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JUSTICE NEWS – Department of Justice, Office of Public Affairs – Thursday, August 8, 2019
Medicare Advantage Provider and Physician to Pay $5 Million to Settle False Claims Act Allegations
US ex rel Nutter DOJ press release (1)
Beaver Medical Group L.P. (Beaver) and one of its physicians, Dr. Sherif Khalil, have agreed to pay a total of $5,039,180 to resolve allegations that they reported invalid diagnoses to Medicare Advantage plans and thereby caused those plans to receive inflated payments from Medicare, the Justice Department announced. Beaver is headquartered in Redlands, California.
“The United States relies on healthcare providers to submit accurate diagnosis data to Medicare Advantage plans to
ensure those plans receive the appropriate compensation from Medicare,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
Under the Medicare Advantage program, also known as the Medicare Part C program, Medicare beneficiaries may opt to obtain health care coverage through private insurance plans that are owned and operated by private insurers known as Medicare Advantage Organizations (MAOs). Medicare pays MAOs a fixed, monthly amount to provide health care coverage to Medicare beneficiaries who enroll in their plans. Medicare adjusts these monthly payments to reflect the health status of each beneficiary. In general, Medicare pays MAOs more for sicker beneficiaries and less for healthier ones.
MAOs often contract with physician groups and other healthcare providers to provide care to Medicare beneficiaries enrolled in their plans. These healthcare providers report diagnoses and other information to the MAOs, which the MAOs then submit to Medicare in order to obtain higher risk-adjusted payments.
In this case, several MAOs in California contracted with Beaver to provide health care to Medicare beneficiaries
enrolled in their plans. The MAOs often compensated Beaver with a share of the payments that the MAOs received
from Medicare for the beneficiaries under Beaver’s care. Thus, Beaver had a financial incentive to submit additional
diagnosis codes to the MAOs in order to increase the payments that the MAOs received from Medicare. The settlement resolves allegations that Beaver and Dr. Khalil knowingly submitted diagnoses that were not supported by the beneficiaries’ medical records in order to inflate the payments that the MAO received from Medicare. “As enrollment in Medicare Advantage continues to grow, investigation into accuracy of diagnosis data becomes ever
more important,” said Timothy B. Francesca, Acting Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Those who inflate bills sent to government health programs can expect to pay a heavy price.”
The settlement resolves allegations originally brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act by Dr. David Nutter, a former employee of Beaver. The act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. Dr. Nutter will receive approximately $850,000.
The government’s intervention in this matter illustrates its emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
This matter was handled by the Civil Division’s Commercial Litigation Branch and the Department of Health and Human Services, Office of Inspector General.
The case is docketed as United States ex rel. David Nutter, M.D., and David Nutter, M.D., individually, v. Sherif F. Khalil, M.D., Beaver Medical group, L.P., The Beaver Medical Clinic, Inc., Epic Management, L.P., and Epic Management, Inc.,
No. CVC17-02035-PSG-KKX (C.D. Cal.).
The claims resolved by the settlement are allegations only; there has been no determination of liability.
Topic(s):
False Claims Act
Component(s):
Civil Division
Press Release Number:
19-844
Updated August 8, 2019
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Our Achievements
100 Million Dollar Settlement Fund for Women Injured by a New Birth Control Product
Jason T. Brown was the first attorney in the country to file a battery of cases on behalf of women who sustained blood clots, such as deep vein thrombosis, pulmonary embolisms, strokes and death from a new Birth control Product. Jason T. Brown’s prior firm was on the PSC (Plaintiff Steering Committee) and served as liaison counsel in the state mass tort action. The firm is no longer accepting new cases.
Tens of Millions in Settlements for Mass Tort Injuries and Class Actions

$7 Million Plus Settlement for Consumer Fraud

$7 Million Dollar Commercial Litigation Settlement

$5.475+ Million Settlement for Temple Online Students
Value of the settlement when factoring in non-economic relief exceeds $7 million dollars. Description and Settlement forms available at:
www.templeombasettlement.com
www.templeotherfoxprogramssettlement.com

Millions in Settlements for Women Injured by New Generation Hormonal Product
Women who sustained blood clots from a new Generation Hormonal Product received and continue to receive compensation for their injuries. Compensable injuries include Pulmonary Embolisms (PE), Deep-Vein Thrombosis (DVT), Strokes and Death. The firm is still investigating and accepting cases.

Nationwide $3.5 Million Settlement for Wage & Hour Class Action Case
Case brought on behalf of at home call center workers who were not paid for all their time worked including boot up time, technical time and other time. Workers were told by the company that boot up time which lasted 15 minutes or more was not paid because it was considered their commute to work. Fair Labor Standards Act (FLSA).

$3.2 Million Settlement for Wage & Hour Class Action Case
Case brought on behalf of workers who were misclassified as salaried exempt from overtime. The employer led employees to believe that they had to work unlimited hours over 40 without overtime compensation even though based on their job duties it was alleged they were entitled to overtime pay.

$2.4 Million Dollar Settlement for Wage & Hour Class Action
Lawsuit was brought as a class action on behalf of workers who worked in excess of 40 hours a week and were not paid overtime. The employer was forcing them to work “off the clock” for those hours and failed to pay proper overtime compensation.

$2 Million Dollar Settlement for False Claims Act (Whistleblower Case)

“$2 Million Dollar False Claims Act (FCA) Settlement – Unnecessary Services”
A case against GenomeDx was brought alleging violations of the False Claims Act (FCA) and the California Insurance Claims Fraud Prevention Act regarding unnecessary services such as the testing of tissues that did not need to be tested. The case resulted in a $350,000 whistleblower award.

$2 Million Dollar Settlement for Truck Accident Victim
Our firm was Of Counsel to a serious truck accident case involving a trucking accident with multiple injuries.

Nationwide $1.3 Million Judgment against Future Income Payments and Scott Kohn for Consumer Fraud
Scott Kohn and Future Income Payments conspired to defraud veterans out of their hard earned pensions by offering them loans at loanshark rates and claiming it was a “purchase” not a loan.

$1.7 Million Dollar Settlement for Wage & Hour Case
Misclassified employees under the FLSA were not paid overtime for hours worked in excess of 40. Due to a confidentiality agreement specific details are intentionally omitted.

Judgment with Maximum Damages for Employment Litigation
Judgment for misclassification under the FLSA including maximum damages under State and Federal Laws, plus an incentive fee for the lead plaintiff with attorney fees paid separately. The case involved a worker who was paid a day rate regardless of the amount of hours worked per day and per week.

Class Action Jury Trial
Workers alleged that they were misclassified according to their job duties. The Defendant claimed an administrative exemption under the FLSA and state law. Misclassification cases under the FLSA are the cases most often tried due to non-monetary considerations. Jury Trial lasted three weeks. Settlement offered in lieu of appeal.

Acquittal at Trial
Despite videotaped evidence that the prosecutor alleged incriminated the defendant, Mr. Brown was able to obtain an acquittal at trial for his client. Please note, that while we, the Brown, LLC will provide consultations in defense matters, the firm spends most of its time litigating complex litigation such as class actions, mass torts and catastrophic injuries.

Judgment with Maximum Damages for Wage & Hour Dispute
Wage & Hour dispute on behalf of hourly employees who were not paid time and a half for hours in excess of 40. Employees were granted double damages for all their time with attorney fees and costs paid separately.

Million Dollar Settlement for Wage & Hour Class Action Case
Workers were compelled to come into work 15 minutes early to set up, but were not paid for their set up time. Gap issues aside, workers received double damages for the time worked for 3 years’ worth of pay with attorney fees paid separately.
This is a non-exhaustive list of prior results and successes of Jason T. Brown and the Brown, LLC. Past results do not guarantee a similar outcome.

For more information about each award see Awards & Accolades – All cases involve Jason T. Brown and/ or Brown, LLC
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