1320a-7b(b)(2). Martin Flanagan and United States of America: Defendant: FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North . Jason S. Greis at 312.624.6412 orjgreis@beneschlaw.com. Appearance form, Docketing Statement, and Transcript Report/Order form due 04/19/2023. The second question is whether there is an exception to the first-to-file bar that would allow relator's pre-2010 claims to survive. 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. 242-55 (NANI in Illinois); id. Finally, the complaint alleges that medical directors were required to sign agreements containing non-competition provisions in order to preclude any medical director and those in the same practice group from engaging in any remunerative relationship with another dialysis company. The complaint alleges that the Bridge Program was actually designed to capture all of a hospital's referrals, as about half of the company's patients came into [FMCNA] clinics via [the discharge planning process]. (Id. As to each, it provides some specifics as to the scheme (such as referral trends and medical-director compensation levels). Co. Ltd., 737 F.3d 116, 123 (1st Cir. Kelly v. Novartis Pharm. 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. In that role, he was responsible for, among other duties, negotiating contracts under which FMCNA provided dialysis treatment to hospital inpatients. 308-14). 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. A more recent docket listing Martin Flanagan's Phone Number and Email Last Update. (Woodlock, Douglas) (Entered: 11/02/2021), Docket(#7) NOTICE of Appearance by Abraham R. George on behalf of United States of America (George, Abraham) (Entered: 10/18/2021), Docket(#6) MOTION for Leave to Appear Pro Hac Vice for admission of James F. Bennett Filing fee: $ 100, receipt number AMADC-9005666 by Fresenius Medical Care Holdings, Inc.. (Attachments: #1 Affidavit Certification of James F. Bennett)(Durant, Maria) (Entered: 10/13/2021), Docket(#5) MOTION for Leave to Appear Pro Hac Vice for admission of Megan S. Heinsz Filing fee: $ 100, receipt number AMADC-9005610 by Fresenius Medical Care Holdings, Inc.. (Attachments: #1 Affidavit Certification of Megan S. Heinsz)(Durant, Maria) (Entered: 10/13/2021), Docket(#4) NOTICE of Appearance by Maria R. Durant on behalf of Fresenius Medical Care Holdings, Inc. (Durant, Maria) (Entered: 10/07/2021), Docket(#3) NOTICE of Appearance by William H. Kettlewell on behalf of Fresenius Medical Care Holdings, Inc. (Kettlewell, William) (Entered: 10/07/2021), Docket(#2) Case transferred in from District of Maryland; Case Number 14-cv-00665-GLR. 176). Martin Flanagan is a Senior National Account Manager at Quick International Courier based in Jamaica, New York. 2014); cf. June 11, 2014). Second, it alleges that FMCNA engaged in improper remuneration relationships with physicians who served as medical directors in its outpatient clinics in five ways: by selecting medical directors based on their expected and historical referrals; by paying them above-market compensation to reward referrals; by making no effort to report or verify their hours; by tracking their referrals to make sure they were not making referrals to competitors; and by requiring them to sign onerous noncompete agreements to lock them into their arrangements with FMCNA. In 2014, a qui tam action was filed in the Eastern District of New York alleging that on FMCNA acquired controlling interests in dialysis clinics and paid physician owners above market value for their clinics and that this excess constituted payment to induce the doctors to refer patients back to these clinics. U.S. ex rel. Martin Flanagan worked for Fresenius Medical Care North America (FMCNA) for 29 years. . 13). (Id. Again, the complaint does not identify a single specific false claim-by Form UB-40, by patient name, by date, by location, by dollar amount, by billing code, by type of service, or otherwise. 286 (Texas) (All such claims . 25). 81-166). For example, in United States ex rel. 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. by. A claim is any request or demand . at 555 (citations omitted). June 21, 2005). Journal of Intensive Care Medicine 2011 26: 4, 237-249 Download Citation. 4:05-cv-985 (E.D. WebView the profiles of people named Martin Flanagan. (Id.). 11). 2:22-CV-01807 | 2022-10-21, U.S. District Courts | Personal Injury | Ex. 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. First, the complaint alleges in general terms that all claims for reimbursement made to Medicare require the submission of a Form UB-40 (or a substantially similar form) that contains various data, including the patient's identifying information and line items for each claim sought to be reimbursed. (Am. 162). Heineman-Guta v. Guidant Corp., 718 F.3d 28, 35-37 (1st Cir. It did not allege that FMCNA improperly provided free services to hospitals and patients in the form of free discharge-planning services, free in-service training to staff, free training to patients, and free quality assessment and improvement program data analysis, nor did it mention the Bridge Program. This action is taken to insure the parties receive timely notice of the properly assigned presiding judge and is without prejudice to consideration by the Court as a whole whether Local Rule 40.1 should be amended in some fashion to eliminate any further misunderstanding by the Clerks Office. Accordingly, the claims concerning joint-venture agreements are barred by the first-to-file rule. 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 25) and five paragraphs addressing how the scheme resulted in false claims (Id. 9(b). were false .); id. 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. In substance, it is a dressed-up version of a generalized allegation: it essentially alleges that if a practice benefited financially from a relationship with FMCNA, and if it administered 104,000 treatments, and 93% of those were to patients who were beneficiaries of government-sponsored healthcare programs, then it submitted 96,720 false claims. 257 (Indiana) (All such claims . This is a qui tam action alleging violations of the Anti-Kickback Statute, 42 U.S.C. WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. Paperback. 23641 (Balboa Nephrology Medical Group in California); id. (CKD Compl. 3730(e)(4)(B). 172, 206-13). Here, despite its length, the amended complaint does not describe a single particular false claim. Fresenius also allegedly provided free discharge planning services and in-service training to hospitals. 22). 119 (2010). 293 (Washington state) (All such claims . (Id. It then alleges, in general terms, that all claims from those facilities were tainted by kickbacks and therefore constitute false claims within the meaning of the False Claims Act. There is, of course, considerable logic to relator's arguments: if 100% of the business of FMCNA is tainted by kickbacks, and if 80% or more of the business of FMCNA involves government payors, it follows that FMCNA must have submitted many false claims. It also contracts with hospitals to provide dialysis services on an outpatient basis. 332-75). (Id. The entire basis of the complaint is a theory of tainted referrals; kickbacks paid by FMCNA tainted the physician-referral process, which enabled the company to obtain, unlawfully, a larger share of referrals than it would have otherwise in a properly functioning market. Dialysis refers to a treatment regimen aimed at artificially replacing some of the functions performed by a healthy kidney. To survive a motion to dismiss, a complaint alleging fraud must state with particularity the circumstances constituting fraud. Fed.R.Civ.P. It includes a blank example of such a form as Exhibit A. Paperback. According to the complaint, FMCNA pitched medical-director positions to nephrologists as a way to earn a considerable income for little or no investment of time. (Id. Of those, thirteen described a scheme to offer dialysis services to hospitals well below cost in order to capture referrals. (Compl. 11). 1999)). Add to 12% off. v. Balfour Beatty Infrastructure, Inc., 2014 WL 2611312, at *2 (N.D. Cal. . 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. (McManus, Caetlin) (Entered: 11/02/2021), (#10) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #5 Motion for Leave to Appear Pro Hac Vice Added Megan S. Heinz. Counsel may need to link their CM/ECF account to their upgraded individual pacer account. (Id. may be available from PACER. The allegations in CKD described a scheme whereby FMCNA allegedly paid kickbacks to doctors with whom it had entered into joint-venture agreements. (Id. [23-1305] (JAW) [Entered: 04/05/2023 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. 284 (North Carolina) (All such claims . 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. Fresenius Medical Care Holdings, Inc., 1:14-cv-00665 Brought to you by the RECAP Initiative and Free Law Project, a non-profit dedicated to creating high quality He did not do so, however, before filing his amended complaint, which is 147 pages long and contains a number of substantially new allegations of different components of the scheme. 2004), abrogated on other grounds by Allison Engine Co. v. United States ex rel. Instead, those services were provided free of charge. United States District Court, D. Massachusetts. Courts have therefore required relators to abide by those requirements when filing an amended complaint that is not substantially similar to the original complaint. MARTIN FLANAGAN, Plaintiff-Relator, v. FRESENIUS, Court:United States District Court, D. Massachusetts. Unless otherwise noted, the following facts are alleged in the amended complaint. 3.06 avg rating 31 ratings published 2005. 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. Phone: 1.619.238.4720 Email: inquiries@hoguebelonglaw.com Home Home Gonzales et al. 85). 3729(a)(1)(C) (Count 3). . 274 (North Carolina) ([E]ach of these claims was false .); id. Duxbury I, 579 F.3d at 33; United States ex rel. Suppose, for example, that in a world free from kickbacks, 25% of the dialysis services business of FMCNA would have been captured by competitors. WebFlanagan v. Fresenius Medical Care Holdings, Inc., No. See 31 U.S.C. (Am. Martin Flanagan. It then used that data to identify physicians and practice groups to target for medical director positions and joint-venture agreements. 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. 3730(b)(5). On February 5, 2021 a long-time former Fresenius Medical Care North America (Fresenius) employee, Martin Flanagan, filed a qui tam relator amended Counsel may need to link their CM/ECF account to their upgraded individual pacer account. WebChutes & LaddersMD Anderson gets new chief quality and value officer as it shifts to value-based care. This docket was last retrieved on December 5, 2022. This docket was last retrieved on April 5, 2023. of Cunningham v. Millennium Lab'ys of Cal., Inc., 713 F.3d 662, 669-70 (1st Cir. As is often the case with qui tam actions, the issue is not whether the complaint alleges an unlawful scheme-it does, in considerable detail-but whether it actually pleads a violation of the False Claims Act. Cases involving fraud against the government, False Claims Act (FCA) - 31 USC 3729-3733. On a motion to dismiss, the court must assume the truth of all well-plead[ed] facts and give . (Id. 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. The public-disclosure bar seeks to prevent parasitic qui tam actions in which relators, rather than bringing to light independently discovered information of fraud, simply feed off of previous disclosures of public fraud. United States ex rel. occurred; (2) said disclosure . See Id. (Id.). Chris Churchill. 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. His last title was Director of Acute Market Development for the Fresenius Western Business Unit. And under Rule 9(b), those claims must be described with some level of specificity. The district court had found that the relators had violated the filing and service requirements of the FCA because the new allegations were not substantially similar to those in the original complaint. 22-1304 | 2022-04-25, U.S. Courts Of Appeals | Other | (Id. Because the complaint does not state allegations of fraud under the FCA with the particularity required by Rule 9(b), the conspiracy claim under the FCA must fail as well. 39). 2023-03-23, Brevard County Courts | Personal Injury | Flanagan v. Fresenius Medical Care Holdings, Inc. FRESENIUS MEDICAL CARE HOLDINGS, INC., d/b/a Fresenius Medical Care North America, CIVIL CASE docketed. Here, the complaint describes in general terms how claims are submitted to Medicare and Medicaid; it describes the various ways in which FMCNA allegedly paid kickbacks for referrals; and as to each such aspect of the scheme, it alleges that every claim or all claims were fraudulent. (Id. The False Claims Act permits relators to reap substantial awards for reporting false claims to the government-in this case, the relator could conceivably recover billions of dollars if his allegations are proved. 132, 140). plaintiff the benefit of all reasonable inferences therefrom. Ruiz v. Bally Total Fitness Holding Corp., 496 F.3d 1, 5 (1st Cir. The statute has a variety of strict requirements, however, that serve both to ensure that the government has a fair opportunity to control the litigation and to screen out claims that are incomplete, redundant, or parasitic. As noted, there are no allegations at all concerning the payments of claims under the CHAMPUS/TRICARE or CHAMPVA programs. And it did not allege that FMCNA provided free or below-cost practice-management services to physicians. Mar 17, 2023 11:00am. 2021) case opinion from the District of Maryland US Federal District Court Among other things, the complaint uses the passive voice throughout: claims were submitted, rather than FMCNA submitted claims.. After a review of the claims, the government declined to intervene. It is true that a violation of the Anti-Kickback Statute that results in a federal health care payment is a per se false claim. Guilfoile, 913 F.3d at 190. See East Bay Mun. 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. 89). (Id. (Id. Previously, Martin was a Direct or, Acute Maket Development Each step in that argument relies on an inference: first, the inference that the relevant financial arrangements were intended as kickbacks; second, the inference that every referral to an FMCNA clinic was made as a result of the kickbacks; and third, the inference that every claim for government reimbursement was tainted by the kickbacks. 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. 40). . The complaint must set forth with particularity the who, what, when, where, and how of the alleged fraud. U.S. ex rel. 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. (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. Poteet v. Medtronic, Inc., 552 F.3d 503, 516-17 (6th Cir. 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. 45). 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. WebA division of Fresenius Medical Care North America, Azura Vascular Care partners with dedicated, highly skilled physicians and surgeons, providing opportunities for practice they [therefore] violated the FCA's filing and service requirements. Wilson, 750 F.3d at 120. Search Google Scholar for this author . L. No. 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. 2016). . However, the First Circuit has rejected the holding in Poteet, explaining that earlier-filed complaints must provide only the essential facts to give the government sufficient notice to initiate an investigation into allegedly fraudulent practices and emphasizing that Section 3730(b)(5) contains no exceptions. United States ex rel. Mo. Casetext, Inc. and Casetext are not a law firm and do not provide legal advice. In any event, as to those aspects of the alleged scheme, the allegations of the submission of false claims are similarly general. 343). CKD Project v. FMCNA, No. Here, the original complaint was 22 pages long and contained 54 numbered paragraphs. 198-205). UniCourt uses cookies to improve your online experience, for more information please see our Privacy Policy. FMCNA is a wholly-owned subsidiary of Fresenius Medical Care AG & Co. KGaA, which is located in Bad Homburg, Germany. In summary, the amended complaint fails to state allegations of fraud under the FCA with the particularity required by Rule 9(b). 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. . 97-106). Martin Flanagan is a journalist and author who writes on sport, Australian culture and the relationship between indigenous and non-indigenous Australia. 22-1305 | 2022-04-25, U.S. Courts Of Appeals | Other | CKD Project, LLC v. Fresenius Med. Beneschs healthcare+ attorneys have significant experience representing nephrology group practices and dialysis organization in governmental fraud and abuse investigations. 308-20). 44). 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. no person other than the Government may intervene or bring a related action based on the facts underlying the pending action. 31 U.S.C. (McManus, Caetlin) (Entered: 11/22/2021), Docket(#15) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #13 Motion for Leave to Appear Pro Hac Vice Added W. Scott Simmer. Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111 (1st Cir. The complaint further alleges that FMCNA provided free or below-cost services to physicians to secure referrals. Co., 827 F.3d 5, 13 (1st Cir. 2019) (quoting U.S. ex rel. Moreover, the CKD complaint alleged that the scheme was nationwide. Read More . 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. 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. Nov. 12, 2014) (ECF No. [23-1305] (JAW) [Entered: 04/05/2023 09:24 PM]. Corp. v. Twombly, 550 U.S. 544, 570 (2007). 2010). (Id.). WebFlanagan v. Fresenius Medical Care Holdings, Inc. View recent docket activity Reflects complaints, answers, motions, orders and trial notes entered from Jan. 1, 2011. The relator is eligible to collect a portion of any damages awarded in a qui tam action, whether or not the government intervenes. (Id. Arch Flanagan, Martin Flanagan. A subscription to PACER is required. (Id. Quick View. 26). 3. Id. The CKD complaint therefore contained the essential facts alleged here, thus barring the allegations contained in the amended complaint. Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111, 118 (1st Cir. 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. Plaintiff-Relator Martin Flanagan (Relator) worked for Fresenius for twenty-nine years, most recently as Director of Acute Market Development for the The Anti-Kickback Statute, 42 U.S.C. I understand that the relevant personnel have since received training to avoid such errors in the future. Appearance form, Docketing Statement, and Transcript Report/Order form due 04/19/2023. (Id. Sandra Martin Work Experience and Education. F. DENNIS SAYLOR IV, CHIEF JUDGE, UNITED STATES DISTRICT COURT, MEMORANDUM AND ORDER ON DEFENDANT'S MOTION TO DISMISS. Documents and certified copy of docket sheet and order of transfer received from the Clerk in the transferor district via Email. 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 5266, 5289). 167-307). Relator first alleged fraud concerning joint ventures in the amended complaint, which was filed in 2021. Please contact one of the authors below or a member of theBenesch Healthcare+ Practice Groupif you have questions regarding information contained in this Client Alert. (McManus, Caetlin) (Entered: 11/02/2021), Docket(#10) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #5 Motion for Leave to Appear Pro Hac Vice Added Megan S. Heinz. In many states, Medicaid pays for treatment costs for ESRD patients who do not qualify for Medicare and/or pays for the 20% of treatment costs not covered by Medicare. 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. 02 Jun 2016. Kelly Flanagan is an Operations Coordinator at Fresenius Kabi based in Bad Homburg, Hessen. 2019) (cleaned up). WebBrigid M. Flanagan, RN, MS, Sean Philpott, PhD, MS, and Martin A. Strosberg, MA, MPH, PhD. Third, defendant contends that relevant public disclosures occurred in multiple SEC filings by FMCNA. 285-91 (practices in Texas); id. (Id. 42 U.S.C. . 750 F.3d at 120. at 999. However, even assuming compliance with those requirements, the claims concerning joint-venture agreements would be barred in any event. 29). It alleges that Flanagan and colleagues were directed by their superiors to pursue contracts even when they resulted in losses. 1:20-CV-11927 | 2020-10-26, U.S. District Courts | Other | Compl. . The question here is whether the complaint has met that standard. 1:2014cv00665 - Document 72 (D. Md. The portions of the claims based on those allegations will therefore be dismissed for failing to comply with the FCA's pre-suit requirements. The first-to-file bar provides that [w]hen a person brings an action . Again, however, no case, to the Court's knowledge, has ever established such a procedure. 2016). Under Rule 9(b), the standard for allegations of fraud is higher than the normal pleading standard. 14). Add to basket. . At most, the filings describe a set of circumstances that might be vulnerable to manipulation. Patients who were referred to non-FMCNA clinics were categorized as leakage. (Id. Free Services to Hospitals and Patients. (Attachments: #1 Affidavit Certificate of Noah M. Rich in Support of Motion for Appearance Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#16) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #14 Motion for Leave to Appear Pro Hac Vice Added Jamie Bennett. 2005)). Therefore, the court may consider any public disclosures made prior to 2021 for purposes of determining whether the claims are prohibited by the public-disclosure bar. (Id. . Conrad v. Abbott Lab'ys, Inc., No. 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.
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