Care Holdings, Inc., 906 F.Supp.2d 1264, 1274 (N.D.Ga. (CKD Compl. Id. 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. 1). Mo. 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. . That statute provides: The policy behind that requirement-allowing the government to investigate the claims and decide whether to intervene-is implicated when a relator amends a complaint to add completely new FCA claims. . 3730(b)(2). . Search Google Scholar for this author Judge Douglas P. Woodlock assigned to case. 274 (North Carolina) ([E]ach of these claims was false .); id. Second, the requirement for direct knowledge was replaced with the requirement that a relator's knowledge must materially add[ ] to the publicly disclosed allegations or transactions. Id. (g), I respectfully disagree with that interpretation. (Id.). 2004), abrogated on other grounds by Allison Engine Co. v. United States ex rel. 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. 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 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. Use the links below to access additional information about this case on the US Court's PACER system. By law, all outpatient dialysis clinics must have a qualified medical director to be responsible for the delivery of patient care and outcomes in the facility. 42 C.F.R. While it is true that CMS data are reports for the purposes of the public disclosure bar, see U.S. ex rel. 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. And it means that relator stands to reap a reward of 15%-30% of any recovery-an amount that might well be measured in tens of billions of dollars. 9(b). 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. There is no contention that any dialysis services performed were medically unnecessary or excessive, or that those services were performed in a substandard manner. Id. In any event, as to those aspects of the alleged scheme, the allegations of the submission of false claims are similarly general. (Id.). In summary, the amended complaint fails to state allegations of fraud under the FCA with the particularity required by Rule 9(b). If relator is correct, that means that the entire government-payor business of FMCNA-which appears to amount to more than $10 billion in revenue per year-is based on fraud. It identifies specific hospitals, doctors, and medical practices that have allegedly benefited financially from the scheme. 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. Dec. 2, 2022). According to the complaint, FMCNA budgeted for the anticipated losses in the acute programs at many of the larger hospitals. WebFlanagan v. Fresenius Medical Care Holdings, Inc., No. 256-69 (IMN and other practices in Indiana); id. See U.S. ex rel. The government had an opportunity to intervene if it chose, and elected not to do so. Compl. of Cunningham v. Millennium Lab'ys of Cal., Inc., 713 F.3d 662, 669-70 (1st Cir. The complaint must set forth with particularity the who, what, when, where, and how of the alleged fraud. U.S. ex rel. Defendant contends that the amended complaint should be dismissed for failure to comply with the pre-suit requirements of the FCA, 31 U.S.C. The plausibility standard is not akin to a probability requirement,' but it asks for more than a sheer possibility that a defendant has acted unlawfully. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 556). Attorneys admitted Pro Hac Vice must have an individual PACER account, not a shared firm account, to electronically file in the District of Massachusetts. Finally, the complaint alleges that FMCNA entered into joint-venture agreements with physicians in order to induce referrals to the joint-venture clinic. 270-84 (ENA and other practices in North Carolina); id. . 3729-33, provides for civil liability for anyone who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval or knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim. 31 U.S.C. 02-11738, 2013 WL 682740, at *5 (D. Mass. The 2005 complaint alleged improper conduct dating from a decade before the conduct alleged here. 2016). (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. . (McManus, Caetlin) (Entered: 11/22/2021), Docket(#17) MOTION for Leave to Appear Pro Hac Vice for admission of Noah M. Rich Filing fee: $ 100, receipt number AMADC-9065658 by Martin Flanagan. 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. The remaining six paragraphs describing the alleged scheme consisted of an introductory paragraph (Compl. It also contracts with hospitals to provide dialysis services on an outpatient basis. 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. (Id. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia. 88). 1998) (rev'd on other grounds, 529 U.S. 765 (2000)). 2005)). . 29 at 10). (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. 22). 42 U.S.C. End-Stage Renal Disease (ESRD) is the stage of advanced kidney impairment that requires either continued dialysis treatments or a kidney transplant to sustain life. Parties for Flanagan v. Fresenius Medical Care Holdings, Inc., A subscription to PACER is required. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 233 (1st Cir. Flanagan and his colleagues were allegedly instructed by their superiors to obtain hospital contracts at any cost to secure the referrals of discharged patients. occurred; (2) said disclosure . We remand for further proceedings. Medical directors are not FMCNA employees, but physicians in private practice. were false .); id. 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. Flanagan v. Fresenius Medical Care Holdings, Inc. 308, 321). Accordingly, [f]ailure to comply with these mandatory threshold requirements warrants dismissal of the qui tam complaint with prejudice. United States ex rel. 3729(a)(1)(A) (Count 1); making or using false records material to a false or fraudulent claim in violation of the False Claims Act, 31 U.S.C. The 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. Duxbury I, 579 F.3d at 33; United States ex rel. Cancellation and Refund Policy, Privacy Policy, and Counsel may need to link their CM/ECF account to their upgraded individual pacer account. Another six described a scheme involving improper remuneration relationships with physicians who serve as medical directors at Fresenius clinics. (Id. WebMichael P. Flanagan, MD. 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. Nonetheless, the First Circuit has identified some examples of specific allegations that may suffice to state a claim with the requisite particularity. . Save US$2.12. See East Bay Mun. A claim is any request or demand . 29). The complaint further alleges that FMCNA paid its medical directors far above fair market value. b. Feb. 25, 2013), the mere publication of compensation information, without an allegation of fraud or misrepresentation, is not sufficient to trigger the bar. WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. 6:22-CV-03192 | 2022-07-28. Add to basket. 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 And even though the regulatory guidance defines the medicaldirector position as occupying 0.25 FTE, the complaint alleges that FMCNA neither tracked nor enforced medical directors' hours spent on duties to their clinics. No published case in the First Circuit, however, has ever gone so far. Counsel may need to link their CM/ECF account to their upgraded individual pacer account. 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. WebChutes & LaddersMD Anderson gets new chief quality and value officer as it shifts to value-based care. Res., 162 F.3d 195, 200 (2d Cir. 3/17/2023 8:35 PM. Quick View. Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111 (1st Cir. Heineman-Guta v. Guidant Corp., 718 F.3d 28, 35-37 (1st Cir. Chris Churchill. It alleges that although FMCNA directed that all services provided under the Bridge Program must be provided at FMV, Flanagan was never required to obtain an FMV analysis for any hospital contract or for Bridge Program services during his tenure with the company. The following is a relevant excerpt from an SEC filing cited by the court in CKD: That excerpt discloses that the joint ventures do not qualify for safe-harbor protection and identifies the penalties that might be imposed should the company be found to be in violation of the relevant statutes. (Id. Add to 142-43). (McManus, Caetlin) (Entered: 11/22/2021), (#14) MOTION for Leave to Appear Pro Hac Vice for admission of Jamie Bennett Filing fee: $ 100, receipt number AMADC-9065597 by Martin Flanagan. 167-69). Compl. 93). As to joint-venture agreements, the complaint again alleges in general terms that all claims submitted by facilities with joint-venture partners are false claims. 02 Jun 2016. (Id. The plaintiff further recounts various instances where Fresenius leadership was questioned about the fair market value of such relationships and the companys alleged failure to enforce annual contractual rate increases. Access the Case Summary and Docket Report to access additional information about this case on the US Court's PACER system. Kelly v. Novartis Pharm. 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. . Martin Flanagan and United States of America: Defendant: FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North 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. Relator Martin Flanagan has brought suit against defendant Fresenius Medical Care Holdings, Inc., d/b/a Fresenius Medical Care North America (FMCNA), alleging that FMCNA improperly provided free or below-cost services to hospitals and physicians, and made various types of improper payments to physicians, in exchange for referrals to its dialysis clinics. 40). Flanagan v. Fresenius Medical Care Holdings, Inc. Martin Flanagan and United States of America, FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North America, US District Court for the District of Massachusetts. 331). 19). 343). 3730(b)(2), (b)(4), (c)(1). Documents and certified copy of docket sheet and order of transfer received from the Clerk in the transferor district via Email. Defendant contends that the 2014 CKD complaint alleged the same fraudulent scheme concerning joint-venture agreements as the amended complaint here, which was filed seven years later. 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. 44). 232-35 (Diablo Nephrology in California); id. Roughly 90% of all dialysis patients undergo hemodialysis at a dialysis clinic three times per week. Martin CHAMPVA, which is administered by the United States Department of Veterans Affairs, is a health-care program for families of veterans with 100% service-connected disabilities and provides ESRD benefits to covered beneficiaries. may be available from PACER. See Kelly, 827 F.3d at 13. United States v. Cyberonics, Inc., 844 F.3d 26, 31 (1st Cir. (Id. Saldivar v. Fresenius Med. (Reuters) - A former top legal executive at Germany's Fresenius Medical Care AG & Co KGaA sued the dialysis clinic operator on Tuesday alleging he was According to the complaint, over the past two decades, the dialysis industry has become increasingly concentrated in the hands of two companies: DaVita and FMCNA. As its Western Division director of acute market development, he was 13). CEO Martin Flanagan still sees a growth opportunity in Chinaand a big risk in Bitcoin. D. Pleading Fraud with Particularity under Rule 9(b). The allegations in CKD described a scheme whereby FMCNA allegedly paid kickbacks to doctors with whom it had entered into joint-venture agreements. 4:05-cv-985 (E.D. Fighting proud: the remarkable story of Indigenous 3.06 avg rating 31 ratings published 2005. Furthermore, they do not directly disclose the existence of any of the alleged schemes, or any other form of fraud, nor do they describe facts from which the existence of a fraudulent scheme might be inferred. Sandra Martin Work Experience and Education. In an FCA case, these may include details concerning the dates of the claims, the content of the forms or bills submitted, their identification numbers, the amount of money charged to the government, the particular goods or services for which the government was billed, the individuals involved in the billing, and the length of time between the alleged fraudulent practices and the submission of claims based on those practices. U.S. ex rel. Martin Flanagan's Phone Number and Email Last Update. 89). (Id. UNITED STATES ex rel. Journal of Intensive Care Medicine 2011 26: 4, 237-249 Download Citation. 1:2014cv00665 - Document 72 (D. Md. 45-49). 247-48). 2021) case opinion from the District of Maryland US Federal District Court Why is this public record being published online? The statute defines original source as an individual who, [1] prior to a public disclosure . 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. 25) and five paragraphs addressing how the scheme resulted in false claims (Id. . Flanagan v. Fresenius Medical Care Holdings, Inc. - Law360 Ex. . (Id. Pilon v. Martin Marietta Corp., 60 F.3d 995, 998-99 (2d Cir. 2016). Martin Flanagan is a Senior National Account Manager at Quick International Courier based in Jamaica, New York. 750 F.3d at 120. 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. Attorneys admitted Pro Hac Vice must have an individual upgraded PACER account, not a shared firm account, to electronically file in the District of Massachusetts. It also provides a very limited amount of statistical evidence to attempt to bolster those allegations. 3730(e)(4)(A). (Id. Access this case on the Massachusetts District Court's Electronic Court Filings (ECF) System. 181). Make your practice more effective and efficient with Casetexts legal research suite. Michael P. Flanagan, MD | Penn State Health Gagne v. City of Worcester, 565 F.3d 40, 45 (1st Cir. And the best part of all, documents in their CrowdSourced Library are FREE! Medicare is a federally-funded health-insurance program that primarily provides benefits to the elderly, but also provides coverage to patients with ESRD, regardless of age. Conrad v. Abbott Lab'ys, Inc., No. This docket was last retrieved on April 5, 2023. DOJ files False Claims Act case against dialysis giant Fresenius 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. 3730(d). Here, the allegations are substantially similar to those in CKD and are thus based upon the public disclosures. at *3 (collecting cases). By continuing to use this website, you agree to UniCourts General Disclaimer, Terms of Service, . 2009). our revenues would decrease. (Id. Phone: 1.619.238.4720 Email: inquiries@hoguebelonglaw.com Home Home Gonzales et al. General Description of Medicare and Medicaid Claim Systems. First, it alleges that FMCNA offered remuneration to hospitals in two ways: by entering into contracts that provided no-cost and/or below-cost inpatient dialysis services, and by providing significant free services, including free dischargeplanning services, free in-service training to staff, free training to patients, and free quality assessment and improvement data analysis to hospitals. 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. 85). (Id. Attorneys admitted Pro Hac Vice must have an individual upgraded PACER account, not a shared firm account, to electronically file in the District of Massachusetts. 3730(e)(4); (3) the claims concerning joint-venture agreements are barred by the FCA's first-to-file bar, 31 U.S.C. FMCNA is America's largest dialysis-services provider. POLEN and STEVENSON, JJ., concur. For present purposes, the Court must assume that it did. (Id. 26). (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. Michael D. Flanagan is a Internist in Bryn Mawr, PA. Find Dr. Flanagan's phone number, address, insurance information, hospital affiliations and more. 2013) (quoting Duxbury I, 579 F.3d at 21). 2019) (quoting U.S. ex rel. Join Facebook to connect with Martin Flanagan and others you may know. Id. 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. As to Diablo Nephrology, the complaint alleges the following: As to Balboa Nephrology Medical Group, it alleges the following: As to NANI, the complaint provides a table of Medicare and Medicaid revenue for a period of five years at seventeen dialysis centers in the Chicago area. Of those, thirteen described a scheme to offer dialysis services to hospitals well below cost in order to capture referrals. (Compl. Where the defendant allegedly caused a third party to submit a false claim to the government, rather than submitting the false claim itself, a more flexible standard applies, under which Rule 9(b) is satisfied by providing factual or statistical evidence to strengthen the inference of fraud beyond possibility without necessarily providing details as to each false claim submitted. U.S. ex rel. Martin Flanagan is a journalist and author who writes on sport, Australian culture and the relationship between indigenous and non-indigenous Australia. 361 (Dallas Nephrology Associates)). See Kelly, 827 F.3d at 15 (It may not be irrational to infer that, given [the allegations of the fraudulent scheme], some false claims . According to the United States Renal Data System, there were approximately 746,557 ESRD patients in the United States at the end of 2017. (Id. That is, [f]actual allegations must be enough to raise a right to relief above the speculative level . . The Court has previously determined that the portion of the amended complaint that alleges claims arising out of the joint-venture agreements and the provision of free services to physicians will be dismissed for failure to comply with the pre-suit requirements of the False Claims Act. (Id. 334-35). . The description of the alleged scheme consisted of 25 paragraphs. were false.); id. To do so, the complaint must both allege the existence of a scheme to defraud and identify particularized false claims. Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. by. It does not follow, however, that where there is an AKS violation, the requirement of establishing a false claim evaporates. . Flanagan v. Fresenius Medical Care Holdings, Inc. 131). (McManus, Caetlin) (Entered: 11/22/2021), (#17) MOTION for Leave to Appear Pro Hac Vice for admission of Noah M. Rich Filing fee: $ 100, receipt number AMADC-9065658 by Martin Flanagan.
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