Whistleblower Lawsuit Against Exact Sciences Leads to $13.75 Million Settlement

On September 26, 2023, Wilbanks & Gouinlock, LLP and Peak Wooten McDaniel & Colwell, LLP secured a $13.75 million settlement in a False Claims Act and Anti-Kickback Statute case just before trial. The lawsuit was filed by Dr. Niles Rosen, a retired pathologist and whistleblower, on behalf of the United States government.

Most of the settlement will be paid to the U.S. Treasury to reimburse taxpayers, while Dr. Rosen will receive a percentage of the recovery under the False Claims Act.

Case Background and Legal Representation

Dr. Niles Rosen was represented by Marlan Wilbanks, Susan Gouinlock, and Elaine Stromgren of Wilbanks & Gouinlock LLP (W&G), along with Brandon Peak and Joseph Colwell of Peak Wooten McDaniel & Colwell LLP (PWMC). The case was heard in the United States District Court for the Middle District of Florida, Tampa Division, under Judge Mary S. Scriven.

The defendants, Exact Sciences Corporation and Exact Sciences Laboratories, LLC, develop and market Cologuard, an at-home colon cancer screening test used across the United States.

Allegations Against Exact Sciences

Dr. Rosen alleged that Exact Sciences violated the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b) by offering Medicare and Medicare Advantage beneficiaries prepaid Visa gift cards to encourage them to return Cologuard test kits for billing to government health programs. He claimed these payments led to false and fraudulent claims under the False Claims Act (31 U.S.C. § 3729).

The case was vigorously contested. Dr. Rosen argued that evidence showed Exact Sciences used financial incentives to drive test kit returns and maximize billing. The company denied wrongdoing, asserting that the incentives were meant to encourage colon cancer screening rather than improperly influence billing.

Legal Challenges and Final Settlement

During litigation, Exact Sciences obtained an Advisory Opinion from the Office of Inspector General (OIG) of the Department of Health and Human Services, which the company claimed cleared it of liability. However, Dr. Rosen and his legal team challenged the validity of this opinion. A motion to exclude it was pending when the case settled.

Statements from Legal Counsel

Brandon Peak (Peak Wooten McDaniel & Colwell LLP), Lead Trial Counsel:
“Dr. Rosen is a courageous man who spent his career fighting fraud, waste, and abuse in the Medicare program. He brought this case forward because he believes medical decisions should not be driven by financial incentives, which can lead to unnecessary testing and waste taxpayer dollars. This case had more twists and turns than a country road, and it was an honor to represent him.”

Joseph Colwell (Peak Wooten McDaniel & Colwell LLP):
“Medicare is vulnerable to abuse by laboratory companies. Over the years, the government has recovered tens of millions from labs pushing costly and often unnecessary tests. Dr. Rosen recognized this potential for fraud and bravely pursued this case.”

Marlan Wilbanks (Wilbanks & Gouinlock, LLP):
“Dr. Rosen and our legal team were committed to achieving the best result for American taxpayers. Despite behind-the-scenes lobbying efforts by the defendant to have the case dismissed, we remained steadfast in seeking justice. The truth and facts should matter more than bureaucratic indifference or corporate influence. Our firms will continue to fight fraud, no matter how powerful the entity responsible.”

Read more about this case in the Report on Medicare Compliance, October 9 Edition. 

Whistleblower Lawsuit Leads to $371 Million Judgment in Laboratory Fraud Case

In December 2019, Jacqueline Cushing filed a False Claims Act (FCA) complaint, which has now resulted in a $371,489,616 damages award through a default judgment entered on September 21, 2023. The judgment was issued against Tomoka Medical Lab, Inc.; Rajen Shah; Golden Rule Management, LLC; Tennessee Valley Regional Laboratory, LLC; Luminus Diagnostics, LLC; and United Diagnostics, LLC for laboratory testing fraud. The lawsuit alleged that the defendants submitted false claims to federal healthcare programs for laboratory services that were not ordered by a licensed healthcare provider.

Details of the Fraud Scheme

Ms. Cushing, who worked as the Operations Manager for Tomoka Medical Lab, Inc. in Ormond Beach, Florida, discovered fraudulent billing practices shortly after starting her role in August 2019. She observed that when a healthcare provider ordered a basic urinalysis with culture and sensitivity, the defendants routinely ignored these orders and instead directed the lab to perform and bill for a more expensive Urine PCR test.

• CMS reimbursement for a standard urinalysis with culture and sensitivity: Approximately $20
• CMS reimbursement for a Urine PCR test: Between $450 – $500

Upon further investigation, Ms. Cushing found that this fraudulent upcoding practice extended beyond Florida, occurring at multiple laboratory locations across different states.

Whistleblower Action and Legal Outcome

When Ms. Cushing became aware of the fraud, she reported it internally and attempted to correct the improper billing practices. However, the defendants refused to change their conduct. Recognizing the widespread financial impact on government healthcare programs, she contacted Wilbanks & Gouinlock, LLP and filed her FCA complaint.

Her actions helped expose and halt a multi-state fraud scheme that cost government healthcare programs hundreds of millions of dollars.

Read more from the U.S. Department of Justice: DOJ Announcement.

Tennessee Dermatology Practice Pays $6.6M to Resolve Billing Fraud Allegations

A major dermatology provider based in the southeastern United States has agreed to pay $6.6 million to resolve allegations of improper billing practices involving federal healthcare programs. The settlement addresses claims that Skin Cancer & Cosmetic Dermatology Center (SCCDC) and its founder, Dr. John Y. Chung, engaged in dermatology billing fraud over a ten-year period.

Improper Medicare Billing Practices Uncovered

The allegations stem from procedures conducted between 2010 and 2020, including Mohs Micrographic Surgeries billed to Medicare, Medicaid, and other federal healthcare programs. Federal investigators assert that the clinic billed for both the surgical and pathology components of these procedures as if they were performed solely by Dr. Chung—even when other individuals performed part of the services.

The investigation also revealed that SCCDC frequently billed for multiple procedures performed on the same patient on the same day in a way that violated Medicare’s multiple procedure reduction rule, a safeguard designed to control overbilling.

This case is one of several recent efforts by federal and state authorities to crack down on dermatology billing fraud, which continues to be a growing concern in government-funded healthcare.

Whistleblower Lawsuit Led to Federal Investigation

The investigation was initiated by a whistleblower lawsuit filed under the False Claims Act’s qui tam provisions, which allow private individuals to report fraud on behalf of the government. In this case, the whistleblower—known as the relator—will receive $1.32 million as their share of the recovery.

The collaborative investigation was led by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the FBI, the Department of Veterans Affairs OIG, the Defense Criminal Investigative Service (DCIS), and multiple state agencies from Tennessee and Georgia.

As part of the settlement, SCCDC entered into an Integrity Agreement with HHS-OIG, committing the practice to strengthened billing compliance procedures and continued oversight of its reimbursement practices across federal health programs.

Protecting the Integrity of Healthcare Systems

Federal officials involved in the case emphasized the importance of compliance in preserving the integrity of public healthcare programs like Medicare, Medicaid, TRICARE, and the VA system. This resolution is another strong example of the government’s dedication to combatting dermatology billing fraud and safeguarding taxpayer dollars.

This case serves as a reminder to healthcare providers across the country: accurate billing is not optional, and violations can carry steep financial and reputational consequences.

Click here to read more about this case, follow the link below.

Contact Us for a Free Consultation

Our firm is dedicated to representing whistleblowers in False Claims Act cases and other government fraud matters. If you have evidence of private or government insurance fraud, contact our office for a free consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Lawsuit Against Sutter Health Moves Forward in Stark Law Case

The False Claims Act (FCA) and the Stark Law are two of the most critical tools used to combat healthcare fraud, particularly in cases involving improper physician compensation and illegal financial relationships between hospitals and referring doctors.

A recent whistleblower lawsuit against Sutter Health highlights the growing importance of Stark Law enforcement in healthcare fraud cases. This lawsuit, brought by a former compliance officer, alleges that Sutter Health engaged in unlawful financial arrangements with Sacramento Cardiovascular Surgeons Medical Group, violating the Stark Law and leading to False Claims Act violations.

Click here to read the Wilbanks & Gouinlock press release on the Sutter Health settlement.

The Whistleblower Lawsuit Against Sutter Health

In September 2014, Wilbanks & Gouinlock (W&G) filed a False Claims Act complaint on behalf of Laurie Hanvey, a former compliance officer at Sutter Medical Center in Sacramento, California. Ms. Hanvey, who had direct knowledge of regulatory violations, alleged that Sutter Health knowingly overpaid Sacramento Cardiovascular Surgeons Medical Group for:

• Physician assistant services
• Medical director agreements

These excessive payments, she contends, were designed to induce referrals, a violation of the Stark Law—which prohibits physician self-referrals for certain healthcare services if a financial relationship exists between the referring doctor and the entity providing the service.

Despite her internal protests, the allegedly improper compensation arrangements continued, leading Ms. Hanvey to take legal action under the False Claims Act’s qui tam provisions.

Government Investigation and Key Allegations

Following a five-year federal investigation, the United States Department of Justice (DOJ) confirmed multiple allegations in Ms. Hanvey’s whistleblower complaint. The Government contended that Sacramento Cardiovascular Medical Group and Sutter Health engaged in a range of improper financial practices, including:

• Stacking multiple medical director agreements – Paying neurosurgeons for overlapping administrative roles, leading to inflated compensation.
• Excessive call coverage fees – Unjustifiably high payments for on-call services, raising concerns about improper inducements.
• Overpaying neurosurgeons for mid-level provider services – Allegations that Sutter Health leased employees at excessive rates, resulting in inflated reimbursements.

According to the whistleblower lawsuit, these practices violated the Stark Law and led to false claims submitted to Medicare and other federal healthcare programs.

A Common Pattern in Stark Law Violations

The Sutter Health whistleblower lawsuit follows a recurring trend in Stark Law enforcement—hospitals allegedly overcompensating key referring physicians in ways that violate federal regulations.

One common tactic involves providing “free employees” to physicians, effectively artificially boosting their compensation while creating an illegal financial relationship.

These improper physician compensation schemes are particularly concerning because they:

• Distort medical decision-making, prioritizing financial incentives over patient care.
• Increase healthcare costs by leading to unnecessary services and inflated reimbursements.
• Violate the False Claims Act, potentially resulting in billions in recoveries for the government.

Ongoing Litigation in the Northern District of California

The whistleblower lawsuit against Sutter Health is currently proceeding in the U.S. District Court for the Northern District of California. While some settlements have already been reached, these represent only a fraction of the total alleged damages in the case.

As the litigation moves forward, Stark Law violations and False Claims Act cases remain a key focus of federal enforcement efforts—with whistleblowers playing a crucial role in exposing fraud.

The Impact of Whistleblower Lawsuits on Healthcare Fraud Enforcement

Cases like Ms. Hanvey’s whistleblower lawsuit against Sutter Health underscore the critical role that whistleblowers play in protecting Medicare, Medicaid, and other government healthcare programs from fraud.

The False Claims Act’s qui tam provisions allow individuals with inside knowledge of fraud to file lawsuits on behalf of the government and receive a percentage of the recovery. In many Stark Law cases, whistleblower lawsuits lead to:

• Significant financial recoveries – The DOJ recovers billions annually from False Claims Act settlements.
• Improved compliance and oversight – Hospitals and healthcare providers implement stronger internal controls following legal actions.
• Better patient care – Eliminating improper financial incentives helps ensure that medical decisions are based on patient needs, not financial gain.

How to Report Stark Law Violations and Healthcare Fraud

If you suspect violations of the Stark Law or have firsthand knowledge of healthcare fraud, you may have grounds for a False Claims Act whistleblower lawsuit. Contact our office for a free consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Health Management Associates Settles False Claims Act Lawsuits for $260 Million

Health Management Associates (HMA), a former hospital chain operating across the United States, agreed in September 2018 to pay $260 million to resolve multiple False Claims Act lawsuits filed by whistleblowers and to enter a criminal guilty plea in connection with fraudulent billing practices.

This landmark healthcare fraud settlement exposed a systemic scheme to increase inpatient hospital admissions, regardless of medical necessity, in violation of federal healthcare laws.

Whistleblowers Represented by Wilbanks & Gouinlock

Among the whistleblowers who played a pivotal role in uncovering the fraudulent practices at HMA were Ralph Williams and Dr. Craig Brummer, both represented by Wilbanks & Gouinlock (W&G).

Their independent complaints, later consolidated as part of the False Claims Act settlement, revealed widespread Medicare and Medicaid fraud within the HMA hospital system.

Click here to read the Wilbanks & Gouinlock press release on the HMA settlement.

Meet the Whistleblowers

• Ralph Williams – Former Chief Financial Officer (CFO) for two HMA-owned hospitals in Georgia.
• Dr. Craig Brummer – Emergency department physician and medical director at the same hospitals.

While their lawsuits were filed separately, both Williams and Brummer provided firsthand evidence of HMA’s fraudulent hospital admission practices.

Allegations of Unnecessary Hospital Admissions

Both whistleblowers exposed a corporate scheme that pressured physicians and hospital staff to prioritize financial gain over patient care. Their False Claims Act complaints revealed that:

Dr. Brummer attended daily meetings where emergency department physicians were pressured to increase inpatient admissions, regardless of medical necessity, to maximize Medicare and Medicaid reimbursements.

Ralph Williams observed HMA leadership setting aggressive system-wide goals for increased hospital admissions, even when patients could have been treated in outpatient settings.

These fraudulent practices violated federal healthcare regulations, including:

• The False Claims Act (FCA) – Prohibiting false or fraudulent claims submitted to government healthcare programs.
• The Anti-Kickback Statute – Preventing financial incentives that improperly influence medical decisions.
• Medicare and Medicaid Rules – Requiring hospital admissions to be based on medical necessity, not financial incentives.

$62.5 Million Recovery and Criminal Case Impact

HMA’s $260 million settlement resolved a wide range of fraud allegations, but the claims filed by Dr. Brummer and Mr. Williams directly led to a $62.5 million recovery.

Their whistleblower complaints also contributed significantly to the criminal case against HMA, resulting in:

• Criminal penalties imposed on the company.
• A guilty plea by HMA for engaging in fraudulent billing practices.
• Increased government scrutiny of hospital admission practices nationwide.

As a result of these whistleblower disclosures, HMA and its leadership faced accountability, marking one of the largest False Claims Act settlements in the hospital industry.

The Role of Whistleblowers in Exposing Healthcare Fraud

The HMA False Claims Act settlement highlights the critical role whistleblowers play in exposing fraudulent healthcare practices. Without the courage of employees like Williams and Brummer, the systemic abuse of government healthcare programs might have continued unchecked.

The False Claims Act (FCA) empowers private individuals—known as qui tam relators—to file lawsuits on behalf of the government when they have evidence of fraud. In return, successful whistleblowers may receive a percentage of the recovered funds as a reward.

Why Whistleblowers Matter in Healthcare Fraud Cases

• Protecting taxpayer dollars – Preventing fraudulent overbilling from draining Medicare and Medicaid funds.
• Ensuring patient care is prioritized – Stopping hospitals from financially incentivizing unnecessary admissions.
• Holding corporations accountable – Preventing profit-driven healthcare decisions that violate federal laws.

In this case, Williams and Brummer’s decision to come forward not only led to millions in recoveries but also set a precedent for holding hospital systems accountable for fraudulent admission schemes.

How to Report False Claims Act Violations

If you have evidence of fraud in healthcare, government contracts, or other federal programs, you may be eligible to file a False Claims Act lawsuit. Contact our office for a free consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

$65 Million False Claims Act Settlement Against Prime Healthcare: A Landmark Whistleblower Case

In a significant victory against healthcare fraud, U.S. ex rel. Berntsen vs. Prime Healthcare, et al. resulted in a $65 million False Claims Act (FCA) settlement announced on August 3, 2018. The case, filed in 2011 in the United States District Court for the Central District of California, was brought forward by whistleblower Karin Berntsen, a former employee at Prime Healthcare’s Alvarado Hospital in California.

Whistleblower Allegations: Medical Necessity & Upcoding Fraud

At the time of the lawsuit, Prime Healthcare operated 14 hospitals in California, all of which were named as defendants. Berntsen’s complaint, based on firsthand knowledge, exposed two fraudulent billing schemes:

1. Medical Necessity Fraud: Prime Healthcare billed Medicare for inpatient admissions that were medically unnecessary, circumventing standard requirements to maximize reimbursements.
2. Upcoding Fraud: The hospital chain inflated billing codes to charge for services at a higher reimbursement rate than what was actually provided.

Government Intervention & Whistleblower-Led Claims

The United States government intervened in the medical necessity fraud allegations, while Berntsen and her legal team pursued the upcoding claims. The settlement resulted in:

• $45 million recovered for improper inpatient admissions.
• $20 million recovered for upcoding violations.

For her instrumental role in exposing this fraud, Karin Berntsen was named the 2018 “Whistleblower of the Year” by the Taxpayers Against Fraud Education Fund.

Prime Healthcare CEO Held Personally Liable

One of the most significant aspects of this settlement was the personal financial liability of Prime Healthcare’s CEO, Dr. Prem Reddy. Of the $65 million total settlement, $3.25 million was required to be paid directly by Dr. Reddy. The Government’s Complaint in Intervention specifically cited multiple instances of misconduct where Dr. Reddy was personally involved, underscoring the severity of the allegations.

Corporate Integrity Agreement & Future Oversight

The magnitude of the fraud prompted the imposition of a Corporate Integrity Agreement (CIA)—a government-mandated oversight mechanism designed to ensure compliance and prevent future misconduct within Prime Healthcare. The CIA introduces additional reporting requirements and safeguards to hold the hospital system accountable.

A Major Win in Healthcare Fraud Enforcement

This $65 million FCA recovery is part of a long history of successful False Claims Act cases led by Wilbanks & Gouinlock, which has repeatedly taken on large hospital chains engaged in systemic fraud. This case serves as a powerful reminder of the importance of whistleblowers in protecting taxpayer dollars and ensuring integrity in the healthcare system.

If you have information about healthcare fraud and need guidance on False Claims Act litigation, contact Wilbanks & Gouinlock today to learn more about your legal options.

Report Defense Contractor Fraud at No Cost

If you have information about healthcare fraud, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Wells Fargo Settles VA Mortgage Fraud Case for $108 Million

Whistleblowers exposed a major fraud scheme in which Wells Fargo allegedly charged hidden fees to veteran borrowers on refinanced home loans backed by the U.S. Department of Veterans Affairs (VA). The case, which was part of a larger investigation into VA mortgage refinance fraud, resulted in a $108 million settlement in August 2017 after years of rigorous litigation.

This settlement was one of several related cases, as six other banks previously settled for a combined total of $161.7 million after being sued by Wilbanks & Gouinlock (W&G) for similar misconduct.

Whistleblowers Uncover VA Mortgage Fraud

The case was brought forward by whistleblowers—VA mortgage brokers who had firsthand knowledge of Wells Fargo’s fraudulent practices. Over the course of several years, they gathered evidence demonstrating that the bank was improperly charging veterans hidden fees on their VA-backed refinanced mortgages. These illegal fees violated federal regulations designed to protect veterans from excessive costs when refinancing their home loans.

The information provided by these whistleblowers not only led to over $200 million being returned to taxpayers but also helped tens of thousands of veterans recognize that they had been misled by major banks engaged in fraudulent lending practices.

Protecting Veterans from Mortgage Fraud

This case highlights the critical role whistleblowers play in exposing corporate misconduct and protecting vulnerable borrowers—particularly veterans who rely on VA-backed loans for home financing. By stepping forward, these whistleblowers ensured that fraudulent practices were held accountable, setting a precedent for greater transparency in VA mortgage lending.

Why This Settlement Matters

• Major Financial Impact: The combined settlements exceed $269 million, ensuring that both taxpayers and defrauded veterans receive restitution.
• Increased Awareness: Many veterans were unaware of the illegal fees attached to their loans. This case has helped educate them on their rights.
• Stronger Oversight: The exposure of these fraudulent practices has led to increased scrutiny on VA mortgage lenders, helping prevent future abuse.

As more whistleblowers come forward to expose fraud in government-backed programs, cases like this serve as a reminder of the importance of accountability in the financial industry. Read more about this settlement here.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Lawsuit Against Tenet Healthcare Fraud Results in $368 Million Settlement

In 2009, Wilbanks & Gouinlock (W&G) initiated a major False Claims Act case against Tenet Healthcare Corporation, one of the largest hospital companies in the U.S. The case, filed on behalf of whistleblower Bill Williams, an Army veteran and former hospital finance executive, was settled in 2016 for $368 million. Mr. Williams received a portion of the civil settlement funds. Click here for the W&G press release.

Illegal Referral Scheme & Medicaid Fraud Allegations

The lawsuit alleged that Tenet and four of its hospitals in Georgia and South Carolina engaged in an illegal kickback scheme with a business called Clinica de la Mama, which operated walk-in obstetric clinics for undocumented Hispanic women.

According to the complaint:

• Tenet allegedly paid Clinica to locate and refer pregnant, undocumented women to its hospitals for childbirth.
• Since labor qualifies as an emergency condition, Emergency Medicaid covered the delivery costs. However, paying for Medicaid patient referrals violates the federal Anti-Kickback Statute and Georgia state laws.

These allegations placed Tenet Healthcare fraud under significant scrutiny, prompting legal action at both the state and federal levels.

Government Joins the Case

Recognizing the significance of the allegations, the State of Georgia joined the lawsuit in 2013, followed by the U.S. Department of Justice in 2014. Tenet was represented by top law firms Alton & Bird, LLP in Atlanta and Latham & Watkins, LLP in Washington, D.C., and Los Angeles.

The case became one of the most significant Tenet Healthcare fraud settlements, reinforcing the importance of whistleblower actions in exposing corporate misconduct.

Criminal Investigation & Additional Restitution

The evidence provided by W&G and Mr. Williams directly led to a criminal investigation, resulting in an additional $145 million in criminal restitution.

This case underscores the vital role of whistleblowers in exposing healthcare fraud and ensuring accountability in the medical industry.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblowers Expose Massive Dialysis Fraud, Leading to $450M Settlement

In 2007, Wilbanks & Gouinlock (W&G) filed a False Claims Act lawsuit on behalf of whistleblowers Dr. Alon Vainer and RN Daniel Barbir, alleging fraudulent Medicare and Medicaid billing practices by DaVita, Inc. and Gambro Healthcare, Inc.. The case, prosecuted without government involvement for eight years, resulted in a historic $450 million settlement in 2015.

Fraudulent Overuse of Dialysis Medications

The lawsuit claimed that DaVita and Gambro intentionally wasted dialysis medications to inflate Medicare and Medicaid reimbursements, costing taxpayers hundreds of millions of dollars. Despite the U.S. government declining to intervene, W&G and trial counsel pressed forward, securing a record-breaking settlement.

This case remains the largest dialysis fraud lawsuit in False Claims Act history where whistleblowers and their legal team successfully litigated without government assistance.

Click here to view Complaint.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes HCA Fraud, Leading to $731M Settlement

Don McLendon, an executive at Olsten Management Company, worked closely with HCA Healthcare and uncovered evidence of improper government fund usage. He discovered that HCA fraudulently classified advertising expensesas “community education” to misuse federal funds. His whistleblower claims played a key role in the record-breaking $731.4 million False Claims Act settlement.

Major Healthcare Fraud Exposure

Mr. McLendon provided critical evidence that the U.S. government relied on in reaching this historic healthcare fraud lawsuit settlement. His allegations alone accounted for over $100 million of the total recovered amount.

At the time, this was the largest healthcare fraud lawsuit settlement in False Claims Act history, demonstrating the power of whistleblowers in holding corporations accountable.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Illegal Physician Referrals, Leading to $118.7M Settlement

In September 2015, Wilbanks & Gouinlock (W&G) secured a record $118.7 million settlement against a hospital chain for illegal physician referrals. The lawsuit, filed under the Stark Law, was brought by a corporate executivewith insider knowledge of improper physician compensation schemes that created unlawful financial incentives for referring government beneficiaries.

Insider Whistleblower Uncovers Widespread Violations

The whistleblower, a corporate executive at Adventist Health, had direct access to key decision-makers within the hospital system. Her evidence and documentation provided the government with undeniable proof of systemic Stark Law violations across multiple Adventist hospitals in several states.

This case remains one of the largest illegal physician referral settlements in history, underscoring the role of whistleblowers in exposing healthcare fraud.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Forest Laboratories Settles $300M Fraud Case

Forest Laboratories agreed to a $300 million settlement following allegations of off-label marketing lawsuit and illegal kickbacks. The lawsuit, which included $106 million in civil recovery, was brought by a whistleblower sales representative who exposed unethical sales practices.

Off-Label Marketing & Kickback Scheme

The whistleblower, a former Forest sales representative, revealed that the company pressured sales staff to promote antidepressants for pediatric use, even though the drugs were not FDA-approved for children. Additionally, Forest Laboratories allegedly provided illegal kickbacks to incentivize physicians to prescribe these medications, violating federal law.

This case remains a landmark off-label marketing lawsuit, reinforcing the importance of whistleblowers in exposing pharmaceutical fraud. Read more about this case here.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Halifax Health Fraud, Leading to $85M Settlement

A whistleblower lawsuit filed by Elin Balid-Kunz led to a record-breaking $85 million settlement against Halifax Health for illegal physician compensation and Medicare fraud. Ms. Kunz, who worked for 17 years as Halifax’s Director of Physician Services, uncovered systemic Stark Law violations and took legal action to hold the hospital accountable.

Medicare Fraud & Illegal Kickbacks

Ms. Kunz alleged that Halifax Health knowingly submitted thousands of fraudulent Medicare claims and paid illegal kickbacks to referring physicians to boost hospital admissions. The Medicare fraud case resulted in one of the largest Stark Law settlements in U.S. history.

Whistleblower’s Fight for Justice

As a compliance professional, Ms. Kunz repeatedly raised concerns with Halifax’s senior management, but her warnings were ignored. Instead, she faced harassment and retaliation for speaking out. Refusing to back down, she pursued the Medicare fraud case, ensuring accountability and justice.

For her courage and persistence, she was named “Whistleblower of the Year” in 2014 by the Taxpayers Against Fraud Education Fund.

This case remains a landmark victory in Medicare fraud cases, demonstrating the critical role of whistleblowers in exposing healthcare fraud.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Home Health Fraud, Leading to $61M Settlement

A whistleblower lawsuit against Olsten Corporation uncovered fraudulent billing, sales, and marketing practices within home health agencies, resulting in a $61 million recovery. Olsten, acting as a management company for Columbia/HCA, was implicated in widespread home health fraud that led to significant financial penalties.

Undercover Whistleblower Uncovers Fraud

The whistleblower in this case took extraordinary measures, even wearing a wire to obtain key evidence that ultimately exposed the fraud scheme. This critical information led to a $61 million recovery from Olsten and over $100 million in penalties against Columbia/HCA.

Landmark Settlement

This case remains a landmark victory in home health fraud cases, highlighting the importance of whistleblowers in exposing healthcare fraud and holding corporations accountable for illegal billing practices.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes C.R. Bard Kickback Scheme, Leading to $48.2M Settlement

C.R. Bard Inc., a multinational medical device company, agreed to pay $48.2 million to the federal government to settle a whistleblower lawsuit alleging illegal Medicare kickbacks. The case exposed how Bard’s urological division and its wholly owned subsidiary, ProSeed Inc., paid doctors and hospitals kickbacks to push Bard’s products at inflated prices for treating Medicare patients with prostate cancer.

Illegal Pay-for-Play Scheme Uncovered

A whistleblower represented by Wilbanks & Gouinlock (W&G) provided hundreds of key documents proving Bard’s involvement in an illegal Medicare kickback scheme. These kickbacks created improper financial incentives, leading to Medicare overbilling and violations of federal fraud laws.

Major Victory In Medicare Kickback Lawsuit

The Medicare kickback lawsuit resulted in a $48.2 million settlement, holding Bard accountable for its fraudulent financial practices. This case serves as a landmark example of how whistleblowers help expose corporate fraud in the healthcare industry.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblowers Expose JP Morgan Chase Veteran Mortgage Fraud, Leading to $45M Settlement

JP Morgan Chase agreed to pay $45 million to settle a whistleblower lawsuit alleging that the bank defrauded military veterans and taxpayers by hiding illegal fees in home refinancing mortgages for veterans. The case, filed by Wilbanks & Bridges on behalf of Victor Bibby and Brian Donnelly, revealed a widespread mortgage fraud scheme affecting veterans nationwide.

Illegal Fees in Veteran Mortgages

The whistleblowers, both experienced professionals in the mortgage refinance industry, uncovered evidence that JP Morgan Chase and other major banks systematically charged hidden fees to military veterans seeking home loan refinancing. These deceptive practices resulted in millions of dollars in improper charges, violating federal regulations designed to protect veterans.

Landmark Veteran Mortgage Fraud Settlement

As a result of this case, JP Morgan Chase agreed to a $45 million settlement, while seven lenders identified in the lawsuit collectively paid over $250 million in penalties. This case stands as a landmark victory in veteran mortgage fraud lawsuits, reinforcing the importance of whistleblowers in protecting veterans from financial exploitation.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblowers Help Secure $45M Settlement in Countrywide VA Mortgage Fraud Case

Bank of America/Countrywide Mortgage agreed to pay $45 million to settle allegations of veteran mortgage fraud, marking another major recovery resulting from a broader VA loan fraud complaint. The case alleged that Countrywide improperly charged hidden and illegal fees to military veterans seeking home loan refinancing, violating federal guidelines designed to protect veteran borrowers.

Part of a Larger VA Loan Fraud Scheme

This settlement was part of a series of lawsuits filed by Wilbanks & Gouinlock (W&G) whistleblowers, who exposed widespread veteran mortgage fraud involving multiple national lenders. Their insider knowledge helped uncover the scope of deceptive practices targeting military families.

Landmark Win Against Veteran Mortgage Fraud

The $45 million recovery from Bank of America/Countrywide adds to over $250 million recovered from seven lenders involved in the broader scheme. This case highlights the critical role whistleblowers play in exposing veteran mortgage fraud and protecting those who have served. Read more about this case here.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblowers Expose PNC Mortgage Fraud, Leading to $38M Settlement

PNC Financial Services agreed to pay $38 million to settle allegations of mortgage fraud involving military veterans, in a case filed by Wilbanks & Gouinlock on behalf of whistleblowers Victor Bibby and Brian Donnelly. The lawsuit revealed that PNC charged improper and illegal fees to veterans under a government-backed mortgage refinance program.

Veteran Loan Fraud Uncovered

The whistleblowers, both industry insiders, exposed how PNC engaged in mortgage fraud by tacking hidden fees onto VA-backed refinance loans—a direct violation of federal guidelines designed to protect veterans from financial exploitation.

Major Recovery in Mortgage Fraud Case

This $38 million settlement adds to the growing list of recoveries in a broader effort to stop PNC mortgage fraud and protect veteran borrowers. The case underscores the vital role of whistleblowers in holding major financial institutions accountable for deceptive lending practices.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Medicare Billing Violations at Saint Joseph’s, Leading to $26M Settlement

Saint Joseph’s Hospital of Atlanta agreed to pay $26 million to settle a whistleblower lawsuit filed by Tami Ramsey, a registered nurse and former hospital employee. The case alleged that Saint Joseph’s engaged in Medicare billing violations by improperly classifying patients as inpatient or outpatient, resulting in inaccurate and excessive claims submitted to the federal government.

Medicare Billing Violations Uncovered

Ms. Ramsey filed the case through Wilbanks & Bridges, alleging that Saint Joseph’s failed to follow Medicare regulations that determine whether a patient’s status should be classified as inpatient or outpatient. These Medicare billing violations led to improper reimbursements and triggered federal scrutiny.

Corporate Integrity Agreement and Major Settlement

As part of the $26 million settlement, Saint Joseph’s Hospital was also required to enter into a Corporate Integrity Agreement with the U.S. government. This case marks a significant accountability win in combating Medicare billing violations, thanks to the efforts of a dedicated healthcare whistleblower.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Shands Hospital Overbilling, Leading to $26M Settlement

Wilbanks & Gouinlock (W&G) successfully prosecuted a qui tam lawsuit against Shands Healthcare in Florida, resulting in a $26 million settlement. The case alleged that Shands improperly billed Medicare and Medicaid by admitting patients for inpatient care when outpatient treatment was medically appropriate—a scheme designed to collect higher reimbursements from the government.

Inpatient vs. Outpatient Billing Abuse

At the heart of the case were medical necessity violations, where Shands routinely admitted patients unnecessarily to maximize profits. These outpatient overbilling practices led to a $22 million settlement related to improper inpatient admissions, and an additional $3 million was recovered for outpatient billing fraud.

Major Win in Outpatient Overbilling Case

This case remains a landmark example of outpatient overbilling, underscoring the critical role whistleblowers play in protecting public healthcare funds. The Shands Hospital settlement sends a clear message that fraudulent billing practices will not be tolerated.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Lawsuit Exposes Loan Certification Fraud, Leading to $16M Settlement

Wilbanks & Gouinlock filed a whistleblower lawsuit involving serious allegations of loan certification fraud. The case centered on a lender that fraudulently bundled and concealed financial information, leading the government to guarantee loans under false pretenses. These guarantees were based on certifications that the lender claimed were accurate—when in fact, they were not.

Government Misled by Fraudulent Certifications

As a result of the loan certification fraud, the U.S. government incurred significant financial losses. The certifications provided by the lender were knowingly false, causing federal loan guarantees to be issued on high-risk or misrepresented loans.

Loan Certification Fraud Settlement

Thanks to the efforts of Wilbanks & Gouinlock, the case was successfully resolved with a $16 million settlement. This outcome underscores the importance of whistleblower actions in identifying and exposing loan certification fraud that threatens public funds.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblowers Expose Citi Mortgage Fraud, Leading to $7.5M Settlement

Wilbanks & Gouinlock filed a whistleblower lawsuit on behalf of clients with insider knowledge of illegal lending practices at Citi Mortgage. The suit alleged that Citi Mortgage defrauded the government by failing to follow federal rules governing refinance loans for military veterans. These violations resulted in improper treatment of veterans and financial harm to taxpayers.

Military Veterans Targeted by Mortgage Fraud

The whistleblowers provided substantial evidence showing that Citi Mortgage knowingly violated regulations designed to protect military veterans. These Citi Mortgage fraud practices included the mishandling of refinance loans backed by government guarantees, leading to widespread noncompliance and financial abuse.

Citi Mortgage Fraud Settlement

The case was resolved with a $7.5 million settlement, holding Citi accountable for its misconduct. As a result, thousands of veterans were made aware of these deceptive lending practices. This case stands as a major win in the fight against Citi Mortgage fraud, and it highlights the power of whistleblowers in exposing illegal activity within the lending industry. Read more about this settlement here.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Memorial Health Overpayments, Leading to $5.08M Settlement

Memorial Health agreed to pay $5.08 million to resolve allegations that it paid excessive fees to physicians, well above fair market value, in violation of federal law. The whistleblower lawsuit, filed by Wilbanks & Gouinlock (W&G) on behalf of a physician with insider knowledge, revealed a pattern of improper physician compensation in the Savannah, Georgia area.

Improper Financial Incentives Uncovered

The whistleblower, a local physician, discovered that Memorial Health was offering illegal financial incentives to other doctors in exchange for patient referrals. These payments exceeded what is legally allowed and violated the Stark Law, which prohibits hospitals from compensating physicians in ways that could influence referral decisions.

Major Recovery in Improper Physician Compensation Case

The improper physician compensation scheme led to a $5.08 million government recovery, reinforcing the serious consequences of violating federal healthcare laws. This case is a strong example of how whistleblowers play a crucial role in uncovering and stopping improper physician compensation practices that compromise healthcare integrity.

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If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Exposes Resurgens Surgery Center Fraud, Leading to $3.8M Settlement

Resurgens Surgery Center agreed to pay $3.8 million to settle allegations of anesthesia billing fraud and Medicare and Medicaid overbilling. The case was brought by Wilbanks & Gouinlock (W&G) on behalf of a former employee who had direct access to internal records critical to proving the fraud.

Anesthesia Billing Fraud Uncovered

The whistleblower uncovered that Resurgens Surgery Center had engaged in billing fraud by submitting improper claims for anesthesia services that were either unnecessary, improperly documented, or inaccurately coded. These false claims led to overpayments from both Medicare and Medicaid.

Key Victory in Billing Fraud Case

Thanks to the whistleblower’s evidence, the government was able to recover $3.8 million, sending a clear message about the consequences of billing fraud. This case highlights the importance of insider knowledge in uncovering healthcare billing schemes and holding providers accountable. Read more about this case here.

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If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.

Whistleblower Lawsuit Recovers $2.2M in Veteran Loan Fraud Case

Wilbanks & Gouinlock filed a whistleblower lawsuit to recover funds lost by taxpayers due to veteran loan fraud. The case involved allegations that a lender violated federal rules while issuing government-backed refinance loans to military veterans—ultimately causing the government to guarantee risky or improperly certified loans.

Taxpayer Funds Misused in Veteran Loan Program

The whistleblowers alleged that improper practices by the lender led to the misuse of taxpayer-backed loan guarantees. These violations contributed to financial losses under the veteran lending program and revealed deeper issues of veteran loan fraud in the system.

Veteran Loan Settlement

The case was resolved with a $2.2 million settlement, holding the lender accountable for its misconduct. This outcome marks another important step in addressing veteran loan fraud and protecting programs intended to serve those who have served our country. Learn more about this lawsuit here.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.