Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed False Claims Act Cases: October 2014

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Trends & Analysis

Between our last Qui Tam Update and the end of June, 65 health care–related qui tam cases were unsealed (28 in April, 18 in May, and 19 in June). Within those 65 cases:1

  • The government declined to intervene in 34 cases (16 in April, 9 in May, 9 in June).
  • The government filed Notices of Non-Intervention in 10 cases (1 in April, 3 in May, 6 in June).
  • The government partially intervened in 10 cases (7 in April, 1 in May, 2 in June).
  • The government fully intervened in 7 cases (4 in April, 3 in June).
  • 19 cases were dismissed prior to settlement (9 of which were dismissed voluntarily by the relator).
  • 12 cases were settled and/or dismissed pursuant to a Settlement Agreement (8 in April, 4 in June)2

Notably, a majority of the unsealed cases were filed within the last two years, but about one-third of the cases predate 2012:

  • Before 2012: 23 cases (35%)
  • In 2012: 15 cases (23%)
  • In 2013: 26 cases (40%)
  • In 2014: 1 case (2%)

While the cases were filed in a wide variety of jurisdictions, historically active jurisdictions for False Claims Act (“FCA”) enforcement (marked with an * below) typically saw a higher concentration of cases filed. Some of the districts involved include:

  • District of Arizona (2)
  • C.D. California (3)*
  • M.D. Florida (4)*
  • S.D. Florida (3)*
  • W.D. Missouri (2)
  • E.D. New York (2)*
  • S.D. New York (2)
  • W.D. New York (2)
  • E.D. Pennsylvania* (7)
  • M.D. Pennsylvania
  • W.D. Pennsylvania
  • District of South Carolina (2)
  • M.D. Tennessee (2)
  • E.D. Texas
  • N.D. Texas
  • W.D. Texas
  • District of Utah
  • E.D. Wisconsin

Featured Cases

United States ex rel. Fox Rx, Inc. v. Managed Health Care Associates, Inc., No. 2:13cv6154 (C.D. Cal.) (“Fox I”).

United States. ex rel. Fox Rx, Inc. v. Managed Health Care Associates, Inc., No. 2:13cv8433 (C.D. Cal.) (“Fox II”)

Complaints Filed: Fox I: August 21, 2013; Fox II: November 14, 2013

Complaints Unsealed: Fox I: April 14, 2014; Fox II: April 11, 2014

Current Status: The court entered Joint Stipulations to Dismiss Fox I and Fox II on July 21, 2014. (See below for further discussion.)

Intervention Status: The United States declined to intervene in Fox I and Fox II on April 11, 2014.

Name of Relator: Fox Rx, Inc. (“Fox”)

Name of Defendants: Managed Health Care Associates, Inc. and its wholly owned subsidiary, MHA LTC, Inc. (collectively, “MHCA”)

Defendants’ Business: MHCA is a pharmacy provider to long-term care facilities.

Relator’s Relationship to Defendants: Fox is a private Medicare Part D plan sponsor with which MHCA contracted to receive Medicare Part D reimbursement for prescription drugs.

Relator’s Counsel: Engstrom, Lipscomb, and Lack

Our featured cases include two qui tam actions, unsealed in April, that were brought by serial relator Fox against MHCA. Fox is a private insurer that acts as a federally reimbursed Medicare Part D Plan sponsor (“PDP”). MHCA, in turn, contracts with PDPs like Fox to provide prescription drugs to the PDPs’ Medicare Part D beneficiaries through MHCA’s network of independent pharmacies. MHCA is one of the largest providers of pharmacy services to long-term care facilities (“LTCFs”).

Fox premised its first FCA case and part of its second case against MHCA on an underlying theory that MHCA improperly billed Fox (instead of its LTCF clients) for drugs that MHCA’s LTCF clients prescribed to their patients for off-label purposes. Fox argued that because the drugs were prescribed for off-label purposes, they were not medically necessary and thus were not covered by Medicare Part D. As such, Fox alleged that MHCA should have billed its LTCF clients, not Medicare (through Fox), for these prescriptions. According to Fox, the claims that MHCA submitted improperly to Fox for these off-label prescriptions were false claims.

Fox contended that based on the mechanisms through which the Medicare Part D program calculates the amount it will pay for prescription drugs, MHCA’s submission of claims for off-label prescriptions directly affected the amount spent by the Centers for Medicare & Medicaid Services (“CMS”). In short, Fox asserted, the more a PDP spends on drugs for each beneficiary, the more the federal government will pay either through (1) the direct monthly capitated payments made to cover the PDP’s cost of providing benefits; (2) the low-income cost-sharing subsidy (to cover the federal government’s portion of cost-sharing payments for certain low-income beneficiaries); or (3) the reinsurance subsidy that comprises the federal government’s share of drug costs for beneficiaries who have reached catastrophic coverage.

Fox also alleged that most Medicare Part D enrollees who reside in LTCFs reach the annual catastrophic coverage trigger, after which the federal government directly reinsures the PDP on an individual enrollee basis against 80% of further prescription drug costs. As such, the majority of LTCF patients enrolled in Medicare Part D have the bulk of their claims reimbursed directly and individually to the PDP by the federal government through catastrophic coverage reinsurance or low-income cost-sharing payments. For those Medicare Part D enrollees who had reached the level of catastrophic reinsurance and to whom MHCA had dispensed off-label prescriptions, MHCA’s submission of claims to Fox allegedly caused Fox, in turn, to submit each such false or fraudulent claim for reimbursement to CMS in violation of the FCA.

Fox I

Claims: The relator brought claims against MHCA for various alleged violations of the FCA for false claims, false statements, conspiracy, and “reverse” false claims (under, 31 U.S.C. §§ 3729(a)(1)(A), (B), (C), and (G)), among others, and also accused MHCA of violating the state False Claims Acts of California, the District of Columbia, Florida, New Jersey, New York, and Texas.

Summary of Case: Fox alleged that from 2006 to August 2013, MHCA billed for atypical antipsychotic drugs dispensed to Medicare Part D beneficiaries (1) who did not suffer from a condition for which the U.S. Food and Drug Administration (“FDA”) had approved the drugs or (2) who suffered from conditions that were the subject of FDA “black box” warnings (i.e., warnings that patients with certain specified conditions were at an increased risk of death if they used the product bearing the warning). Because there was no medically accepted indication for these prescriptions, Fox argued, the claims should have been submitted to the LTCF, not the Medicare Part D program (Fox made similar claims regarding Depakote in Fox II, discussed below).

Fox further alleged that MHCA was induced to commit the improper dispensing of atypical antipsychotic drugs, and in turn the submission of claims to CMS in violation of the FCA, because MHCA received volume-based rebates directly from the manufacturers of those drugs, which it then shared with its member pharmacies so they would also dispense atypical antipsychotics. According to Fox, MHCA failed to report these rebates to Fox (as it is required to do by Medicare Part D program rules), which would then have reported the rebates to CMS so CMS could take those amounts into account when calculating Medicare Part D beneficiary premium amounts. Fox alleged that MHCA’s failure to report these rebates and its payment of rebates to member pharmacies violated the Anti-Kickback Statute (“AKS”).

Another alleged AKS violation arose in MHCA’s failure to collect required co-payments from beneficiaries in an effort to induce those beneficiaries to purchase or receive prescription drugs. According to Fox, MHCA’s knowing submission of claims rendered false by the underlying AKS violations constituted a violation of the FCA.

Fox also accused MHCA of violating the AKS by offering financial inducements to LTCFs to contract with its member pharmacies. Specifically, Fox asserted that by not billing the LTCFs (as it should have) for drugs that were prescribed to beneficiaries for off-label purposes, MHCA incentivized those LTCFs to continue to write off-label prescriptions for atypical antipsychotics.

Fox argued (as it also did in Fox II, below) that by submitting such allegedly false claims to Medicare, MHCA affected the amounts paid by CMS on each such claim (based on the mechanisms CMS uses to calculate the amount paid to PDPs under the Part D Program). Fox also asserted that because states are required to pay a portion of the costs associated with providing federal Medicare drug coverage to beneficiaries who are eligible for both Medicare and Medicaid, MHCA’s conduct also affected the plaintiff states as a result of their involvement with Medicaid.

Fox II

Claims: The relator brought claims against the defendants for alleged violations of the FCA for false claims; false statements and “reverse” false claims (under 31 U.S.C. §§ 3729(a)(1)(A), (B), and (G)); and also for violations of the state False Claims Acts of California, the District of Columbia, Florida, New Jersey, New York, and Texas.

Summary of Case: Fox alleged that between January 1, 2006 and November 2013 MHCA violated the FCA by submitting claims to Fox seeking reimbursement for dispensing the anticonvulsant Depakote and its generic equivalents to Medicare Part D beneficiaries for off-label uses. MHCA’s alleged failure to bill the LTCFs resulted in significant financial benefits to those LTCFs in terms of costs shifted from the LTCF (i.e., MHCA’s clients) to the federal government (which, Fox argued, was an unlawful kickback to MHCA’s clients that rendered false the resulting claims submitted to Medicare Part D).

Fox also alleged that based on the mechanisms through which the Medicare Part D program calculates the amount it will pay for prescription drugs (explained above), MHCA’s submission of claims for Depakote directly affected the amount spent by CMS, as the majority of LTCF patients enrolled in Medicare Part D have most of their claims reimbursed directly and individually to the PDP by the federal government through catastrophic coverage reinsurance or low-income cost-sharing payments. For those Medicare Part D enrollees who had reached the level of catastrophic reinsurance and to whom MHCA had dispensed Depakote, MHCA’s submission of claims to Fox allegedly caused it, in turn, to submit each such false or fraudulent claim for reimbursement to CMS in violation of the FCA.

In addition to harming CMS and the federal government, Fox argued that MHCA’s practices harmed the plaintiff states because they are responsible for paying a portion of the Medicare Part D coverage of patients who are eligible for both Medicare and Medicaid benefits.

Reasons to Watch: The cases filed by Fox are noteworthy for a few reasons, the first being the relator. While relators in qui tam cases come in all shapes and sizes, sponsors of Medicare Part D prescription drug plans have not, in the past, frequently served as relators. Fox, however, appears to have embraced the role of qui tam relator, to the point of becoming a serial relator bringing multiple claims against pharmacy providers. One of Fox’s other cases was noted in our November 2013 Qui Tam Update, in which we discussed an earlier-unsealed case brought by Fox alleging that Walgreen Company overcharged Fox’s subsidiary insurance company, other Medicare Part D plan sponsors, and state Medicaid programs for prescription drug claims dispensed to beneficiaries because Walgreen Company failed to substitute generic drugs for brand-name drugs in states that require such substitution and submitted claims for drugs that were expired in violation of state and federal laws.3

While Fox asserts a different theory of liability in the instant cases, these are not the first cases in which Fox has alleged that an LTCF pharmacy provider has violated the FCA by seeking reimbursement under Medicare Part D for prescriptions written for off-label uses. Fox filed similar claims against Omnicare, Inc. in a suit initiated in March 2011. In that case, Fox accused Omnicare of engaging in various schemes across the country to defraud the Medicare Part D program by seeking reimbursement for prescriptions for atypical antipsychotic drugs for off-label use (the same claims it made in Fox I). In late May 2014, the U.S. District Court for the Northern District of Georgia granted Omnicare’s motion for summary judgment on the grounds that the evidence Fox presented did not support its claim that Omnicare knowingly submitted to CMS false claims for thousands of off-label prescriptions for atypical antipsychotics. This ruling, in turn, prompted Fox (and MHCA) to agree to the Joint Stipulations of Dismissal entered in Fox I and II.4

While it is notable that the United States has declined to intervene in each of these cases — and perhaps more notable that Fox entered into Joint Stipulations of Dismissal in both Fox I and II — the fact that one PDP sponsor has served as the relator in at least four qui tam cases (three of which were unsealed within the last eight months) may signal a growing willingness on the part of some PDPs to bring FCA enforcement actions.

Other Recently Unsealed Cases

United States ex rel. Angel v. Alliance Rehabilitation LLC, No. 1:10cv2124 (D.D.C.).

Complaint Filed: December 16, 2010

Complaint Unsealed: April 7, 2014

Current Status: Joint Notice of Voluntary Dismissal and Settlement entered on April 7, 2014.

Intervention Status: The United States intervened in part on April 4, 2014 for the purpose of effectuating the Settlement Agreement. The government did not file a complaint.

Name of Relators: Kathya Angel and Alexis Natal

Defendants’ Business: The defendants provide physical therapy services in Washington, D.C., Maryland, and Virginia and include five corporate entities and three associated individuals.

Relators’ Relationship to Defendants: Former employees

Relators’ Counsel: The Employment Law Group

Claims: Among other things, the relators brought claims against the defendants for alleged violations of the FCA for false claims, false statements, and conspiracy (under 31 U.S.C. §§ 3729(a)(1)(A), (B), and (C)), and also for retaliation (31 U.S.C. § 3730(h)).

Summary of Case: The relators alleged that the defendants engaged in fraudulent and improper billing practices when submitting claims to the Medicare and TRICARE programs. The allegations included assertions of billing for work performed by unlicensed providers and other unqualified personnel, “upcoding” or misrepresenting services provided, submitting claims for services never provided, and recommending services that were not in the patient’s best interests (i.e., “not medically necessary”).

Ultimately, the government chose to intervene in part to effectuate a settlement, and the parties agreed to a joint voluntary dismissal. The defendants agreed to pay the United States $2.78 million to settle allegations that the defendants had falsely represented that the physical therapy services being billed were rendered or supervised by the provider whose National Provider Identifier (“NPI”) was listed on the claim, when, in some cases, the provider identified had no involvement in the treatment.

The defendants also entered into a five-year Corporate Integrity Agreement (“CIA”) with the Office of Inspector General for the Department of Health and Human Services (“OIG”). Among other obligations, the CIA requires the defendants to obtain an independent review of coding, billing, and claims submissions to federal health care programs.

Reasons to Watch: This case is yet another example of a Settlement Agreement being filed promptly after the unsealing of a qui tam complaint. It should be noted that the resulting CIA imposes obligations on both the corporations and the three individual defendants. This case is also interesting as an example of a qui tam relator being represented by what is nominally — and in this case, quite literally — an employment law firm. Many whistleblowers start out as disgruntled current and former employees. Plaintiff-side employment law firms are increasingly capitalizing on that dynamic to bring whistleblower claims in addition to traditional discrimination or wrongful termination actions. Growth in the number of qui tam actions being filed may both incentivize and be fueled by entry of traditional employment firms into the field of whistleblower litigation.

United States ex rel. Madany v. Shahab, No. 2:09-cv-13693 (E.D. Mich.)

Complaint Filed: September 17, 2009 (original); May 14, 2014 (Complaint in Intervention)

Complaint Unsealed: April 30, 2014

Current Status: Pending

Intervention Status: The United States intervened in part against a subset of the named defendants (24 individual defendants and 8 home health service providers) on April 17, 2014. The relators dismissed their claims against the remaining individual and corporate defendants against whom the government did not intervene on July 7, 2014.

Name of Relators: Ruqiayah Madany and John B. Collins

Defendants’ Business: Multiple home health corporations and their individual owners and operators in the Detroit metropolitan area, as well as hundreds of named and unnamed individual physicians, physical therapists, patients, patient recruiters, and marketers/consulting entities for these entities who were allegedly involved in the scheme.

Relators’ Relationship to Defendants: Employees (billing and administrative staff)

Relators’ Counsel: Vezina Law, PLC and Nacht, Roumel, Salvatore, Blanchard & Walker, P.C.

Claims: Among other things, the relators brought claims against the defendants for alleged violations of the FCA for false claims, false statements, conspiracy, concealment of an obligation to repay the government (31 U.S.C. §§ 3729(a)(1)(A), (B), (C), and (G)), and for common law unjust enrichment.

Summary of Case: The relators alleged that the defendants submitted false claims for home health services based on underlying violations of the AKS. Specifically, the relators accused the principal defendants both of conspiring to provide kickbacks to a vast network of marketers, patient recruiters, and physicians, and also of engaging in a complex patient transfer scheme that allowed the owners of the various home health agencies (“HHAs”) to “churn” patients from agency to agency (or from facility to facility) based on false certifications of eligibility for home health services. In addition, the home health providers involved in the scheme allegedly often did not provide the services they claimed patients received, inflated the level of services provided to patients, and filed false cost reports with the government. The alleged churning of patients among the conspiring home health providers also concealed that patients were receiving multiple 60-day episodes of home care without being properly certified or recertified for such services. Relators asserted FCA claims premised on both false certification of compliance with federal law (due to the purported illegal kickbacks) and factually false claims (based on billing for services allegedly not provided or billing for different and more expensive services than those actually provided).

Reasons to Watch: This case exemplifies the government’s continuing focus on HHA-related fraud schemes. The relators in this case alleged a large-scale conspiracy closely resembling past cases that the Medicare Fraud Strike Force (“Strike Force”) for the Eastern District of Michigan pursued and won. The government has focused its investigatory resources on large-scale investigations to get “more bang for the buck” and to maximize public visibility of health care fraud enforcement efforts. For instance, in the most recent “mega-takedown,” the Strike Force charged 90 individuals who were purportedly responsible for $260 million in false billings to federal health care programs. 5 Seven of these 90 individuals were located in Detroit and were charged for their roles in fraud schemes involving approximately $30 million in false claims for medically unnecessary services, including home health services, psychotherapy, and infusion therapy. It is unclear whether this case was linked to the existing Strike Force’s efforts or whether it was brought to the government’s attention independently.

Of note, the government whittled down the number of defendants in the case in electing to intervene only in part.

United States ex rel. Brown v. Holy Spirit Hospital of the Sisters of Christian Charity, No. 1:12-cv-1197(M.D. Pa.)

Complaint Filed: June 22, 2012

Complaint Unsealed: May 15, 2014

Current Status: Dismissed

Intervention Status: The United States declined to intervene on May 14, 2014.

Name of Relators: Natalie Brown and Renee Connor

Defendants’ Business: Holy Spirit Hospital of the Sisters of Christian Charity is an acute care, nonprofit hospital operating in Camp Hill, Pennsylvania. The relators also sued Holy Spirit Health System, which owns and operates Holy Spirit Hospital, and Quantum Imaging and Therapeutics Associates, Inc., which provides physician services for interpreting nuclear imaging studies.

Relators’ Relationship to Defendants: Brown and Connor are former employees of Holy Spirit Hospital. Brown was the hospital’s Charge Master Coordinator and Connor worked as the Denial Management Coordinator.

Relators’ Counsel: Kline & Specter, PC

Claims: The relators brought claims against the three defendants for alleged violations of the FCA for false claims, false statements, and “reverse” false claims (31 U.S.C. §§ 3729(a)(1)(A), (B), and (G)).

Summary of Case: The relators independently discovered that Holy Spirit Hospital had been allegedly improperly billing several diagnostic tests without actually performing them. After notifying colleagues of these alleged improprieties, the relators contended that the administration decided to stop billing for the tests, but also decided not to repay the government. The complaint alleges that, in response to a discussion about repaying the government, one relator’s supervisor supposedly commented, “[i]f they want it, they can come get it.”

The relators alleged that Holy Spirit Hospital engaged in what was called “explode billing” or “bundling.” They asserted that the hospital’s radiology department would always bill for a certain diagnostic test, in addition to three underlying imaging examinations. However, the radiology personnel would allegedly only perform the underlying examination, not the additional diagnostic test. Automatically pairing this unperformed diagnostic test with the imaging examination allegedly led to overpayments by the government. The relators also contended that the Emergency Department and Sleep Diagnostic Center would bill for unperformed diagnostic tests, for which Holy Spirit Hospital never repaid the government.

Reasons to Watch: The relators in this case asserted that Holy Spirit Hospital acknowledged that several of its billing practices resulted in overpayments by the government but chose not to report or repay that amount. Although Holy Spirit Hospital did end those allegedly problematic billing practices, it still faces potential liability under the FCA for failing to report the overpayment to the government within 60 days. For entities that encounter an internal report of potential overpayment, this case may serve as another factor to consider: not only should the practices resulting in overpayment be stopped, but also the overpayment should be reported and refunded within 60 days to avoid potential FCA liability.

United States ex rel. Mahmood v. Elizabethtown Hematology Oncology, PLC, et al., No. 3:11-cv-00376 (W.D. Ky.).

Complaint Filed: June 27, 2011

Complaint Unsealed: June 3, 2014

Current Status: Settled on June 3, 2014

Intervention Status: The United States intervened (but the date of intervention is unclear because part of the docket is still sealed).

Name of Relator: Dr. Ijaz Mahmood

Defendants’ Business: The defendant Elizabethtown Hematology Oncology, PLC is a health care provider specializing in the treatment of medical conditions related to hematology and oncology. Individual defendants are doctors and partners at Elizabethtown.

Relator’s Relationship to Defendants: Dr. Mahmood was formerly employed as a hematologist/oncologist at Elizabethtown.

Relator’s Counsel: Caudill Law Firm

Claims: The relator brought claims against the defendants for alleged violations of the FCA for false claims and conspiracy to submit false claims (under 31 U.S.C. §§ 3729(a)(1) and (3)) and also for an AKS violation (under 42 U.S.C. § 1320a-7(b)(1) and (2), and § 1395nn).

Summary of Case: Elizabethtown Hematology Oncology, PLC, and its owners agreed to pay $3.7 million to resolve allegations that they submitted or caused to be submitted false claims to the Medicare, Medicaid, TRICARE, and the Federal Employee Health Benefit Program (“FEHBP”) for unnecessarily extending the duration of chemotherapy infusion treatments to patients and inappropriately billing office visits for infusion therapy treatments. The relator will receive $283,412 as part of the settlement.

Specifically, according to the settlement agreement, the United States and the Commonwealth of Kentucky alleged that, from January 1, 2005 through December 31, 2010, the defendants billed Medicare, Medicaid, TRICARE, and FEHBP for unnecessary office visit evaluations at the same time patients were receiving chemotherapy or other types of infusion treatments. The defendants allegedly did this by improperly billing evaluation and management codes using Modifier-25, which allows for billing evaluation and management necessary prior to the performance of a procedure.

The United States and the Commonwealth of Kentucky also alleged that, from January 1, 2006 through December 31, 2012, the defendants unnecessarily and improperly extended the duration of chemotherapy infusion treatment times for their patients in order to improperly bill Medicare, Medicaid, TRICARE, and FEHBP for the additional hours of chemotherapy infusion treatments. As part of his qui tam lawsuit, the relator alleged that the defendants developed written protocols that increased chemotherapy infusion times by a factor of three or more beyond generally recognized standards of medical practice.

In addition to the $3.7 million payment, Elizabethtown Hematology Oncology entered into a three-year CIA with the OIG. The agreement requires enhanced accountability and wide-ranging monitoring activities, to be conducted by both internal and independent external reviewers.

Reasons to Watch: This settlement is noteworthy for several reasons. First, the nature of the alleged conduct — manipulating cancer treatment protocols to unsafe levels in order to increase reimbursement — is, as stated by the government, “utterly unconscionable.” The conduct described in the relator’s complaint likely contributed in part to the government’s decision to intervene.

Second, as stated above, the alleged conduct involved the extension of actual services rendered and the provision of potentially unnecessary evaluation services. By intervening, the government put itself in the position of having to prove what treatments and evaluations were medically necessary and appropriate.

Third, this settlement is a worthwhile reminder that the FCA applies not only to Medicare and Medicaid, but also to all other government payors, including TRICARE, which covers uniformed service members and their families, and FEHBP, which covers federal government employees.

Endnotes

1 Please note that due to overlap in categories discussed below, the sum of the totals for the various sub-categories of cases addressed below does not add up to 65 cases.

2 These 12 cases dismissed pursuant to a Settlement Agreement are not included in the 18 cases listed as having been dismissed prior to settlement.

3 In yet another case, Fox filed suit in January 2012 against Omnicare Inc. and NeighborCare Inc. (“Omnicare”), PharMerica Corp., and MHA Long Term Care Network (a named defendant in Fox I and II), all of which provide drugs to long-term-care facilities, accusing them of violating the federal False Claims Act and state false claims laws by not providing generics when they were requested and by dispensing expired drugs (United States ex rel. Fox Rx, Inc. v. Omnicare, Inc., No. 1:12-cv-00275-DLC (S.D.N.Y.)). The U.S. District Court for the Southern District of New York dismissed the suit and rejected Fox’s theory that by engaging in such practices (which were prohibited by state law), the defendants had falsely indicated in submissions to a federal agency that the drugs they dispensed were covered by Medicare. The court dismissed the Fox claim in reliance on settled Second Circuit precedent, first established in Mikes v. Straus, 274 F.3d 687, 697 (2d Cir. 2001), holding that a claim based on an implied false certification is only actionable if the underlying statute or regulation explicitly conditions payment on a provider’s compliance with that statute or regulation. See Court Dismisses Lawsuit Alleging Pharmacies Submitted False Claims, BNA Bloomberg Health Law Resource Center (Aug. 14, 2014), http://healthlawrc.bna.com/hlrc/4225/split_display.adp?fedfid=51545069&vname=hcenotallissues&jd=a0f4q2d4e1&split=0.

4 United States ex rel. Fox Rx, Inc. v. Omnicare, Inc., No. 1:11-cv-00962-WSD (N.D. Ga.). See also Joint Stipulation of Dismissal, United States ex rel. Fox Rx, Inc. v. Managed Health Care Associates, Inc., No. 2:13cv6154 (C.D. Cal.); Joint Stipulation of Dismissal, United States ex rel. Fox Rx, Inc. v. Managed Health Care Associates, Inc., No. 2:13cv08433 (C.D. Cal.).

5 Press Release, “Medicare Fraud Strike Force charges 90 individuals for approximately $260 million in false billing,” (May 13, 2014) available at http://www.hhs.gov/news/press/2014pres/05/20140513b.html. Detroit, in fact, is one of the cities subject to the six-month moratorium on new HHA provider enrollment in the Medicare program. Centers for Medicare & Medicaid Services, “Second wave of CMS’ enrollment moratoria extended for home health and ground ambulance suppliers; four new geographic areas added, (Jan. 30, 2014) available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2014-Press-releases-items/2014-01-30-2.html

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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How We Protect Your Information

JD Supra takes reasonable and appropriate precautions to insure that user information is protected from loss, misuse and unauthorized access, disclosure, alteration and destruction. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. You should keep in mind that no Internet transmission is ever 100% secure or error-free. Where you use log-in credentials (usernames, passwords) on our Website, please remember that it is your responsibility to safeguard them. If you believe that your log-in credentials have been compromised, please contact us at privacy@jdsupra.com.

Children's Information

Our Website and Services are not directed at children under the age of 16 and we do not knowingly collect personal information from children under the age of 16 through our Website and/or Services. If you have reason to believe that a child under the age of 16 has provided personal information to us, please contact us, and we will endeavor to delete that information from our databases.

Links to Other Websites

Our Website and Services may contain links to other websites. The operators of such other websites may collect information about you, including through cookies or other technologies. If you are using our Website or Services and click a link to another site, you will leave our Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We are not responsible for the data collection and use practices of such other sites. This Policy applies solely to the information collected in connection with your use of our Website and Services and does not apply to any practices conducted offline or in connection with any other websites.

Information for EU and Swiss Residents

JD Supra's principal place of business is in the United States. By subscribing to our website, you expressly consent to your information being processed in the United States.

  • Our Legal Basis for Processing: Generally, we rely on our legitimate interests in order to process your personal information. For example, we rely on this legal ground if we use your personal information to manage your Registration Data and administer our relationship with you; to deliver our Website and Services; understand and improve our Website and Services; report reader analytics to our authors; to personalize your experience on our Website and Services; and where necessary to protect or defend our or another's rights or property, or to detect, prevent, or otherwise address fraud, security, safety or privacy issues. Please see Article 6(1)(f) of the E.U. General Data Protection Regulation ("GDPR") In addition, there may be other situations where other grounds for processing may exist, such as where processing is a result of legal requirements (GDPR Article 6(1)(c)) or for reasons of public interest (GDPR Article 6(1)(e)). Please see the "Your Rights" section of this Privacy Policy immediately below for more information about how you may request that we limit or refrain from processing your personal information.
  • Your Rights
    • Right of Access/Portability: You can ask to review details about the information we hold about you and how that information has been used and disclosed. Note that we may request to verify your identification before fulfilling your request. You can also request that your personal information is provided to you in a commonly used electronic format so that you can share it with other organizations.
    • Right to Correct Information: You may ask that we make corrections to any information we hold, if you believe such correction to be necessary.
    • Right to Restrict Our Processing or Erasure of Information: You also have the right in certain circumstances to ask us to restrict processing of your personal information or to erase your personal information. Where you have consented to our use of your personal information, you can withdraw your consent at any time.

You can make a request to exercise any of these rights by emailing us at privacy@jdsupra.com or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

You can also manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard.

We will make all practical efforts to respect your wishes. There may be times, however, where we are not able to fulfill your request, for example, if applicable law prohibits our compliance. Please note that JD Supra does not use "automatic decision making" or "profiling" as those terms are defined in the GDPR.

  • Timeframe for retaining your personal information: We will retain your personal information in a form that identifies you only for as long as it serves the purpose(s) for which it was initially collected as stated in this Privacy Policy, or subsequently authorized. We may continue processing your personal information for longer periods, but only for the time and to the extent such processing reasonably serves the purposes of archiving in the public interest, journalism, literature and art, scientific or historical research and statistical analysis, and subject to the protection of this Privacy Policy. For example, if you are an author, your personal information may continue to be published in connection with your article indefinitely. When we have no ongoing legitimate business need to process your personal information, we will either delete or anonymize it, or, if this is not possible (for example, because your personal information has been stored in backup archives), then we will securely store your personal information and isolate it from any further processing until deletion is possible.
  • Onward Transfer to Third Parties: As noted in the "How We Share Your Data" Section above, JD Supra may share your information with third parties. When JD Supra discloses your personal information to third parties, we have ensured that such third parties have either certified under the EU-U.S. or Swiss Privacy Shield Framework and will process all personal data received from EU member states/Switzerland in reliance on the applicable Privacy Shield Framework or that they have been subjected to strict contractual provisions in their contract with us to guarantee an adequate level of data protection for your data.

California Privacy Rights

Pursuant to Section 1798.83 of the California Civil Code, our customers who are California residents have the right to request certain information regarding our disclosure of personal information to third parties for their direct marketing purposes.

You can make a request for this information by emailing us at privacy@jdsupra.com or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

Some browsers have incorporated a Do Not Track (DNT) feature. These features, when turned on, send a signal that you prefer that the website you are visiting not collect and use data regarding your online searching and browsing activities. As there is not yet a common understanding on how to interpret the DNT signal, we currently do not respond to DNT signals on our site.

Access/Correct/Update/Delete Personal Information

For non-EU/Swiss residents, if you would like to know what personal information we have about you, you can send an e-mail to privacy@jdsupra.com. We will be in contact with you (by mail or otherwise) to verify your identity and provide you the information you request. We will respond within 30 days to your request for access to your personal information. In some cases, we may not be able to remove your personal information, in which case we will let you know if we are unable to do so and why. If you would like to correct or update your personal information, you can manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard. If you would like to delete your account or remove your information from our Website and Services, send an e-mail to privacy@jdsupra.com.

Changes in Our Privacy Policy

We reserve the right to change this Privacy Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our Privacy Policy will become effective upon posting of the revised policy on the Website. By continuing to use our Website and Services following such changes, you will be deemed to have agreed to such changes.

Contacting JD Supra

If you have any questions about this Privacy Policy, the practices of this site, your dealings with our Website or Services, or if you would like to change any of the information you have provided to us, please contact us at: privacy@jdsupra.com.

JD Supra Cookie Guide

As with many websites, JD Supra's website (located at www.jdsupra.com) (our "Website") and our services (such as our email article digests)(our "Services") use a standard technology called a "cookie" and other similar technologies (such as, pixels and web beacons), which are small data files that are transferred to your computer when you use our Website and Services. These technologies automatically identify your browser whenever you interact with our Website and Services.

How We Use Cookies and Other Tracking Technologies

We use cookies and other tracking technologies to:

  1. Improve the user experience on our Website and Services;
  2. Store the authorization token that users receive when they login to the private areas of our Website. This token is specific to a user's login session and requires a valid username and password to obtain. It is required to access the user's profile information, subscriptions, and analytics;
  3. Track anonymous site usage; and
  4. Permit connectivity with social media networks to permit content sharing.

There are different types of cookies and other technologies used our Website, notably:

  • "Session cookies" - These cookies only last as long as your online session, and disappear from your computer or device when you close your browser (like Internet Explorer, Google Chrome or Safari).
  • "Persistent cookies" - These cookies stay on your computer or device after your browser has been closed and last for a time specified in the cookie. We use persistent cookies when we need to know who you are for more than one browsing session. For example, we use them to remember your preferences for the next time you visit.
  • "Web Beacons/Pixels" - Some of our web pages and emails may also contain small electronic images known as web beacons, clear GIFs or single-pixel GIFs. These images are placed on a web page or email and typically work in conjunction with cookies to collect data. We use these images to identify our users and user behavior, such as counting the number of users who have visited a web page or acted upon one of our email digests.

JD Supra Cookies. We place our own cookies on your computer to track certain information about you while you are using our Website and Services. For example, we place a session cookie on your computer each time you visit our Website. We use these cookies to allow you to log-in to your subscriber account. In addition, through these cookies we are able to collect information about how you use the Website, including what browser you may be using, your IP address, and the URL address you came from upon visiting our Website and the URL you next visit (even if those URLs are not on our Website). We also utilize email web beacons to monitor whether our emails are being delivered and read. We also use these tools to help deliver reader analytics to our authors to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

Analytics/Performance Cookies. JD Supra also uses the following analytic tools to help us analyze the performance of our Website and Services as well as how visitors use our Website and Services:

  • HubSpot - For more information about HubSpot cookies, please visit legal.hubspot.com/privacy-policy.
  • New Relic - For more information on New Relic cookies, please visit www.newrelic.com/privacy.
  • Google Analytics - For more information on Google Analytics cookies, visit www.google.com/policies. To opt-out of being tracked by Google Analytics across all websites visit http://tools.google.com/dlpage/gaoptout. This will allow you to download and install a Google Analytics cookie-free web browser.

Facebook, Twitter and other Social Network Cookies. Our content pages allow you to share content appearing on our Website and Services to your social media accounts through the "Like," "Tweet," or similar buttons displayed on such pages. To accomplish this Service, we embed code that such third party social networks provide and that we do not control. These buttons know that you are logged in to your social network account and therefore such social networks could also know that you are viewing the JD Supra Website.

Controlling and Deleting Cookies

If you would like to change how a browser uses cookies, including blocking or deleting cookies from the JD Supra Website and Services you can do so by changing the settings in your web browser. To control cookies, most browsers allow you to either accept or reject all cookies, only accept certain types of cookies, or prompt you every time a site wishes to save a cookie. It's also easy to delete cookies that are already saved on your device by a browser.

The processes for controlling and deleting cookies vary depending on which browser you use. To find out how to do so with a particular browser, you can use your browser's "Help" function or alternatively, you can visit http://www.aboutcookies.org which explains, step-by-step, how to control and delete cookies in most browsers.

Updates to This Policy

We may update this cookie policy and our Privacy Policy from time-to-time, particularly as technology changes. You can always check this page for the latest version. We may also notify you of changes to our privacy policy by email.

Contacting JD Supra

If you have any questions about how we use cookies and other tracking technologies, please contact us at: privacy@jdsupra.com.

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This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.