The Court has previously determined that the portion of the amended complaint that alleges claims arising out of the joint-venture agreements and the provision of free services to physicians will be dismissed for failure to comply with the pre-suit requirements of the False Claims Act. Previo Read More Export Get Full Access to Martin's Info Last Update 12/13/2021 10:41 PM Email @fmcna.com HQ Phone (781) 699-9000 Company Fresenius Medical Care North SALTER, GARY vs. FRESENIUS MEDICAL CARE HOLDINGS INC, Instituto Mexicano del Seguro Social v. Fresenius Medical Care AG & Co. KGaA. plaintiff the benefit of all reasonable inferences therefrom. Ruiz v. Bally Total Fitness Holding Corp., 496 F.3d 1, 5 (1st Cir. The fact that the CKD complaint was dismissed on jurisdictional grounds is therefore irrelevant. medical director agreements that compensated physicians in excess of fair market value and contained sticks and carrots, in the form of onerous non-competition covenants and medical directorship rights of first refusal to provide medical director services at other centers; non-fair market value joint venture arrangements that allegedly did not comply with applicable fraud and abuse safe harbors, both because physician referral sources often held more than a 40% equity interest in such centers and because they were offered equity in such centers at less than fair market value. As to some of those medical practices, the complaint provides some amount of additional detail, although again it does not describe any specific false claims. 42 U.S.C. Rather, the complaint must allege both the existence of a scheme and the making of particular false claims resulting from the scheme. 154). may be available from PACER. Previously, Kelly was a Quality Assurance Analyst at S Read More Contact Kelly Flanagan's Phone Number and Email Last Update 3/15/2023 6:18 PM Email k***@fresenius-kabi.com Engage via Email Contact Number (708) ***-**** Engage via Free or Below-Cost Management Services. But this is not enough to satisfy Rule 9(b).). Protecting Participants of Clinical Trials Conducted in the Est. Martin Flanagan | Book Depository occurred in the manner which is specified in the FCA; and (3) the relator's suit [is] based upon' those publicly disclosed allegations or transactions. U.S. ex rel. . Add to at 999. Martin Flanagan Quick View. (Id. 247-48). It then provides a table of patients and patient treatments for the same facilities over the same time period. Here, the allegations are substantially similar to those in CKD and are thus based upon the public disclosures. (Id.). 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. 2:22-CV-01807 | 2022-10-21, U.S. District Courts | Personal Injury | And it further alleges that Flanagan was instructed not to enforce escalator clauses, which called for annual fee increases of up to 4.0%. 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. For the sake of simplicity, the Court will focus first on the Medicare claims. Fourth, it alleges that FMCNA entered into favorable leases with medical directors that paid them above-market rates. ESRD expenditures by Medicare exceed $40 billion annually. 331). After a review of the claims, the government declined to intervene. In substance, the complaint alleged that FMCNA engaged in a scheme to pay kickbacks to physicians with whom it had entered into joint-venture agreements. WebSenior Vice President of Strategic Business Integrations Fresenius Medical Care. 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. Compl. No published case in the First Circuit, however, has ever gone so far. Paperback. (Id. 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. (Id. United States v. Fresenius Med. Care Holdings - casetext.com 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. 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. Previously, Martin was a Senior Na tional Account Manager at QuickSTAT. Access this case on the Massachusetts District Court's Electronic Court Filings (ECF) System. If the trial Judge issues an Order of Reference of any matter in this case to a Magistrate Judge, the matter will be transmitted to Magistrate Judge Judith G. Dein. Nor does it provide any representative or sample claims. (Id.). Journal of Intensive Care Medicine 2011 26: 4, 237-249 Download Citation. 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. Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111 (1st Cir. . If relator is correct, that means that the entire government-payor business of FMCNA-which appears to amount to more than $10 billion in revenue per year-is based on fraud. (Id. MEMORANDUM AND ORDER: This case was erroneously assigned to my docket as a result of a failure by docketing personnel in the Clerks Office to recognize that it is not related to the MDL proceeding assigned to me. (Id. We remand for further proceedings. 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. Bell Atl. Feb. 25, 2013), the mere publication of compensation information, without an allegation of fraud or misrepresentation, is not sufficient to trigger the bar. 84). (Id. Flanagan 2014), the First Circuit affirmed the denial of a motion to amend the complaint a third time. (Id. Under the FCA, a relator must comply with the following requirements: Those notification requirements were enacted to allow the Government an adequate opportunity to fully evaluate the private enforcement suit and determine both if that suit involves matters the Government is already investigating and whether it is in the Government's interest to intervene and take over the civil action. United States ex rel. 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. Patients who were referred to non-FMCNA clinics were categorized as leakage. (Id. (Id. Why is this public record being published online? 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. 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. Ex. The plausibility standard is not akin to a probability requirement,' but it asks for more than a sheer possibility that a defendant has acted unlawfully. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 556). 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. 3729(a)(1)(A) (Count 1); making or using false records material to a false or fraudulent claim in violation of the False Claims Act, 31 U.S.C. The complaint alleges that certain medical practices, such as Diablo and Balboa, benefited financially from medical-director agreements and joint-venture agreements with FMCNA, that in return they referred patients to FMCNA facilities, and as a result all of their claims for government reimbursement were false. (Id. (Finn, Mary) (Entered: 10/05/2021). Plaintiff-Relator Martin Flanagan (Relator) worked for Fresenius for twenty-nine years, most recently as Director of Acute Market Development for the It appears, therefore, that the government may have suffered little or no actual financial loss. 2016). 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. constitutes a false claim.); id. The third, and perhaps most difficult, issue is whether the amended complaint pleads fraud with sufficient particularity to meet the requirements of Fed.R.Civ.P. Relator responds that (1) the complaints do not allege the same essential facts and (2) the CKD complaint was later dismissed on jurisdictional grounds, which makes the first-to-file bar inapplicable. However, general allegations of illegal or fraudulent practices, without more, are not sufficient to state a claim under the False Claims Act. 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. Pilon v. Martin Marietta Corp., 60 F.3d 995, 998-99 (2d Cir. v. Fresenius Medical Care See Kelly, 827 F.3d at 15 (It may not be irrational to infer that, given [the allegations of the fraudulent scheme], some false claims . Now, a relator may also qualify as an original source if prior to a public disclosure under subsection (e)(4)(a), [he] voluntarily disclosed to the Government the information on which allegations or transactions in a claim are based. Id. 83). UNITED STATES ex rel. FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North America, (#20) NOTICE of Appearance by Noah M Rich on behalf of Martin Flanagan (Rich, Noah) (Entered: 11/24/2021), (#19) NOTICE of Appearance by W. Scott Simmer on behalf of Martin Flanagan (Simmer, W.) (Entered: 11/22/2021), Affidavit Certificate of Noah M. Rich in Support of Motion for Appearance Pro Ha, Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro H, Affidavit Certificate of W. Scott Simmer in Support of Motion for Admission Pro, (#12) NOTICE of Appearance by Christopher P. Sullivan on behalf of Martin Flanagan (Sullivan, Christopher) (Entered: 11/18/2021), Affidavit Certification of Megan S. Heinsz, (#4) NOTICE of Appearance by Maria R. Durant on behalf of Fresenius Medical Care Holdings, Inc. (Durant, Maria) (Entered: 10/07/2021), (#3) NOTICE of Appearance by William H. Kettlewell on behalf of Fresenius Medical Care Holdings, Inc. (Kettlewell, William) (Entered: 10/07/2021), Docket(#20) NOTICE of Appearance by Noah M Rich on behalf of Martin Flanagan (Rich, Noah) (Entered: 11/24/2021), Docket(#19) NOTICE of Appearance by W. Scott Simmer on behalf of Martin Flanagan (Simmer, W.) (Entered: 11/22/2021), Docket(#18) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #17 Motion for Leave to Appear Pro Hac Vice Added Noah M. Rich. 3730(b)(5). (Id.). According to the complaint, FMCNA budgeted for the anticipated losses in the acute programs at many of the larger hospitals. The Call. See East Bay Mun. for money or property presented to an officer, employee, or agent of the United States. 750 F.3d at 120. The settlement required DaVita to repay a total of $400 million to the federal government and various states, and the CIA that it entered into with the government impacted various aspects of DaVitas business operations. 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. 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. our revenues would decrease. (Id. Martin Flanagan worked for Fresenius Medical Care North America (FMCNA) for 29 years. United States ex rel. Flanagan v. Fresenius Med. Care To the extent that the amended complaint addresses those remuneration relationships, therefore, the claims will not be dismissed. The complaint further alleges that FMCNA paid its medical directors far above fair market value. The government can intervene in a qui tam action and assume primary responsibility over it. 184-97). 2023-03-21, U.S. Courts Of Appeals | Other | Search Google Scholar for this author 97-106). 31 U.S.C. (Id. Subscribe to Justia's Free Newsletters featuring summaries of federal and state court opinions. Roughly 90% of all dialysis patients undergo hemodialysis at a dialysis clinic three times per week. v. Fresenius Medical Care [$6,000,000.00] - San Diego Sexual Harassment Attorneys, Sexual Harassment Lawyers in San Diego, CA. See Wilson, 2011 WL 2462469, at *7. 2016) (citing Duxbury I, 579 F.3d at 29). 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. Finally, one place to get all the court documents we need. 85). were false.); id. The description of the alleged scheme consisted of 25 paragraphs. Poteet v. Medtronic, Inc., 552 F.3d 503, 516-17 (6th Cir. L. No. 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. The qui tam provisions of the FCA permit relators, in some instances, to reap huge financial windfalls. Flanagan and his colleagues were allegedly instructed by their superiors to obtain hospital contracts at any cost to secure the referrals of discharged patients. 4:05-cv-985 (E.D. 3729 et seq., by a company that provides dialysis services to patients with kidney failure. Submission of claims to Medicaid that were ineligible for payment because of violation of the AKS are actionable under the FCA because the payments of those claims were made with federal funds. The statute defines original source as an individual who, [1] prior to a public disclosure . 198-205). These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia. Accordingly, and for the following reasons, the motion to dismiss will be granted. 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. 02-11738, 2013 WL 682740, at *5 (D. Mass. Flanagan v. Fresenius Medical Care Holdings, Inc., No. 18). (Id. President, National Cardiovascular Partners; President, Spectra Laboratories. 38). Sanders, 553 U.S. 662 (2008). 25). 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. 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.

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