A former vice president of Accredo Health Group has sued Accredo and its affiliates claiming they committed Medicare fraud by engaging in a kickback scheme with certain charities that support hemophilia patients. Steve Greenfield, the former eastern US area vice president of Accredo, filed his lawsuit under the federal False Claims Act, a law that pays whistleblowers huge awards for information about fraud involving government healthcare programs. The defendants deny the charge and say that charitable donations do not violate the law and were never intended as kickbacks.
Greenfield’s case has been pending since January of 2012. The government long ago declined to participate in the case meaning Greenfield must prosecute the case on his own. After four separate amended complaints, the donation versus kickback controversy finally appears ready for resolution. Both sides look at the same facts in different ways and think the court should rule in their favor.
Greenfield Sues Accredo Health Group
Steve Greenfield first brought his lawsuit in 2012. Prior to filing the suit, Steve served as a vice president of sales and marketing. His employer, Accredo, is a Tennessee company that provides specialty pharmacy services for patients suffering from chronic illnesses including hemophilia.
Accredo is owned by Medco Health Systems, another specialty pharmacy provider. Medco also owns a company called Hemophilia Health Services (HHS). Greenfield claims that the two affiliates, Accredo and HHS, were the companies paying the kickbacks.
To better understand this post, some brief history is useful. Congress passed the Anti-Kickback Statute, a law that makes it illegal to pay or give anything of value in an attempt to influence a healthcare decision. The first thing that comes to mind when someone hears the word “kickback” is a cash bribe. Healthcare providers have grown quite sophisticated, however, and often disguise kickbacks. An example is a hospital that offers doctors phony medical directorships or research grants in return for getting those doctors to admit more patients.
Congress believes that medical care decisions should be based on medical necessity and the patient’s best interest, not kickbacks.
A violation of the Anti Kickback Statute is considered Medicare fraud thus making these schemes eligible for whistleblower awards.
At the heart of this case are the donations being made by the companies. Greenfield says they are not donations at all but instead are thinly disguised kickbacks. According to his lawsuit, the companies make donations to Hemophilia Services Inc. and the Hemophilia Association of New Jersey, both nonprofit charities. Greenfield says the charities use their political power to sway business to the Medco companies.
Greenfield also claims that the companies give “expensive gifts” to the patients in order to keep their business.
Federal Anti Kickback Statute
To determine whether or not the “donations” are really kickbacks, one must look to the Anti Kickback Statute itself. That law says it is illegal to:
“Offer, receive, or solicit any remuneration, kickback, bribe or rebate, whether directly or indirectly, overtly or covertly, in cash or in kind, to or from any person in order to induce such person to purchase, lease, or order, or arrange for or recommend the purchasing, leasing, or ordering of any good or service or item for which payment may be made in whole or in part under a Federal Health Care Program.”
Like all federal programs, there are exceptions.
Medicare has trodden cautiously in the area of charitable donations. On the one hand, society should encourage others to give generously to charities. Yet, Medicare doesn’t want charitable contributions to be used as bribes.
Medicare Fraud or Legitimate Donations?
New Jersey has just four active hemophilia home care providers including Accredo. To be a provider, one must first be licensed by the state. But the state regulations specifically allow the hemophilia charities to approve providers. In other words, if you want to deliver hemophilia home care services in New Jersey, you first need to pass muster with the charities… the same charities that receive the companies multi-million dollar “donations.”
To prove his Medicare fraud claims, Greenfield needs to show more than just a suspicion that the companies’ donations were influencing healthcare decisions. He does so by attaching several incriminating emails between the charities and the companies. The emails suggest a direct link between the size of the donations and the amount of healthcare business Accredo receives.
Is this enough evidence? Were Accredo and the other companies making legitimate donations? Were those donations really kickbacks? Or were the companies being held hostage and suffering extortion committed by the charities? These are the questions that should soon be answered.
What Does this Case Mean for Whistleblowers?
The case is fascinating. We haven’t seen anything like this before. A charity that has official power to approve a healthcare provider’s ability to deliver Medicare and Medicaid services .
What makes this case even more interesting is that Accredo settled another False Claims Act Medicare fraud case last year. That case resolved for $60,000,000.00. Once again, it was filed by a whistleblower (one who was slated to receive $9 million for his information.)
Beyond the fascinating facts, the case is important because it shows how far the anti kickback statute has evolved. Today the term “kickback” goes well beyond cash. If there is an exchange of anything of value, there could be a kickback. We have seen successful cases where the only thing of value was placing an ambulance company on a hospital’s “preferred provider list.” (In exchange, the ambulance service diverted patients to that particular hospital even if others were closer.)
If you have information about healthcare fraud involving the use of kickbacks of any sort, contact us. Under the federal False Claims Act, whistleblowers with original source information about Medicaid, Tricare or Medicare fraud can receive a percentage of whatever the government collects from the wrongdoer. Million whistleblower awards in Medicare fraud cases are not unusual.
To obtain the award, one must first file a lawsuit under seal in federal court (just like Steve Greenfield). Calling a Medicare fraud hotline doesn’t qualify you. While the case is being investigated, it remains secret. Ultimately the Justice Department (or state in a Medicaid fraud case) must decide whether to take over the case or allow the whistleblower to prosecute. That decision affects the percentages ultimately awarded to the whistleblower. The more work the whistleblower’s lawyer must do, the higher the award percentage.
As an added benefit, the False Claims Act also contains powerful anti-retaliation benefits.
Information on Becoming a Medicare Fraud Whistleblower
Need more information? The Medicare fraud lawyers at MahanyLaw have already helped their clients receive over $100 million in awards. They have also helped our clients stop fraud and collect billions for taxpayers.
Whistleblowers are the new American heroes. In Medicare fraud cases, they sometimes even help save lives.
Interested in learning more? Visit our Medicare fraud information page or better yet, contact us directly. All inquiries are protected by the attorney – client privilege and kept completely confidential. For more information, contact attorney Brian Mahany at *protected email* or by telephone at (414) 704-6731.
MahanyLaw – America’s Medicare Fraud Whistleblower Lawyers
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