Qui Tam Team

A Timeline of Big Pharma Settlements

Erica Teichert of FiercePharma.com crafted a very handy outline of the biggest Big Pharma offenders of recent years. Sometimes there's strength in numbers.

Sometimes pharma companies bend the rules. And increasingly, they're getting caught. After Novartis' recent $422.5 million settlement with the U.S. Attorney's office and reader requests, we looked back at other Department of Justice and government fines levied against Big Pharma for improper marketing and other infractions. Those fines range from a relatively light slap on the wrists to multi-billion dollar charges in addition to criminal penalties.

Nelnet trial to start next week

OMAHA - The amounts of money on the line are staggering.

If Lincoln-based student lender Nelnet fails to fend off a lawsuit accusing it of defrauding the federal treasury, it could be on the hook for almost $1 billion.

And for a former Nebraskan who blew the whistle on questionable federal subsidies collected by Nelnet, that result would be like hitting the lottery. Under the little-known law under which Jon Oberg brought the suit, he would receive up to 30 percent of any judgment he recovers for U.S. taxpayers - a figure that could exceed $300 million.

Those are the possible stakes in United States of America ex. rel. Jon H. Oberg v. Nelnet Inc. et al., a case currently set to go to trial next week in a federal court in Virginia.

The suit is the latest chapter in a controversy that began seven years ago when Nelnet, one of the nation's largest student lenders, used a loophole to boost by about $300 million the federal subsidies it received on some student loans.

Oberg brought the case under the U.S. False Claims Act, which allows citizens to sue on behalf of the government alleging fraud by federal contractors. And under that law, any damages awarded are tripled.

With such big dollars on the line for Nelnet, other lenders, taxpayers and Oberg, a federal judge presiding over the case is strongly urging an out-of-court settlement. The judge last week scheduled a settlement conference for Wednesday and delayed the start of the trial a day, to Aug. 17.

Nelnet officials said they will participate in the settlement meeting but also continue to feel they have a strong defense against the allegations.

"We remain confident in our position," Nelnet spokesman Ben Kiser said Monday. "The law and the facts have always been on our side, and no new evidence has been presented to change that."

Oberg's lawsuit says Nelnet and the other student loan companies out of greed illegally boosted their profits at the expense of a program intended to help students and their families. The companies should not be allowed to get away with their fraudulent financial gains, the suit says.

"In truth, [the student loan firms] were more Bernie Madoff than Mother Theresa," Oberg's attorneys say in a court filing. "Their universal goal was to grab every possible taxpayer dollar."

Nelnet argues that it informed education department officials up front how it was increasing its subsidy billings and the legal basis for the claims - proving there never was any intent to defraud the government.

Nelnet officials cite statements from several department officials, including an assistant secretary who said such increased claims were "no fraud and abuse."

"Far from being fraudulent, Nelnet's claims for payment were lawful and proper under the statutes, regulations and agency guidance that existed at the time," its attorneys wrote in one brief.

Nelnet also argues a 2007 settlement it reached with the U.S. Department of Education over its alleged overcharges long ago resolved the dispute.

By Henry J. Cordes

Published: Tuesday, August 10, 2010 4:10 AM CDT
World-Herald News Service

From http://www.nptelegraph.com/articles/2010/08/10/news/state/60006925.txt#small

Exclusive: Whistleblower Claims Many U.S. Interpreters Can't Speak Afghan Languages

By Matthew Mosk, Brian Ross, and Joseph Rhee

More than one quarter of the translators working alongside American soldiers in Afghanistan failed language proficiency exams but were sent onto the battlefield anyway, according to a former employee of the company that holds contracts worth up to $1.4 billion to supply interpreters to the U.S. Army.

"I determined that someone -- and I didn't know [who] at that time -- was changing the grades from blanks or zeros to passing grades," said Paul Funk, who used to oversee the screening of Afghan linguists for the Columbus, Ohio-based contractor, Mission Essential Personnel. "Many who failed were marked as being passed."

After being asked about the allegations, U.S. Army officials confirmed to ABC News they are investigating the company.

Funk outlined his claims in a whistleblower lawsuit unsealed earlier this year against Mission Essential Personnel, saying the company turned a blind eye to cheating on language exams taken over the phone and hired applicants even though they failed to meet the language standards set by the Army and spelled out in the company's contract. He alleges that 28 percent of the linguists hired between November 2007 and June 2008 failed to meet the government's language requirements. The company has contested those claims in court, and this week rejected them as false in an interview with ABC News.

Civilian translators have for nearly a decade been playing a crucial if unsung role in the Afghanistan war, embedding with troops as they have moved through the countryside, helping soldiers gather information from local villagers, and attempting to spread the message of security, moderation and peace that undergirds the U.S. presence there. Some Afghan veterans have rated the value of a skilled interpreter as equal to that of a working weapon or sturdy body armor.

But a former top screener of translators heading to Afghanistan tells ABC News in an exclusive interview that will air tonight on World News with Diane Sawyer and Nightline that he believes many of the translators currently in the field cannot perform their function.

"There are many cases where soldiers have gone out into the field and have spoken to elders [who] handed messages to the interpreter that a possible ambush three miles up the road would occur. The interpreter cannot read the message and they are attacked," Funk said. "We're talking about soldiers lives here."

Marc Peltier, MEP's chief operating officer, said in an interview with ABC News that he had "no reports from the field" of translators who could not communicate in Dari or Pashto, and said the company has received "100 percent outstanding" ratings from the Army and shared a copy of what he said was an internal company survey that showed 82 percent of its customers were satisfied with the performance of its translators. An attorney accompanying Peltier to the interview said the company would answer Funk's allegations in court, and not in the media.

"We are concerned that ABC is being used to influence the litigation, which the company has moved to dismiss, and on which we expect to prevail," a statement from the company said.

Peltier told ABC News that he found it "troublesome that [Funk] has come to ABC to make these charges." He questioned Funk's financial motives in bringing the suit, and alleged that Funk had "offered to resign and resigned over financial improprieties." Peltier would not elaborate. Funk's lawyer said the alleged improprieties involved a subordinate in Funk's unit, and had nothing to do with his departure.

Despite Peltier's reluctance to discuss the allegations against his company, Mission Essential Personnel executives have spoken very publicly about its ability to fulfill the rapidly growing demands of the U.S. Army for Afghan translators. In a hearing before a congressional committee in July, CEO Chris Taylor testified that within a year of accepting the Afghan contract, his company "was able to achieve a 97 percent fill rate of the government's requirement for linguists. Previous contractors never exceeded 43 percent."

How Mission Essential Personnel was able to find hundreds of willing and translators from among a tiny pool of qualified Americans -- which Peltier put at roughly 3,800 -- was initially something of a mystery to Funk. He said the company struggled to find American citizens who spoke the Afghan languages Dari and Pashto. Ultimately, Funk alleged in his lawsuit that the company resorted to fudging their proficiency test results in order to hit staffing targets that entitled them to more money from the Army.

Funk told ABC News he wrote emails to the then-CEO of Mission Essential describing how job candidates would cheat on oral exams conducted over the phone.

"I told him that it was corrupt. Stand-ins were taking the test. That's comparable to, if you're a lawyer, that's comparable to taking the bar exam over the phone. You need to be face-to-face with that individual. You need to identify them. You need to know who they are and they had stand-ins on the phone taking the test," Funk said. "They had stand-ins on the phone taking the test because there is no way that these people could possibly pass if they can't even get through an interview."

One of the company's translators working in Afghanistan now confirmed the practice in an interview with ABC News, saying he personally had taken the exam for others who could not have passed it themselves. The employee, who described the practice on the condition he not be identified, called a follow-up written exam "bull."

Peltier said the company has caught applicants cheating, but in those cases the candidates were not hired. In a statement to ABC News, the company said it has "the strongest and most comprehensive language testing and pre-deployment screening of any company providing linguists to Afghanistan." That process includes an initial phone test, a written test administered by an autonomous outside vendor, and an integrity test that occurs by video conference or in person, the company said. The phone tests and written tests are catalogued and saved for review by the military.

Funk said he believes the company's motive for letting unqualified linguists through the screening process is simple.

"It's simply a matter of dollars," he said. "All the interpreters I have spoken to know & what's going on. It's money. It's money for meeting those requirements."

The result, he said, and American war veterans confirmed, is that many of the interpreters are simply unable to perform the delicate work of interpreting conversations between Americans and Afghans. The problem predates Mission Essential's arrival on the scene in Afghanistan.

Genevieve Chase served as a Pashto-language-trained US Army Sergeant in Afghanistan in 2006 in Bagram and Lashkargah, Helmand Province. She told ABC News it was not unusual to encounter interpreters who were unable to speak Pashto, or had limited English. At times, she said she believes the failure to communicate has put soldiers lives at risk.

"Somewhere along the line somebody is doing something they're not supposed to be doing," Chase said. "It is not difficult to pick out somebody who can't speak Pashto. In fact, for me it was rather simple to isolate those people."

Chase said Army units quickly identified interpreters who could not do their jobs. She recalled odd exchanges where Afghan elders would speak at great length and the interpreter would turn to the American soldiers and translate, "He said, 'Okay.'"

She said it was common for units to simply hand off bad translators to other units, rather than carry the risk of relying on one themselves.

John McHugh, a British journalist who was embedded with American troops, said he spoke enough Pashto to realize the interpreter with his unit was not giving correct translations. He was so alarmed by the disparities he began filming an exchange between an American soldier and an Afghan elder.

"At one stage you can see in the film where the elder talks about the Taliban coming into the village and the fact that the villagers are helpless to do anything about it. And the translator essentially says, 'the Taliban are behind that hill, if you want to find them, they're over there.' Which wasn't at all what the elder had said," McHugh recounted in an interview.

Mission Essential officials said the translator in the footage is not one of their employees. After the incident McHugh returned to London and hired a translator to go over his tapes.

"We went through a huge amount of the footage and there were massive differences in what was translated and what was actually said," McHugh said. "And I'm not talking about slightly shortening sentences or phrasing in a succinct way. I'm talking about huge amounts of information simply being left out and at times, pure mistranslation."

McHugh said he believes unskilled translators take on the jobs, and the risks associated with them, because they are so lucrative. American citizens serving as translators can be paid annual salaries that top $200,000. Afghan nationals who are hired locally are paid less, but still in amounts that vastly exceed the typical pay for someone in that country.

"They are quite keen to make money," McHugh said. "One of them described himself to me as the rock star of his village, because the money he made was equivalent to a rock star's money."

Trouble with translators has also been observed by Afghanis.

Daod Sultanzoy, a member of the Afghan parliament, told ABC News that he has encountered U.S. Army translators who lack a command of Pashto. The interpreters, he said, "play a very important role that can be positive or negative. And in this case, I've heard and I've seen occasions, that have been reported to me, it has caused the failures of some missions and also the ill-will of the Afghan communities in certain parts."

The Army acknowledged in a statement to ABC News that the change in Afghanistan strategy and the troop buildup over the past year has significantly increased the need for linguists and translators, and that demand has become "enormously challenging, but we continue to try to meet the commander's needs on the ground through use of both military and civilian contracted linguists."

A U.S. Army spokesman said in an emailed statement that the wide variation in languages and dialects makes translating difficult for even the most skilled linguists. As for the assertion that Mission Essential has permitted unskilled translators to embed with Army troops, officials said they could not comment, other than to say that "there is a military investigation underway into alleged fraud."

American veterans like Chase, who founded the advocacy group American Women Veterans, remain deeply concerned about the risks associated with unskilled translators on the battlefield.

Asked what she would say to executives at Mission Essential Personnel, Chase was unequivocal. "I would just ask yourself, 'If that was your daughter, or your son, or you yourself, would you want to work with these people? Would you want to go outside of the wire in Marja, in Helmand province, with an interpreter that doesn't really speak Pashto?' And if you can sleep at night after you think about that," she said, "then keep doing what you're doing."

Funk, a Vietnam-era veteran who is now serving with another contractor in Iraq, told ABC News he could not stomach sending what he believed to be unqualified translators into battle with American soldiers. He said that is why he resigned, and why he initiated the suit against his former employer.

The stakes, he said, could not be higher.

"If you're trying to win the hearts and minds of the population, it's a matter of communication," he said. "If you cannot communicate, if you cannot read and write, if you cannot do these things, you cannot win the war."

Copyright © 2010 ABC News Internet Ventures

Rick Scott health care company accused of overbilling Medicare

Two weeks before Florida’s primary, new allegations of improper Medicare billing by Solantic, a health care company co-founded by Rick Scott, have surfaced, in addition to charges made by former Solantic doctors that their names and licenses were used without their consent. Within hours of being pressed for answers by The Florida Independent, Solantic officials and Scott held hastily arranged press conferences Tuesday to rebut the charges.

Two doctors — both former employees of Solantic, the chain of clinics launched by Scott and in which he is a majority investor — allege that Solantic repeatedly used their name and medical license information without their permission or knowledge. Both doctors state that by allegedly misappropriating their information, the company was able to keep clinics operating in contravention of state law.

One of the doctors asserts that he also came upon evidence of billing irregularities involving Medicare, which, if true, would be the second time a Scott-run company was accused of improperly billing Medicare.

The two doctors don’t know each other, and didn’t work at Solantic at the same time.

Dr. P. Mark Glencross began working at Solantic in 2003 as its chief medical officer. He filed a lawsuit in 2008 claiming the company used his information without his knowledge to license six different clinics. He states in his lawsuit that he left Solantic shortly after he discovered the incidents of “unauthorized misappropriation” in 2004.

Dr. Randy Prokes worked at Solantic from 2004 to November of 2009 as an on-site doctor treating patients at one of its clinics. He says that he saw documents listing his name on billing forms and medical records at clinics he never visited, with patients he never met. When he cross-referenced those records with patient information, he says he saw that the patients were treated mostly by doctors hired on a temporary basis. Prokes alleges Solantic improperly used his license to cover clinics without his knowledge or consent.

In interviews with The Florida Independent, Prokes did not offer documents to substantiate his claims. The privacy of patients’ records is protected by federal law. But three former Solantic employees corroborated his account. After looking into the alleged unauthorized use of his name and license, Prokes says that he also came upon records indicating that Medicare was not being billed properly when a nurse practitioner was working alone at a clinic.

Nurse practitioners are allowed to work alone at a clinic, as long as they have a collaborative agreement with a doctor to operate under his license. But if a nurse practitioner treats a patient when there is no doctor on site, Medicare will only pay 85 percent of the scheduled fee for those visits. Prokes says that the records he saw showed that Medicare was being charged 100 percent for those visits.

In some circumstances Medicare will pay the full amount when a nurse practitioner working alone sees a patient, including if the nurse is under the direct supervision of a doctor as part of a patient’s treatment plan. But generally it is not allowed. “This is a problem area that we do see,” says Marc Wolfson, public affairs director at the Health and Human Services Office of the Inspector General. “A company will bill Medicare for services not by the physician who signs a claim, but by other people working in the company. That is a violation of federal regulations.” Wolfson emphasizes he is not commenting on Solantic, and adds that only an investigation could determine if there were violations and whether they were criminal or civil.

Prokes says he’s concerned about the position in which the company put him. “I don’t think anybody could hold me liable for malpractice, because I didn’t see the patients,” he says. “But maybe I could be held accountable for some kind of fraud.”

Neither doctor states they have evidence Rick Scott knew of the alleged misuse of their names, or of their complaints to management. Several ex-employees say that Scott was a hands-on owner, who talked frequently with management and approved all major policy decisions.

Prokes would not have had access to financial records, said Dr. Nathan Newman, Solantic’s chief medical officer, at today’s press conference. He added that the allegation that Prokes’ name and medical license were used improperly is “completely false.”

GLENCROSS’ AND PROKES’ allegations come during a campaign in which Scott is repeatedly criticized for his previous role running a company that engaged in Medicare fraud.

In 1997 Scott was forced to resign as the CEO of Columbia/HCA, then the country’s largest hospital chain, while it was being investigated for massive Medicare and Medicaid fraud. Federal agents seized records from several Columbia/HCA hospitals that revealed how the hospitals kept two sets of books: one that reflected a procedure’s true costs and another with inflated expenses charged to Medicare. There were also allegations that hospitals paid illegal kickbacks to doctors for patient referrals. Four executives were indicted. Two of them were found guilty and sent to prison. The company ultimately pleaded guilty to 14 felonies and ended up paying $1.7 billion in fines and settlements.

Scott was never charged, or even interviewed by authorities. Columbia/HCA paid Scott about $10 million, along with roughly $300 million worth of stock, to leave the company. He has previously said he had no knowledge of the wrongdoing and would not have condoned it. But people familiar with the case, like John Schilling, a former Columbia/HCA employee who reported the abuses to the feds, have stated that Scott’s aggressive emphasis on profits and cost created the environment for the fraud to develop.

Because Scott has never held public office before, he is running for governor on his record as a businessman. On his campaign website, he states: “I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader.”

Solantic was Scott’s first major attempt to get back into the health care business after his ouster from Columbia/HCA. He co-founded the company in 2001 with partner Karen Bowling. The company’s first medical director Dr. David Yarian, has said that all decisions, including hiring people, had to be approved by Scott. (Yarian sued the company during a contract dispute in which he alleged he was fired for opposing Scott’s discriminatory hiring practices. Solantic settled with him.)

Glencross joined Solantic in 2003 as medical director, responsible for designing, implementing and delivering Solantic’s clinical services company-wide. At the time the company did not accept Medicare patients. In his lawsuit, he states that he was “secretly” named medical director of six of the company’s clinics in 2004, to comply with new state regulations requiring that each clinic designate a medical director who agreed to accept legal responsibility at each site. “A clinic’s failure to employ such a Medical Director constitutes grounds for emergency suspension of the clinic’s license,” the lawsuit states. Solantic exposed him to personal liability he never agreed to accept, according to the lawsuit, and when Glencross discovered it, he left the company.

Solantic settled the case with Glencross in May. Glencross declined to comment for this article. At today’s press conference, a lawyer for Solantic would not discuss the Glencross case, calling it a “private matter.”

Dr. Grant Tarbox took over Glencross’ job as the company’s chief medical officer from 2004 to 2006. Tarbox says Scott was an involved owner who was aggressive about running an efficient company. “I’d talk to Rick a couple of times a week, easy,” Tarbox says. “He was actively involved.” But Tarbox says that Scott never pushed him to make any decisions that were unethical or compromised patient care, and that he never knew of any doctors’ licenses being misappropriated.

Solantic CEO Karen Bowling says that Scott talked to her for quarterly board meetings and monthly operation reviews.

Prokes joined Solantic in 2004 as a doctor treating patients in the company’s Beaches clinic in Neptune Beach. He says that in 2007, shortly after the company began accepting Medicare patients, he was asked to take part in a quality control program that required him to review patient charts from different clinics, and to make sure the medical care provided and the prices charged were consistent with a patient’s condition. That’s when he discovered the allegedly unauthorized use of his name.

“I was at the Beaches office and they sent me a bunch of charts from the Northside office,” Prokes recalls. “All of a sudden I see my name popping up on charts. I see my name with patients I had never seen. I never gave them permission to do anything like that.” He says he saw his name used without his permission at least 15 times on the charts he reviewed. “It’s just a really unethical practice.”

Prokes says that he complained widely to the company’s operations managers. “As soon as I brought it up, it was brushed under the carpet and ignored.”

One former operations manager, who asked not to be identified, recalls that Prokes “raised the question to me,” and in response he looked into the matter. “It was pretty easy to see; when a patient came in to pay a bill, you would see the doctor’s name and his NPI [national provider identifier] number, but when you pulled up the medical information in EMR [electronic medical records], you’d see that it was actually someone else who saw the patient, and the doctor was at a different location.”

Another operations manager and a nurse practitioner, who both asked not to be identified, say that Prokes complained to them as well. They separately reviewed the records Prokes was talking about and confirmed that his name was on patient records at times he was not at the clinic.

Newman, Solantic’s chief medical officer, says he has no knowledge that Scott was aware of Prokes’ and Glencross’ allegations.

PROKES SAYS THAT after he looked into the matter he discovered a separate issue: what he thought were suspicious billing procedures. Solantic was repeatedly charging Medicare 100 percent of a scheduled fee when patients saw nurse practitioners while there was no doctor at the clinic he says. He complained about this practice to the operations managers as well.

Newman, Solantic’s chief medical officer, dismisses Prokes’ accusation: “Dr. Prokes would never have been involved in billing.”

The first operations manager says he confirmed Prokes’ charges by cross-referencing billing records showing that Solantic charged Medicare 100 percent for a patient’s visit under a doctor’s license, with EMR records showing that the patient was treated by a nurse practitioner while the doctor was not in the clinic.

“They would bill as a physician visit,” the former manager says. “They weren’t billing for an N.P. [nurse practitioner]. It was very clear. We had to do daily audits.”

Newman says that any incident where Prokes’ name was used when he didn’t see a patient was because he was the supervisory physician. Nurse practitioners only worked alone “on occasion,” Newman says. It was not general Solantic practice.

The former manager says he brought the issue up with his superiors.”The response was, ‘We’re correcting it on the back end.’ I don’t have proof it wasn’t corrected on the back end, but I never saw proof it was.”

The second operations manager the doctor complained to, who was responsible for two clinics, says that when he looked into it, he found evidence that the billing discrepancy was never corrected on the back end.

“My experience there, as far as the Medicare discrepancies, it was pretty rampant,” this former manager says. “This would be tens of thousands of dollars a month. And if they did correct it on the back end, it would show on the monthly statement. And I had to review the monthly statements for the clinics I was responsible for.” He adds that there was never any downward adjustment made to the monthly receipts, which would indicate the charges had been reduced when the bills were sent to Medicare.

“When we did question our supervisors about this, we were told it was brought to the attention of senior management and that we should focus on more important things,” the second operations manager says. “I witnessed this for more than a year, until I left.”

The nurse practitioner who worked with Prokes says she worked alone at clinics a couple of days a month. She says that she never saw billing information and had no idea how Medicare visits were being billed until she reviewed the same records Prokes did. “I saw them charging the full fee when I was working alone,” she says. She adds that when she heard it was being corrected on the back end, she never saw information either proving or disproving that.

Solantic fired Prokes on Nov. 23, 2009. He says he can’t discuss the matter, because he hired a lawyer and settled with Solantic. The nurse says that Prokes was fired shortly after he began questioning the records discrepancies. Solantic officials say that he was fired for violating the company’s policies by seeing a patient outside the office and writing a narcotic prescription that wasn’t properly recorded.

The Florida Independent first contacted Prokes in June, after a former Solantic employee had seen earlier stories about Solantic and put the Independent in touch with him. Prokes initially agreed to speak with a reporter off the record. After two interviews, Prokes decided he wanted to report what he knew to the authorities so they could investigate. He called a Medicare hotline in early July, but says he was kept on hold for four hours. He then tried to get in touch with state authorities who he says were not responsive.

Out of frustration, he sent an email on July 16 to the campaign of Bill McCollum, Rick Scott’s opponent in the heated Republican governor’s primary, explaining what he saw while at the company. Within days, a political operative arrived in Jacksonville to interview Prokes. Campaign officials acknowledge receiving this information and say they referred his allegations to the appropriate investigative agencies. The operative wrote up a report, which was soon leaked to different media. But Prokes declined to be interviewed, and no outlet published his allegations. He tells the Independent the McCollum campaign violated a verbal agreement to conceal his identity.

Monday, Steven Andrews, a Tallahassee medical malpractice lawyer, filed a lawsuit requesting a videotaped deposition Scott gave in the Glencross case under a public records law, stating that Scott’s stewardship of health care companies in Florida posed a public hazard. Andrews included Prokes’ name and allegations in the lawsuit. Andrews says he was motivated because, “I routinely sue hospitals and medical facilities and I believe this sort of information should be public.”

When Prokes’ email was first leaked to the media, the Independent spoke with him about the likelihood of his name becoming public. He agreed it was likely and, after going over quotes he gave the Independent, said, “Well, I don’t have a problem with that; that’s true.”

Andrews’ lawsuit: >> http://floridaindependent.com/5617/new-allegations-of-improper-medicare-billing-hit-health-care-company-founded-by-rick-scott