17). This is the same scheme with the same methodology as alleged here. Courts have therefore required relators to abide by those requirements when filing an amended complaint that is not substantially similar to the original complaint. (Id. WebChutes & LaddersMD Anderson gets new chief quality and value officer as it shifts to value-based care. Wilson v. Bristol-Myers Squibb, Inc., 2011 WL 2462469, at *6-7 (D. Mass. . First, defendant contends that the salaries paid to all of its medical directors is a matter of public record and is available on the website of the Center for Medicare and Medicaid Services (CMS). Accordingly, even if relator had complied with the pre-suit requirements of the False Claims Act, the public-disclosure bar would preclude the claims concerning joint-venture agreements. Previously, Martin was a Senior Na tional Account Manager at QuickSTAT. on the assumption that all the allegations in the complaint are true (even if doubtful in fact). Id. A subscription to PACER is required. Util. . US$20.14. 184-97). The proposed amendments in that case were completely new allegations from a new qui tam plaintiff. 232-35 (Diablo Nephrology in California); id. (Danieli, Chris) (Entered: 11/02/2021), (#8) Judge Douglas P. Woodlock: ELECTRONIC ORDER FOR TRANSFER entered. A medical director's productivity was tracked, and contracts with medical directors who generated a large number of patients were renewed. There must be particularized allegations of claims for payment arising from that scheme. (Id. The relator is eligible to collect a portion of any damages awarded in a qui tam action, whether or not the government intervenes. See Ge, 737 F.3d at 124 (stating that the court reject[s][the] approach sought by the relator, which was a per se rule that if sufficient allegations of misconduct are made, it necessarily follows that false claims and/or material false information were filed). (Id. Flanagan v. Fresenius Med. Menu and widgets. 2019) (cleaned up). Of those, thirteen described a scheme to offer dialysis services to hospitals well below cost in order to capture referrals. (Compl. Flanagan v. FRESENIUS MEDICAL CARE HOLDINGS, INC. (1:21-cv-11627), Massachusetts District Court Flanagan v. FRESENIUS MEDICAL CARE HOLDINGS, 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. Scott Downing at 312.624.6326 or sdowning@beneschlaw.com, Mark Silberman at 312.212.4952 or msilberman@beneschlaw.com, Juan Morado Jr. at 312.212.4967 or jmorado@beneschlaw.com, Whistleblower Lawsuit Against Fresenius Alleges Unlawful Arrangements with Hospitals and Nephrologists Intended to Induce Dialysis Referrals. 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. Martin Flanagan is a Senior National Account Manager at Quick International Courier based in Jamaica, New York. (Id. Compl. Here, despite its length, the amended complaint does not describe a single particular false claim. 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. Fresenius also allegedly provided free discharge planning services and in-service training to hospitals. Beginning in approximately 2007, FMCNA allegedly realized that the company's organic growth (that is, growth from adding new patients and not through acquisitions) was almost nonexistent. The complaint also alleges that Fresenius regularly entered into a variety of problematic arrangements with nephrologists and nephrology group practices intended to secure patient referrals for Fresenius wholly-owned and joint venture outpatient dialysis centers, including: Many of the allegations contained in the Complaint of inappropriate physician arrangements are similar, in many regards, to the allegations contained in whistleblower David Barbettas complaint filed against DaVita in federal district court in 2009. (Id.). See 31 U.S.C. (Am. Finally, one place to get all the court documents we need. Internal spreadsheets from the Western Business Unit show that FMCNA recorded losses on its contracts with hospitals, often in excess of the budgeted losses. As to the appellee L. Martin Flanagan, we affirm. 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. FMCNA also inserted non-competition clauses into their JVAs in order to lock partners into referring patients to its facility. (Finn, Mary) (Entered: 10/05/2021), Nineteenth Circuit Courts - Martin County | Personal Injury | (Id. Gonzales et al. 2013) (quoting Duxbury I, 579 F.3d at 21). Although this financial incentive encourages would-be relators to expose fraud, it also attracts parasitic relators who bring FCA damages claims based on information within the public domain or that the relator did not otherwise discover. United States ex rel. 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. 99-345, 1986 U.S.C.C.A.N. Phone: 1.619.238.4720 Email: inquiries@hoguebelonglaw.com Home Home Gonzales et al. 2012). 332-75). Compl. 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. That may, in part, be a result of the fact that relator did not work in any financial or billing capacity, but rather worked as the Director of Acute Market Development for the Fresenius Western Business Unit, and negotiated contracts between FMCNA and hospitals for in-patient dialysis treatment. Learn more about the survey. 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. See 31 U.S.C. MARTIN FLANAGAN, Plaintiff-Relator, v. FRESENIUS, Court:United States District Court, D. Massachusetts. Martin Flanagan is a resident of Texas. 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. United States ex rel. The complaint goes on to identify four specific sets of joint-venture arrangements (Balboa, NANI, ENA, and Dallas Nephrology Associates) and again alleges that all claims submitted in connection with patients treated by those physicians or facilities were tainted by kickbacks and therefore false. Id. . 1:2014cv00665 - Document 72 (D. Md. of Cunningham v. Millennium Lab'ys of Cal., Inc., 713 F.3d 662, 669-70 (1st Cir. . 83). 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. Flanagan filed the original complaint on March 6, 2014, alleging presentation of false claims in violation of the False Claims Act, 31 U.S.C. For the sake of simplicity, the Court will focus first on the Medicare claims. 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. US$14.87 US$16.99. The first-to-file bar provides that [w]hen a person brings an action . 90). . WebMichael D. Flanagan, MD, specializes in Obstetrics / Gynecology and Maternity Care, Geriatrics and sees patients in Bryn Mawr. Co., 827 F.3d 5, 13 (1st Cir. (Id. . That is not sufficient, under the case law, to state a false claim with particularity within the meaning of Rule 9(b). If the government declines to intervene and the qui tam case is unsealed, further proceedings are governed by 31 U.S.C. That is, [f]actual allegations must be enough to raise a right to relief above the speculative level . Previo usly, 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. 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. Michael D. Flanagan is a Internist in Bryn Mawr, PA. Find Dr. Flanagan's phone number, address, insurance information, hospital affiliations and more. Martin Flanagan is a Director, National of Acute Dialysis Services at Fresenius Medical Care North America based in Waltham, Massachusetts. See Kelly, 827 F.3d at 13. 39). Defendant also contends that the claims concerning joint-venture agreements are barred by the first-to-file rule. 1999)). . 223). These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia. Wilson v. Bristol-Myers Squibb, Inc., 750 F.3d 111 (1st Cir. No published case in the First Circuit, however, has ever gone so far. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 233 (1st Cir. To survive a motion to dismiss, the complaint must state a claim that is plausible on its face. were false.); id. The 2005 complaint alleged improper conduct dating from a decade before the conduct alleged here. Family Medicine Call for an (Entered: 10/05/2021), Docket(#1) ELECTRONIC NOTICE of Case Assignment. (Id. Mo. Fourth, it alleges that FMCNA entered into favorable leases with medical directors that paid them above-market rates. 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. (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. 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. 2014); cf. Id. 3730(c)(3). 38). Accordingly, the claims concerning joint-venture agreements are barred by the first-to-file rule. Instead, it alleges that FMCNA paid kickbacks for referrals on a widespread basis, and that therefore all claims for payment that it submitted to the government were false. MARTIN FLANAGAN, Plaintiff-Relator, v. FRESENIUS MEDICAL CARE HOLDINGS, INC., d/b/a FRESENIUS MEDICAL CARE NORTH AMERICA, Defendant. Relator responds that (1) the complaints do not allege the same essential facts and (2) the CKD complaint was later dismissed on jurisdictional grounds, which makes the first-to-file bar inapplicable. Kelly v. Novartis Pharm. WebView the profiles of people named Martin Flanagan. 25) and five paragraphs addressing how the scheme resulted in false claims (Id. 238 (Balboa Nephrology Medical Group) (Every claim . occurred; (2) said disclosure . The complaint alleges various methods by which FMCNA improperly induced the referral of patients to its dialysis clinics. Free Services to Hospitals and Patients. He is also a trustee and vice-Chair of the Inv Martin Flanagan's Phone Number and Email Last Update 4/3/2023 2:19 PM Contact Number (***) ***-**** Engage via Phone Mobile Number (***) ***-**** Engage via Mobile Test Drive Defendant contends that the allegations concerning the compensation of medical directors were publicly disclosed prior to the filing of the complaint. Among other things, the complaint uses the passive voice throughout: claims were submitted, rather than FMCNA submitted claims.. 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. FMCNA tracked the referrals recorded as part of the Bridge Program. ESRD expenditures by Medicare exceed $40 billion annually. 3/17/2023 8:35 PM. 26). Flanagan v. Fresenius Medical Care Holdings, Inc. FRESENIUS MEDICAL CARE HOLDINGS, INC., d/b/a Fresenius Medical Care North America, CIVIL CASE docketed. 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. 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. Arch Flanagan, Martin Flanagan. Here, the motion to dismiss presents three sets of issues, all arising from the strict requirements for pleading such claims. 23). Webmartin flanagan freseniusno credit check homes for rent in tucker, ga. at Edisto Beach. Moreover, the CKD complaint alleged that the scheme was nationwide. occurred in the manner which is specified in the FCA; and (3) the relator's suit [is] based upon' those publicly disclosed allegations or transactions. U.S. ex rel. free or discounted physician practice alignment services, including providing dedicated chronic kidney disease educator services, financial coordination services for patients beginning dialysis, vascular access development services and assistance with physician recruiting through Fresenius online recruiting platform. Third, it alleges that FMCNA provided physicians free or below-cost practice-management services. The 2010 Patient Protection and Affordable Care Act amendment to the public-disclosure bar made two notable changes to that definition. Since 1972, Medicare has been the primary payor for more than 80% of the cost of dialysis treatment for nearly 800,000 ESRD patients in the United States. Moreover, referral sources were routinely permitted to own more than 40% of the joint venture investment, contrary to HHS OIG guidance. Compl. Dismissal is appropriate if the complaint fails to set forth factual allegations, either direct or inferential, respecting each material element necessary to sustain recovery under some actionable legal theory. Gagliardi v. Sullivan, 513 F.3d 301, 305 (1st Cir. 02-11738, 2013 WL 682740, at *5 (D. Mass. were false .); id. Paperback. A former employee filed an amended whistleblower complaint against Fresenius Medical Care North America, alleging the dialysis company had unlawful to purchase . (CKD Compl. 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. 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. I understand that the relevant personnel have since received training to avoid such errors in the future. Web1 of 5 stars 2 of 5 stars 3 of 5 stars 4 of 5 stars 5 of 5 stars. 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. Under the circumstances presented here, the Court concludes that he cannot. 1998) (rev'd on other grounds, 529 U.S. 765 (2000)). 361 (Dallas Nephrology Associates)). . It alleges that FMCNA courted nephrologists in multi-physician private practices with high numbers of patients to be medical directors, often offering to pay them more than $100,000 annually in exchange for patient referrals. . The complaint further alleges that FMCNA provided free or below-cost services to physicians to secure referrals. Currently, Sandra Martin works as a Clinical Application Specialist at Fresenius Medical Care North America. It then alleges: The complaint does not, however, identify a single specific false claim submitted in connection with any of those dialysis centers. 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. 3729 et seq., by a company that provides dialysis services to patients with kidney failure. 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. Counsel may need to link their CM/ECF account to their upgraded individual pacer account. WebMartin Flanagan is a Director, National of Acute Dialysis Services at Liberty Dialysis based in Anchorage, Alaska. Search Google Scholar for this author For present purposes, the Court must assume that it did. Compl. 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. (Id. 3730(b)(2). DaVita settled that case in October 2014 by entering into a Corporate Integrity Agreement ("CIA") with the Office of Counsel to the Inspector General of the Department of Health and Human Services. UniCourt uses cookies to improve your online experience, for more information please see our Privacy Policy. Add to basket. (Id. FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North America, (#20) NOTICE of Appearance by Noah M Rich on behalf of Martin Flanagan (Rich, Noah) (Entered: 11/24/2021), (#19) NOTICE of Appearance by W. Scott Simmer on behalf of Martin Flanagan (Simmer, W.) (Entered: 11/22/2021), Affidavit Certificate of Noah M. Rich in Support of Motion for Appearance Pro Ha, Affidavit Certificate of Jamie Bennett in Support of Motion for Appearance Pro H, Affidavit Certificate of W. Scott Simmer in Support of Motion for Admission Pro, (#12) NOTICE of Appearance by Christopher P. Sullivan on behalf of Martin Flanagan (Sullivan, Christopher) (Entered: 11/18/2021), Affidavit Certification of Megan S. Heinsz, (#4) NOTICE of Appearance by Maria R. Durant on behalf of Fresenius Medical Care Holdings, Inc. (Durant, Maria) (Entered: 10/07/2021), (#3) NOTICE of Appearance by William H. Kettlewell on behalf of Fresenius Medical Care Holdings, Inc. (Kettlewell, William) (Entered: 10/07/2021), Docket(#20) NOTICE of Appearance by Noah M Rich on behalf of Martin Flanagan (Rich, Noah) (Entered: 11/24/2021), Docket(#19) NOTICE of Appearance by W. Scott Simmer on behalf of Martin Flanagan (Simmer, W.) (Entered: 11/22/2021), Docket(#18) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #17 Motion for Leave to Appear Pro Hac Vice Added Noah M. Rich. Martin Flanagan and United States of America: Defendant: FRESENIUS MEDICAL CARE HOLDINGS, INC. doing business as Fresenius Medical Care North The complaint must set forth with particularity the who, what, when, where, and how of the alleged fraud. U.S. ex rel. Attorneys admitted Pro Hac Vice must have an individual PACER account, not a shared firm account, to electronically file in the District of Massachusetts. 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. Rule 9(b) may be satisfied where, although some questions remain unanswered, the complaint as a whole is sufficiently particular to pass muster under the FCA. U.S. ex rel. The allegations in CKD described a scheme whereby FMCNA allegedly paid kickbacks to doctors with whom it had entered into joint-venture agreements. Email. . Chris Churchill. In affirming that decision, the First Circuit stated that the new paragraphs in the [p]roposed [complaint] were attributable to the new relator and . . Based on the allegations of the complaint, it appears that all of the patients in question would have received treatment at a facility operated by FMCNA or a competitor, and all of those treatments would have been paid by Medicare regardless. Patients who were referred to non-FMCNA clinics were categorized as leakage. (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. (Attachments: #1 Affidavit Certificate of W. Scott Simmer in Support of Motion for Admission Pro Hac Vice)(Sullivan, Christopher) (Entered: 11/22/2021), (#11) Chief Judge F. Dennis Saylor, IV: ELECTRONIC ORDER entered granting #6 Motion for Leave to Appear Pro Hac Vice Added James F. Bennett. (Id. It also provides a very limited amount of statistical evidence to attempt to bolster those allegations. 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. June 16, 2011). 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. Please contact one of the below authors if you have questions about the lawsuit and its implications for the nephrology and dialysis industry. (Id.). (McManus, Caetlin) (Entered: 11/22/2021), Docket(#14) MOTION for Leave to Appear Pro Hac Vice for admission of Jamie Bennett Filing fee: $ 100, receipt number AMADC-9065597 by Martin Flanagan. The Clerks Office nevertheless takes the position that the matter may not reassigned by their corrective action alone but requires some action of a judicial officer under the Local Rules. The original complaint referred to joint-venture agreements between FMCNA and physicians, but only in order to contrast such agreements (which it referred to as a product of arms-length negotiations) with the higher compensation paid to medical directors in the absence of such agreements. 2016). 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. Quick View. 3729(a)(1)(A), (a)(1)(B). were false.); id. 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. (Id.). 217). at *3 (collecting cases). 331). 2009) (Duxbury I). The critical question is whether the complaint meets the exacting standard for FCA claims required by law. However, even assuming compliance with those requirements, the claims concerning joint-venture agreements would be barred in any event. were false .); id. However, general allegations of illegal or fraudulent practices, without more, are not sufficient to state a claim under the False Claims Act. A subscription to PACER is required. 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. (Finn, Mary) (Entered: 10/05/2021). (Id. Judge Douglas P. Woodlock assigned to case. 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. Dec. 2, 2022). (Id. The CKD complaint alleged that FMCNA used joint-venture agreements as a way to provide remuneration to physicians in exchange for referrals. at 253. Poteet v. Medtronic, Inc., 552 F.3d 503, 516-17 (6th Cir. 42 U.S.C. 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.