If you remember, L Lin Wood, is the lead attorney on this case. He felt strongly about this enough to leave the large legal firm he was with to not have any appearance of conflict of interest and took the gamble of setting up his own firm during the recession, and it appears his gamble was RIGHT!!!
(CNN) — It started with a chance conversation between a doctor and a nurse several years ago. But that brief encounter may end up exposing what could be one of the largest Medicare frauds in U.S. history.
Dr. Alon Vainer, a medical director at dialysis clinics in Georgia, was discussing clinic procedures with one of the nurses, Daniel Barbir. The two men say they saw something they believed was very wrong: expensive medicine, and lots of it, was being tossed in the trash. And the clinic workers were being told to do it, the two men say.
“When we sat down and started talking about it and getting into details, we actually realized exactly what was going on,” Vainer said.
The alleged waste was being carried out on a massive scale and, the nurse and the doctor said, they knew why almost immediately. They claim it was a way for their company, DaVita Inc., to defraud the government, overbill Medicare and Medicaid and make a fortune.
“We’re talking in the hundreds of millions, easily,” Vainer said. “The profit this company raked from those two schemes, only from those two drugs, was hundreds of millions of dollars.”
The allegations of massive fraud have implications for all Americans. The alleged fraud would have involved Medicare and Medicaid patients, whose medicine is paid for by U.S. taxpayers.
…DaVita Inc., based in downtown Denver, is one of the nation’s largest dialysis companies. The name means “Giving Life” in Italian. The company just moved into a brand new $101 million office tower, complete with fountains, gardens and even a suspended ski gondola inside for private meetings.
DaVita has grown in the past couple of years and now runs roughly 2,000 dialysis clinics across the country, which has added up to a $7 billion business. The dialysis empire is run by CEO Kent Thiry, who dresses like one of the Three Musketeers, has adopted a company slogan of ‘One for all and all for one’ and in company staff meetings leads his employees, who he calls villagers, in cheers of “DaVita!”
Thiry is reportedly paid an estimated $15 million a year, according to the Wall Street Journal, which has called him the best compensated CEO in Colorado.
Most of DaVita’s revenue comes from a single source: taxpayers. More than two-thirds of DaVita’s revenue comes from Medicare and Medicaid payments.
If Vainer and Barbir’s allegations are true, the company threw away hundreds of millions of dollars of medicine, and taxpayers paid for it.
…both men have filed a whistleblower lawsuit under the U.S. False Claims Act on behalf of the U.S. government, charging DaVita with massive Medicare fraud. They stand to make millions if DaVita is found guilty.
… the company’s attorney Kim Rivera did. When asked about the plaintiffs’ allegation that DaVita had come up with so-called schemes to throw away drugs and maximize profits, Rivera said: “Well that’s just wrong. If you look at the facts of the case, first of all, the doctors make the dosing decisions…. When you look at what the practices were — decisions being made by doctors, based on what was in the best interest of their patients. And they took into account a variety of things.
“You can’t just look at one issue. You have to look at things like infection control, what the patient’s going to do, how the patient’s going to do with particular doses. And so, during that entire time what we did, what the doctors did, was appropriate.”
But other companies, including DaVita’s main competitor, used smaller vials and smaller combinations at times, limiting what was thrown away.
…Plaintiffs’ attorneys Lin Wood and Marlan Wilbanks, who claim DaVita made as much as $800 million over-billing the government, say that DaVita’s defense won’t hold up in court.
“It’s not just the taxpayers that are the victims here, it’s the health care system,” Wood said.
“It doesn’t take a graduate degree to understand what’s going on here,” Wilbanks said. “This is just dishonesty.”
DaVita denies that and vows to fight the case in court. But earlier this year, while denying it did anything wrong, DaVita settled a similar case in Texas for $55 million.
Pat Burns, with the watchdog group “Taxpayers Against Fraud,” says the bigger problem is that even if a company gets caught cheating the government, the company executives never seem to face any punishment. Fines are paid and business continues as usual.
You need to read the full article on CNN, it well worth a read and why are these guys never charged criminally?
Just to catch up on the papers we have here are the two we have up and I will prowl PACER tonight.
In my not so humble opinion, this is “entitlements” that the U. S. Department of Justice needs to prosecute and set examples to protect Medicare and Medicaid recipients not just save us money on. Millions would pay out how many legitimate claims in a year?
We will also be updating the Beth Holloway suit against the National Enquirer and the Sheldon Adelson cases this week. These are some great cases to follow. HOWEVER IF YOU HAVE A CASE YOU WANT US TO FOLLOW, JUST FILL OUT THE CONTACT US FORM AT THE TOP. WE ARE ALSO ALWAYS LOOKING FOR GOOD GUEST AUTHORS SO IF YOU HAVE A CASE WHERE PAPERS ARE AVAILABLE AGAIN JUST FILL OUT THE FORM ABOVE, WE WILL GET THE PAPERS AND YOU CAN WRITE ARTICLES FOR ROSE SPEAKS.COM.
Those of us who remember May 2011 when L. Lin Wood left Bryan Cave LLP and suddenly created a small law firm in less than three weeks. Why we all asked? As one poster here on Rose Speaks.com said, “Looks like he sees a way to make millions of dollars.” Yes but how?
Wood had agreed with attorney Marlan Wilbanks to leave Bryan Cave set up new offices and toss his hat into the Qui Tam Action against accusing dialysis providers DaVita, Inc. and
Gambro Healthcare, Inc. of deliberately wasting hundreds of millions of dollars of medications in order to fraudulently boost reimbursements from Medicare and Medicaid. That folks is illegal but the people involved in this suit, don’t have criminal charges pending they are involved in a Civil Federal Suit of “Qui Tam Action”.
What does that mean? Let’s start with the definition of “Qui Tam Action”.
Qui tam action (kwee tam) n. Latin for who as well, a lawsuit brought by a private citizen (popularly called a “whistle blower”) against a person or company who is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation, when there is a statute which provides for a penalty for such violations. Qui tam suits are brought for “the government as well as the plaintiff.” In a qui tam action the plaintiff (the person bringing the suit) will be entitled to a percentage of the recovery of the penalty (which may include large amounts for breach of contract) as a reward for exposing the wrong-doing and recovering funds for the government. Sometimes the federal or state government will intervene and become a party to the suit in order to guarantee success and be part of any negotiations and conduct of the case. This type of action is generally based on significant violations which involve fraudulent or criminal acts, and not technical violations and/or errors.
MEDICARE FRAUD!!!! In days of yesteryear “the federal or state government will intervene and become a party to the suit in order to guarantee success and be part of any negotiations and conduct of the case,” happened and “We the people” never knew what the hell was going on because the records were seal.
NO MORE until a case at least gets to this stage, now while our U. S. Congress is trying to cut benefits to those Americans who receive Medicare and/or Medicaid in services, doctors visits, in-patient care and on and on and on, these corporations have in the past been slapped in the past with a fine, and THE RECORDS SEALED. No more now we get to follow these cases and call our congressional representatives and ask them WTF??? Do they get contributions from these large corporations or perhaps it goes into the hole of the new “Super Pacs”, and in the vacuum we have no way of knowing which members of congress are aware, has been aware in the past and has done the old political trick of wink wink, don’t listen to what I say to the voter.
Here are the papers for you to read, and like me GET MAD AS HELL THIS IS GOING ON AND HAS BEEN FOR EONS, MEDICARE FRAUD IS NOT THE LITTLE OLD MAN OR WOMAN FIGHTING FOR PAYMENTS TO DOCTORS, MEDICARE FRAUD IS A PRIME EXAMPLE OF THIS CASE!!!!
Here is as close to a lay person description as we can get:
According to the suit, the companies designed multiple sets of directly conflicting internal protocols dictating how specific drugs should be administered based on how the costs for such drugs were reimbursed by the government. The suit also charges that these “dosing grids” were designed to increase volume rebates and discounts to the defendants from the manufacturers of the medications.
“The complaint makes clear that for years, DaVita has used different sets of rules to game the Medicare system and illegally inflate their government reimbursements at taxpayer and patient expense,” said L. Lin Wood, attorney for the whistle blowers.
“Taxpayers and patients should feel a sense of outrage when they read the complaint and learn how DaVita has become a multi-billion dollar business due in large part to corporate strategies and protocols focused on extracting every dollar possible from the government rather than on improving the care of chronically ill patients.”
The scheme centered on three drugs routinely administered to patients during dialysis: Venofer, an iron supplement; Zemplar, a vitamin D analog; and Epogen, a glycoprotein hormone also known as EPO.
In the case of Venofer and Zemplar, the government reimbursed the defendants for “necessary wastage,” such as medication that remained in a vial after the vial dose was administered. The internal protocols developed and mandated by DaVita and the others named in the suit were explicit about the vial sizes employees were required to use and whether vials could be entered with a needle more than once to extract the contents. According to the suit, these protocols were designed to maximize the amount of drug wasted because the government paid DaVita for the amount of drug administered to the dialysis patients and the amount intentionally wasted and thrown away.
For example, instead of using three 2 mcg vials to administer a 6 mcg dose of Zemplar with no waste, DaVita’s protocols required employees to use a 10 mcg vial. The patient received 6 mcgs, and the remaining 4 mcgs were discarded but still billed to the government. Medicare unknowingly paid DaVita for all 10 mcgs in the vial, including the 4 mcgs of wasted medication that ended up in DaVita’s trash cans thousands of times each week from 2003 through the end of 2010 at its hundreds of centers across the United States.
Reimbursement rules for Epogen, on the other hand, made clear that no waste would be
reimbursed. As a result, the DaVita dosing grids were formulated to guarantee that every
available drop of medication in every vial was used and billed for, including any excess
medication, or overfill, for which they had not paid.
On January 1, 2011, Medicare guidelines were changed to halt all payments for wasted drugs.
According to the suit, DaVita immediately put in place new protocols that effectively eliminated iron waste and significantly reduced Vitamin D waste.
“When the reimbursement rules changed on January 1, 2011, the protocols that mandated the
unnecessary waste of Venofer and Zemplar stopped as well.”
“This had nothing to do with a New Year’s resolution to be more efficient but had everything to do with how money drives corporate practices and protocols at DaVita.”
Denver-based DaVita, which is currently the second largest independent provider of dialysis services for second largest independent provider of dialysis services, acquired Gambro’s dialysis clinics in the U.S. in 2005. According to the suit, DaVita and Gambro engaged in similar fraudulent practices prior to the merger. Afterward, DaVita selectively implemented additional fraudulent practices at the clinics it acquired and adopted some of Gambro’s wrongful practices and procedures at its own legacy facilities.
The suit alleges that the post-merger goals of DaVita were to increase wastage whenever possible for Vitamin D and iron drugs where the government paid for the wastage while ensuring that there was no waste of EPO. To accomplish this goal, the suit provides evidence of totally contradictory internal protocols that were used on most, if not all, of the 100,000-plus patients who receive dialysis treatments at DaVita centers across the United States.
The suit was filed on behalf of the U.S. government under the False Claims Act in the United States District Court for the Northern District of Georgia by a former Gambro/DaVita clinic director, Daniel D. Barbir, R.N., and Alon J. Vainer, M.D., a nephrologist who served as Medical Director of Gambro and DaVita dialysis clinics in Georgia.
So if someone in your family is on Medicare, it is time to be angry, very angry and to began to ask some tough questions of our members of congress of how one company could be fined and just do it again, and again and again. Any of us would be heading to jail. Thank God for this doctor and nurse who took a stand for their patients.
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