here is whether the complaint has met that standard. Furthermore, the defendants in that case were entities that at the time were not affiliated with FMCNA. This is a qui tam action alleging violations of the Anti-Kickback Statute, 42 U.S.C. (McManus, Caetlin) (Entered: 11/22/2021), Docket(#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. It includes a blank example of such a form as Exhibit A. Dialysis company hit with False Claims Act suit - Becker's . 35). 334-35). A former employee filed an amended whistleblower complaint against Fresenius Medical Care North America, alleging the dialysis company had unlawful (Id. 3730(b)(5). 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. Family Medicine Call for an Ex. Dialysis refers to a treatment regimen aimed at artificially replacing some of the functions performed by a healthy kidney. 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. . 2014), the First Circuit affirmed the denial of a motion to amend the complaint a third time. The second issue is whether the public-disclosure bar of the statute precludes all or any of the claims-that is, whether relator is filing suit concerning matters that had been previously disclosed to the public. 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. See Pub. 142-43). And even though the regulatory guidance defines the medicaldirector position as occupying 0.25 FTE, the complaint alleges that FMCNA neither tracked nor enforced medical directors' hours spent on duties to their clinics. 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 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. 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 Nor is the issue whether the scheme should, in some fashion, be redressed. 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. Flanagan v. Fresenius Medical Care Holdings, Inc. :: Justia Dockets & Filings Notice of appeal (doc. 353, 357 (Balboa); id. 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. Bell Atl. The amended complaint describes-in considerable detail-a multi-part scheme to compensate caregivers in return for referrals. 3730(e)(4)(B). Relator Martin Flanagan has brought suit against defendant Fresenius Medical Care Holdings, Inc., d/b/a Fresenius Medical Care North America (FMCNA), The qui tam provisions of the FCA permit relators, in some instances, to reap huge financial windfalls. And, presumably, it has other weapons in its arsenal for dealing with fraudulent conduct. Patients who were referred to non-FMCNA clinics were categorized as leakage. (Id. June 16, 2011). (McDonagh, Christina). Menu and widgets. Michael D. Flanagan, MD | Main Line Health 286 (Texas) (All such claims . 321-31). Flanagan v. Fresenius Medical Care Holdings, Inc. - Law360 (Id. 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. 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. Care Holdings, Civil Action 21-11627-FDS (D. Mass. See U.S. ex rel. The complaint further alleges a scheme to provide favorable leases to physician groups in order to induce referrals. Free Services to Hospitals and Patients. Saldivar v. Fresenius Med. Cases involving fraud against the government, False Claims Act (FCA) - 31 USC 3729-3733. 167-307). These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia. As to Scripps, it alleges the following: The complaint further alleges, at considerable length, a scheme to pay medical directors compensation above fair market value in order to induce referrals. 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. (CKD Compl. In summary, the amended complaint fails to state allegations of fraud under the FCA with the particularity required by Rule 9(b). 26). (Id.). As to the alleged scheme to provide other services to hospitals, the complaint alleges the following: As to the scheme to provide free or below-cost practice-management services, the complaint alleges the following: As noted, despite its length and detail, the description of the fraudulent scheme set out in the complaint, without more, is insufficient to state a claim under the False Claims Act. Quick View. Here, the complaint describes in general terms how claims are submitted to Medicare and Medicaid; it describes the various ways in which FMCNA allegedly paid kickbacks for referrals; and as to each such aspect of the scheme, it alleges that every claim or all claims were fraudulent. 29). 131). 88). 22). 2016). As the Chair of the Local Rules Committee when the relevant rules were adopted, see generally L.R. See Id. (McManus, Caetlin) (Entered: 11/22/2021), (#14) MOTION for Leave to Appear Pro Hac Vice for admission of Jamie Bennett Filing fee: $ 100, receipt number AMADC-9065597 by Martin Flanagan. 23). 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. . Third, defendant contends that relevant public disclosures occurred in multiple SEC filings by FMCNA. . FMCNA then moved to dismiss the complaint. President, National Cardiovascular Partners; President, Spectra Laboratories. (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. (Id. 308-14). Certainly it would not be irrational to conclude that the presence of kickbacks taints the entire payment process, so that 100% of the claims may be deemed to have been caused by the violation. As to joint-venture agreements, the complaint again alleges in general terms that all claims submitted by facilities with joint-venture partners are false claims. Finally, one place to get all the court documents we need. Flanagan (McManus, Caetlin) (Entered: 11/02/2021), Docket(#10) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #5 Motion for Leave to Appear Pro Hac Vice Added Megan S. Heinz. See Kelly, 827 F.3d at 13. 40. 45). . A subscription to PACER is required. Fresenius United States v. Takeda Pharm. Connect via Twitter or email . 4:05-cv-985 (E.D. (Id.). Accordingly, the claims concerning joint-venture agreements are barred by the first-to-file rule. 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. The complaint further alleges that FMCNA paid its medical directors far above fair market value. WebMichael D. Flanagan, MD, specializes in Obstetrics / Gynecology and Maternity Care, Geriatrics and sees patients in Bryn Mawr. WebFlanagan v. Fresenius Medical Care Holdings, Inc., No. (McManus, Caetlin) (Entered: 11/22/2021), (#15) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #13 Motion for Leave to Appear Pro Hac Vice Added W. Scott Simmer. CKD Project, LLC v. Fresenius Med. 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. D. Pleading Fraud with Particularity under Rule 9(b). b. Williams v. Renal Care Grp., et al., No. Furthermore, they do not directly disclose the existence of any of the alleged schemes, or any other form of fraud, nor do they describe facts from which the existence of a fraudulent scheme might be inferred. Plaintiff-Relator Martin Flanagan (Relator) worked for Fresenius for twenty-nine years, most recently as Director of Acute Market Development for the It is insufficient to allege a scheme and then to make generalized allegations that the scheme must have, as a matter of logic, resulted in false claims. 93). Fresenius Medical Care North America, Waltham, MA, USA See all articles by this author. Previously, Martin was a Direct or, Acute Maket Development According to the complaint, FMCNA also paid physician groups rent above fair market value and provided leases below fair market value in order to secure referrals. 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). 1999)). 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. 2012). constituted false claims .); id. 223). 9(b). Counsel may need to link their CM/ECF account to their upgraded individual pacer account. (Id. free or discounted physician practice alignment services, including providing dedicated chronic kidney disease educator services, financial coordination services for patients beginning dialysis, vascular access development services and assistance with physician recruiting through Fresenius online recruiting platform. (Id. 2016). Access the Case Summary and Docket Report to access additional information about this case on the US Court's PACER system. 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. It did not allege that FMCNA improperly provided free services to hospitals and patients in the form of free discharge-planning services, free in-service training to staff, free training to patients, and free quality assessment and improvement program data analysis, nor did it mention the Bridge Program. CKD Project v. FMCNA, No. 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. Wilson v. Bristol-Myers Squibb, Inc., 2011 WL 2462469, at *6-7 (D. Mass. at 555 (citations omitted). (Id. . 9(b). 12% off. 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. In any event, as to those aspects of the alleged scheme, the allegations of the submission of false claims are similarly general. In 2010, Congress amended the AKS to clarify that any Medicare claim that includes items or services resulting from a violation of [the AKS] constitutes a false or fraudulent claim for the purposes of [the FCA]. 42 U.S.C. Those arguments, however, are unavailing. 308-20). (Id. (Id. Accordingly, the public-disclosure bar does not preclude the claims concerning unlawful medical-director agreements. 3730(b)(5); (4) the complaint has not pleaded fraud with particularity as required by Rule 9(b); and (5) the complaint fails to state a claim for FCA conspiracy. 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. . US$14.87 US$16.99. 368-74). 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. 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. On a motion to dismiss, the court must assume the truth of all well-plead[ed] facts and give . A claim is any request or demand . (Id. Public Records Policy. The relator is eligible to collect a portion of any damages awarded in a qui tam action, whether or not the government intervenes. 2010). Third, it alleges that FMCNA provided physicians free or below-cost practice-management services. 89). A more recent docket listing 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. 3730(e)(4)(A). Attorneys admitted Pro Hac Vice must have an individual PACER account, not a shared firm account, to electronically file in the District of Massachusetts. Instead, those services were provided free of charge. 308, 321). (Id. Please contact one of the below authors if you have questions about the lawsuit and its implications for the nephrology and dialysis industry. Although this financial incentive encourages would-be relators to expose fraud, it also attracts parasitic relators who bring FCA damages claims based on information within the public domain or that the relator did not otherwise discover. United States ex rel. L. No. Ex. Martin Flanagan | Book Depository 247-48). (Id.). 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. 1:19-OP-45655 | 2019-07-22, U.S. Courts Of Appeals | Property | Email. 750 F.3d at 120. It alleged that [t]hese problematic physician relationships generally break down into two areas. (Id.). (Id. 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. Martin Flanagan 9(b). 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. 1320a-7b(b)(2). (Attachments: #1 Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), Docket(#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. 198-205). CEO Martin Flanagan still sees a growth opportunity in Chinaand a big risk in Bitcoin. Rather than spend time at this point disputing and, if necessary clarifying rule language, however, I have simply consulted with the Chief Judge and under L.R. 30-31). See East Bay Mun. 494.150; Am. ESRD expenditures by Medicare exceed $40 billion annually. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 233 (1st Cir. See Wilson, 2011 WL 2462469, at *7. That is not sufficient, under the case law, to state a false claim with particularity within the meaning of Rule 9(b). Fresenius also allegedly provided free discharge planning services and in-service training to hospitals. Suppose, for example, that in a world free from kickbacks, 25% of the dialysis services business of FMCNA would have been captured by competitors. Want to Read. (Id. 13). Instead, it alleges that FMCNA paid kickbacks for referrals on a widespread basis, and that therefore all claims for payment that it submitted to the government were false. . WebDr. 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 25) and five paragraphs addressing how the scheme resulted in false claims (Id. 3730(e)(4); (3) the claims concerning joint-venture agreements are barred by the FCA's first-to-file bar, 31 U.S.C. 25). . According to the complaint, FMCNA offered physicians the opportunity to enter into free practice-management agreements, in return for which it obtained the practice's data from the prior three to five years. 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. were false.) (emphasis added)). 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. 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. 170. (Reuters) - A former top legal executive at Germany's Fresenius Medical Care AG & Co KGaA sued the dialysis clinic operator on Tuesday alleging he was 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. The remaining six paragraphs describing the alleged scheme consisted of an introductory paragraph (Compl. The complaint also alleges that Fresenius regularly entered into a variety of problematic arrangements with nephrologists and nephrology group practices intended to secure patient referrals for Fresenius wholly-owned and joint venture outpatient dialysis centers, including: Many of the allegations contained in the Complaint of inappropriate physician arrangements are similar, in many regards, to the allegations contained in whistleblower David Barbettas complaint filed against DaVita in federal district court in 2009. Under the circumstances, the Court concludes that the bar does not apply. Dec. 2, 2022). The U.S. Justice Department said on Tuesday it joined a whistle-blower lawsuit against Fresenius Medical Care AG, the world's biggest dialysis care company, on claims that it defrauded Medicare. Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. 28, 38-40, 60-65). Each step in that argument relies on an inference: first, the inference that the relevant financial arrangements were intended as kickbacks; second, the inference that every referral to an FMCNA clinic was made as a result of the kickbacks; and third, the inference that every claim for government reimbursement was tainted by the kickbacks. 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. Read More . Internal spreadsheets from the Western Business Unit show that FMCNA recorded losses on its contracts with hospitals, often in excess of the budgeted losses. 181). 17). However, even if allegations are based upon public disclosures, claims may nonetheless be asserted if the relator is an original source. Before 2010, the statute defined an original source as an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the Government before filing an action under this section which is based on the information. 31 U.S.C. . By continuing to use this website, you agree to UniCourts General Disclaimer, Terms of Service, Martin Flanagan - Director, Natio.. - Liberty Dialysis (Id. 02 Jun 2016. Care Holdings, Inc., 551 F.Supp.3d 27, 43 (E.D.N.Y. 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 . 14). As its Western Division director of acute market development, he was Martin Flanagan United States of America Defendant FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North America 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. Gonzales et al. . Util. 15). claims . Defendant contends that the allegations concerning the compensation of medical directors were publicly disclosed prior to the filing of the complaint. 1). Martin Flanagan FMCNA is headquartered in Waltham, Massachusetts. 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. (Id. 249 (NANI) (All . The complaint alleges that FMCNA violated the Anti-Kickback Statute (AKS) and caused the submission of false claims for payment to Medicare, Medicaid, and other government health-care payors. 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). The 2005 complaint alleged improper conduct dating from a decade before the conduct alleged here. Co., 827 F.3d 5, 13 (1st Cir. 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. Defendant contends that the 2014 CKD complaint alleged the same fraudulent scheme concerning joint-venture agreements as the amended complaint here, which was filed seven years later. (McManus, Caetlin) (Entered: 11/02/2021), (#9) ELECTRONIC NOTICE of Case Reassignment. . constitutes a false claim.); id. (Id. 119 (2010). Care Holdings, Inc., 906 F.Supp.2d 1264, 1274 (N.D.Ga. Defendant contends that the amended complaint should be dismissed for failure to comply with the pre-suit requirements of the FCA, 31 U.S.C. Accordingly, the motion to dismiss will be granted. 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.