General Description of Medicare and Medicaid Claim Systems. 198-205). However, general allegations of illegal or fraudulent practices, without more, are not sufficient to state a claim under the False Claims Act. 299 (Washington state) (All such claims . Michael P. Flanagan, MD | Penn State Health Id. 38). 1320a-7b, and False Claims Act, 31 U.S.C. 22-1304 | 2022-04-25, U.S. Courts Of Appeals | Other | The original complaint referred to joint-venture agreements between FMCNA and physicians, but only in order to contrast such agreements (which it referred to as a product of arms-length negotiations) with the higher compensation paid to medical directors in the absence of such agreements. Join Facebook to connect with Martin Flanagan and others you may know. (Id. He was employed by Fresenius for 29 years. L. No. The allegations in CKD described a scheme whereby FMCNA allegedly paid kickbacks to doctors with whom it had entered into joint-venture agreements. 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. (Id. 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. 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. Martin Flanagan The CKD complaint therefore contained the essential facts alleged here, thus barring the allegations contained in the amended complaint. (Id. 31 U.S.C. Martin UNITED STATES ex rel. A subscription to PACER is required. The Call. 88). Winkelman v. CVS Caremark Corp., 827 F.3d 201, 208 (1st Cir. Defendant further contends that the original complaint did not contain any allegations concerning medical-director agreements, and that all claims based on such agreements should likewise be dismissed. Email. Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. (Id. Stevens v. Vermont Agency of Nat. To survive a motion to dismiss, a complaint alleging fraud must state with particularity the circumstances constituting fraud. Fed.R.Civ.P. 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 Appearance form, Docketing Statement, and Transcript Report/Order form due 04/19/2023. (Id. Scott Downing at 312.624.6326 or sdowning@beneschlaw.com, Mark Silberman at 312.212.4952 or msilberman@beneschlaw.com, Juan Morado Jr. at 312.212.4967 or jmorado@beneschlaw.com, Whistleblower Lawsuit Against Fresenius Alleges Unlawful Arrangements with Hospitals and Nephrologists Intended to Induce Dialysis Referrals. Finally, one place to get all the court documents we need. claims . 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. See Id. (Id. were false .); id. . The complaint alleges that FMCNA engaged in improper remunerative relationships with medical directors in its outpatient clinics to capture their referrals. (Id. 285-91 (practices in Texas); id. As noted, there are no allegations at all concerning the payments of claims under the CHAMPUS/TRICARE or CHAMPVA programs. It does not follow, however, that where there is an AKS violation, the requirement of establishing a false claim evaporates. See 31 U.S.C. 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. These arrangements allegedly also used long-term non-competition covenants to lock in patient referrals for the centers; non-fair market value space leases for dialysis centers where there was a landlord physician referral source; and. In assessing whether a given later-filed suit is based upon' publicly disclosed allegations, [courts] look to whether those allegations are substantially similar' to said allegations. Cunningham, 713 F.3d at 670. 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. constituted false claims .); id. (Id. Essentially, that version of the complaint alleged that FMCNA's efforts to incentivize referrals to its clinics violated the Anti-Kickback Statute, 42 U.S.C. Relator did comply with that requirement before filing his original complaint, which was 22 pages long and described an illegal scheme with two essential components. (Id. Martin Flanagan United States of America Defendant FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North America CKD Project v. FMCNA, No. 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. (Id. It might also be entirely rational to shift the burden to the defendant: that is, once a relator has established the existence of a kickback scheme, arguably the burden should be shifted to the defendant to prove that certain referrals were not caused by payment of kickbacks. 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. Sandra Martin Work Experience and Education. See United States ex rel. Flanagan v. Fresenius Medical Care Holdings, Inc. 23-1305 | U.S. Court of Appeals, First Circuit | Justia Justia Dockets & Filings First Circuit U.S. Court of Appeals, were false.) (emphasis added)). (Id. WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. 9(b). (Id. Contact. Beginning in approximately 2007, FMCNA allegedly realized that the company's organic growth (that is, growth from adding new patients and not through acquisitions) was almost nonexistent. The central issue is whether relator can sidestep the requirement to plead false claims with particularity by alleging that every single claim is necessarily false. (McDonagh, Christina). Winkelman v. CVS Caremark Corp., 827 F.3d 201, 213 (1st Cir. The government can intervene in a qui tam action and assume primary responsibility over it. Flanagan v. FRESENIUS MEDICAL CARE HOLDINGS, INC. Under the circumstances, the Court concludes that it does not. Public Records Policy. 332-75). UniCourt uses cookies to improve your online experience, for more information please see our Privacy Policy. 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. 2:22-CV-01807 | 2022-10-21, U.S. District Courts | Personal Injury | were false .); id. As to the claims arising from that scheme, the complaint alleges the following: As set forth above, the allegations of the complaint concerning joint-venture agreements, free services to hospitals and patients, and free practice-management services to physicians will be dismissed for failure to comply with the notification and other requirements of the False Claims Act. According to the complaint, FMCNA clinics and other providers treating ESRD submit to the government one reimbursement claim bill per month for each patient, including the charges for several dialysis treatments, any separately billable laboratory services, and separately billable drugs. (Entered: 10/05/2021), (#1) ELECTRONIC NOTICE of Case Assignment. v. Fresenius Medical Care Currently, Mr. Flanagan is President, Chief Executive Officer & Director at Invesco Ltd. Mr. Flanagan is also Chairman at Metro Atlanta Chamber of Commerce and on the board of 19 other companies. Moreover, the CKD complaint alleged that the scheme was nationwide. Free or Below-Cost Management Services. As to each, it provides some specifics as to the scheme (such as referral trends and medical-director compensation levels). 247-48). Duxbury v. Ortho Biotech Prods., L.P., 719 F.3d 31, 33 (1st Cir. 334-35). Fighting proud: the remarkable story of Indigenous 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. Cancellation and Refund Policy, Privacy Policy, and A former employee filed an amended whistleblower complaint against Fresenius Medical Care North America, alleging the dialysis company had unlawful And, presumably, it has other weapons in its arsenal for dealing with fraudulent conduct. 119 (2010). According to the complaint, FMCNA budgeted for the anticipated losses in the acute programs at many of the larger hospitals. . 2019) (quoting U.S. ex rel. Gagne v. City of Worcester, 565 F.3d 40, 45 (1st Cir. It is sufficient to conclude that judgmental immunity is not applicable where, as here, there is evidence, if believed, that the attorneys fell below the standard of reasonable care in representing their client. Free Services to Hospitals and Patients. MARTIN FLANAGAN, Plaintiff-Relator, v. FRESENIUS, Court:United States District Court, D. Massachusetts. 4.9 out of 5 from 219 Patient Satisfaction Ratings. 2010). (Id. Moreover, referral sources were routinely permitted to own more than 40% of the joint venture investment, contrary to HHS OIG guidance. 3730(b)(2). Since then Sandra has changed 4 companies and 4 roles. 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. 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. Lutz v. United States, 853 F.3d 131, 135 (4th Cir. at 555 (citations omitted). 83). It also contracts with hospitals to provide dialysis services on an outpatient basis. Chief Judge F. Dennis Saylor, IV assigned to case. 2014), the First Circuit affirmed the denial of a motion to amend the complaint a third time. Martin Flanagan is a journalist and author who writes on sport, Australian culture and the relationship between indigenous and non-indigenous Australia. 1320a-7b, states that whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person . Nor does it provide any representative or sample claims. Save US$5.33. 223). WebBrigid M. Flanagan, RN, MS, Sean Philpott, PhD, MS, and Martin A. Strosberg, MA, MPH, PhD. 9(b). For the foregoing reasons, defendant's motion to dismiss is GRANTED. Under the circumstances presented here, the Court concludes that he cannot. It then alleges: The complaint does not, however, identify a single specific false claim submitted in connection with any of those dialysis centers. 3729(a)(1)(C) (Count 3). Co. Ltd., 737 F.3d 116, 123 (1st Cir. 02 Jun 2016. US$20.14. Marvel Studios Phenomenon WebA division of Fresenius Medical Care North America, Azura Vascular Care partners with dedicated, highly skilled physicians and surgeons, providing opportunities for practice 2007) (citing Rogan v. Menino, 175 F.3d 75, 77 (1st Cir. Counsel may need to link their CM/ECF account to their upgraded individual pacer account. SALTER, GARY vs. FRESENIUS MEDICAL CARE HOLDINGS INC, Instituto Mexicano del Seguro Social v. Fresenius Medical Care AG & Co. KGaA. Third, defendant contends that relevant public disclosures occurred in multiple SEC filings by FMCNA. It then alleges: Similarly, for North Carolina, the complaint provides a table of Medicaid (but not Medicare) revenue for a period of six years at fourteen dialysis centers. President, National Cardiovascular Partners; President, Spectra Laboratories. . WebView the profiles of professionals named "Martin Flanagan" on LinkedIn. Duxbury I, 579 F.3d at 33; United States ex rel. 750 F.3d at 120. Fourth, it alleges that FMCNA entered into favorable leases with medical directors that paid them above-market rates. 1320a-7b(b), and the resulting claims to Medicare were tainted by illegal kickbacks in violation of the False Claims Act. (McManus, Caetlin) (Entered: 11/02/2021), Docket(#9) ELECTRONIC NOTICE of Case Reassignment. 2021), the court found that SEC filings disclosing the nature of the joint-venture relationships and the regulatory risks associated with them were sufficient to qualify as public disclosures. WebChutes & LaddersMD Anderson gets new chief quality and value officer as it shifts to value-based care. 15). Here, defendant contends that the allegations were previously disclosed in multiple ways, including a 2005 government investigation and a 2005 Corporate Integrity Agreement (CIA) between FMCNA and the Office of Inspector General of the Department of Health and Human Services (OIG). 286 (Texas) (All such claims . Id. (Am. 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. . 331). 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. Here, despite its length, the amended complaint does not describe a single particular false claim. 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. After describing that scheme in some detail, the complaint alleges the following as to the submission of actual false claims: The complaint also provides a somewhat more complete description of the false claims for services allegedly provided to Scripps Health, a large health care system with five hospitals in San Diego, California. (Id. . 3730(e)(4)(B). FMCNA also established the Bridge Program, allegedly to help hospitals save money by streamlining the process for patient discharge from the hospital and admission to a chronic facility for dialysis. (Id. 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. (Id. (Id. (Id. . Employed by Penn State Health. 2017)). (Attachments: #1 Docket Sheet from District of Maryland, #2 Docket Entries 1-30, #3 Docket Entries 31-50, #4 Docket Entries 51-56, #5 Docket Entries 58-74) (Jones, Sherry) Modified on 10/7/2021 to correct docket text. FMCNA generated reports to track which medical directors and their practice groups referred patients to outside clinics and the reasons why. . Add to basket. Martin Flanagan hasnt hidden himself from view in The Short Long Book but he says he wouldnt trust any journalist who did. 3730(d). 154). At most, the filings describe a set of circumstances that might be vulnerable to manipulation. Hardback. 2016) (citing Duxbury I, 579 F.3d at 29). WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. 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. 162). 40. A more recent docket listing 45). 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. 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. Martin Flanagan is a Director, National of Acute Dialysis Services at Fresenius Medical Care North America based in Waltham, Massachusetts. 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. a. (Attachments: #1 Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#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. According to the complaint, FMCNA paid inflated amounts for controlling interests in the joint venture while selling shares below fair market value to physicians who were in a position to make referrals. In addition to Medicare and Medicaid, CHAMPUS/TRICARE, which is administered by the United States Department of Defense, provides ESRD benefits to health-care programs for individuals and dependents affiliated with the armed forces and to covered beneficiaries. 184-97). 167-307). The Court takes judicial notice of the proffered SEC filings as undisputed documents provided by the parties in connection with a Rule 12(b)(6) motion based on the public-disclosure bar. [23-1305] (JAW) [Entered: 04/05/2023 40.1(i) and with the approval of the Chief Judge hereby return the case for reassignment by the Clerk through the random draw appropriate for this case, under which all eligible judges -including me - will be eligible for proper assignment according to the luck of the draw. 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. In any event, as to those aspects of the alleged scheme, the allegations of the submission of false claims are similarly general. 321-31). That may, in part, be a result of the fact that relator did not work in any financial or billing capacity, but rather worked as the Director of Acute Market Development for the Fresenius Western Business Unit, and negotiated contracts between FMCNA and hospitals for in-patient dialysis treatment. While it is true that CMS data are reports for the purposes of the public disclosure bar, see U.S. ex rel. (Am. . (Id. . The amended complaint in this case, which was the first time relator raised any allegations concerning joint ventures, was filed three years later, in 2021. If the government declines to intervene and the qui tam case is unsealed, further proceedings are governed by 31 U.S.C. It then used that data to identify physicians and practice groups to target for medical director positions and joint-venture agreements. 84). were false .); id. 233 (Diablo Nephrology) (Every claim for reimbursement [FMCNA] submitted to [f]ederal health care programs associated with the treatment of these patients was tainted by kickbacks and therefore false within the meaning of the FCA.); id. Dialysis refers to a treatment regimen aimed at artificially replacing some of the functions performed by a healthy kidney. 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. (Id. The SEC filings at issue state that (1) at most of our clinics, a relatively small number of physicians account for the referral of all or a significant portion of the patient base, (Def. 4:05-cv-985 (E.D. 3730(b)(2). It then provides a table of patients and patient treatments for the same facilities over the same time period. Mem. . (Id. our revenues would decrease. (Id. Martin Flanagan Accordingly, the public-disclosure bar does not preclude the claims concerning unlawful medical-director agreements. Flanagan v. Fresenius Medical Care Holdings, Inc. - Law360 . In that role, he was responsible for, among other duties, negotiating contracts under which FMCNA provided dialysis treatment to hospital inpatients. United States ex rel. Flanagan v. Fresenius Med. Care they [therefore] violated the FCA's filing and service requirements. Wilson, 750 F.3d at 120. v. Fresenius Medical Care [$6,000,000.00] Gonzales et al. It alleged that [t]hese problematic physician relationships generally break down into two areas. (Id.). The 2005 complaint alleged improper conduct dating from a decade before the conduct alleged here. Suppose, for example, that in a world free from kickbacks, 25% of the dialysis services business of FMCNA would have been captured by competitors. 3/17/2023 8:35 PM. 128). June 11, 2014). The complaint describes a culture of doing whatever it takes to enter into hospital contracts to secure patient referrals for Fresenius outpatient dialysis centers. plaintiff the benefit of all reasonable inferences therefrom. Ruiz v. Bally Total Fitness Holding Corp., 496 F.3d 1, 5 (1st Cir. In affirming that decision, the First Circuit stated that the new paragraphs in the [p]roposed [complaint] were attributable to the new relator and . 40.1(i) and with the approval of the Chief Judge hereby return the case for reassignment by the Clerk through the random draw appropriate for this case, under which all eligible judges -including me - will be eligible for proper assignment according to the luck of the draw. (Id. We remand for further proceedings. 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. Martin Flanagan has been a director and President and Chief Executive Officer of Invesco since 2005. And it did not allege that FMCNA provided free or below-cost practice-management services to physicians. Roughly 90% of all dialysis patients undergo hemodialysis at a dialysis clinic three times per week. 30-31). 02-11738, 2013 WL 682740, at *5 (D. Mass. As to the submission of false claims, it makes the following general allegations: The complaint also describes the compensation paid to a number of specific medical directors around the United States. 12% off. 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. 23-7001 | 2023-01-06, U.S. District Courts | Personal Injury | US$184.67 US$190.00. 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. 99-345, 1986 U.S.C.C.A.N. Dialysis company hit with False Claims Act suit - Becker's 308-20). Thus, the statute now defines original source as an individual who. For present purposes, the Court must assume that it did. Martin Flanagan is a Director, National of Acute Dialysis Services at Fresenius Medical Care North America based in Waltham, Massachusetts. The first question, for the purpose of applying the first-to-file bar, is whether the first-filed complaint contained all the essential facts of the fraud later alleged. United States v. Millenium Lab'ys, Inc., 923 F.3d 240, 252 (1st Cir. Feb. 25, 2013), the mere publication of compensation information, without an allegation of fraud or misrepresentation, is not sufficient to trigger the bar. The matter was unsealed, and therefore publicly disclosed, in 2018. Conrad v. Abbott Lab'ys, Inc., No. In United States ex rel. WebMartin Flanagan. 368-74). Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111 (1st Cir. Appearance form, Docketing Statement, and Transcript Report/Order form due 04/19/2023. The second was that these same doctors are often provided with opportunities to rent office space that they own to Fresenius at above or at the very top of fair market value, with guaranteed long-term leases that are not commercially reasonable. (Id. Documents and certified copy of docket sheet and order of transfer received from the Clerk in the transferor district via Email. (Attachments: #1 Affidavit Certificate of W. Scott Simmer in Support of Motion for Admission Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), Docket(#12) NOTICE of Appearance by Christopher P. Sullivan on behalf of Martin Flanagan (Sullivan, Christopher) (Entered: 11/18/2021), Docket(#11) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #6 Motion for Leave to Appear Pro Hac Vice Added James F. Bennett. The complaint further alleges that FMCNA provided free or below-cost services to physicians to secure referrals.
List Of Funeral Homes In San Antonio, Texas,
Gerson Clinic Hungary,
Jb Hunt Certificate Of Insurance,
United Supreme Council Southern Jurisdiction,
Royal London Hospital Doctors List,
Articles M
