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74-687: Overlook Hospital was founded in 1906 by Dr. William Henry Lawrence, Jr. , who, at the age of 26, bought the Faitoute property on the "highest point in Summit" overlooking the Baltusrol Valley and which was only ten minutes walk away from the train station. He borrowed $ 15,000 from three civic leaders to build the three-story structure which housed an operating room, x-ray facility, and hydraulically powered elevator. The hospital began with 42 beds, and cost approximately $ 30,000 in total. The hospital

148-403: A False Claims Act suit filed by former employees of Overlook Hospital in U.S. ex rel. Doe et al. v. AHS Hospital Corp., et al., Civ. No. 08-2042 (D.N.J.). Area residents have proposed a 7.3-mile pedestrian linear park along the main line of the abandoned Rahway Valley Railroad . The rail trail would run eastbound from the medical center on the edge of downtown Summit and head south along

222-706: A 2000 case, Vermont Agency of Natural Resources v. United States ex rel. Stevens , 529 U.S. 765 (2000), the United States Supreme Court held that a private individual may not bring suit in federal court on behalf of the United States against a State (or state agency) under the FCA. In Stevens , the Supreme Court also endorsed the "partial assignment" approach to qui tam relator standing to sue, which had previously been articulated by

296-506: A 2023 combined case, United States ex rel. Schutte v. SuperValu Inc. and United States ex rel. Proctor v. Safeway , a unanimous U.S. Supreme Court opinion rejected an attempt to dilute the FCA's "knowledge standard." Under the knowledge standard, a defendant is liable under the FCA if a false claim is "knowingly" submitted to the government for payment. The statute defines "knowingly" as acting with actual knowledge, deliberate ignorance, or reckless disregard. The unanimous opinion found that

370-423: A FCA suit filed by two whistleblowers. The suit alleged that Ortho-McNeil-Janssen Pharmaceuticals, Inc. (OMJPI) acted improperly concerning the marketing, promotion and sale of the anti-convulsant drug Topamax . Specifically, the suit alleged that OMJPI "illegally marketed Topamax by, among other things, promoting the sale and use of Topamax for a variety of psychiatric conditions other than those for which its use

444-679: A brain tumor center in 1999. Overlook Hospital is part of Atlantic Health System which also runs the Morristown Medical Center . Overlook is located in Summit, NJ. Overlook has the following departments: Cancer center, Cardiology , Dental surgery , Dermatology , Gastroenterology , Intensive care unit, Internal medicine, Neurology , OB/GYN , Orthopedic services , Pathology , Pediatrics , Physical therapy , Plastic surgery , Psychiatric ward , Radiology , Rehabilitation services , Surgery , Trauma center , and Urology . Notable departments and centers are: Overlook has

518-420: A cafeteria in conjunction with Baltimore-based Donna's Restaurants, Inc. The hospital pays Donna's for use of its brand name as well as methods of operation and recipes. The neurosciences research center at Overlook cost $ 15 million. In the early 1990s, Overlook Hospital was contrasted with the urban hospital of St. Joseph's Regional Medical Center . St. Joseph's had a much greater percentage of charity patients;

592-525: A claim. The Fraud Enforcement and Recovery Act of 2009 reversed the Court's decision and made the types of fraud to which the False Claims Act applies more explicit. In a 2009 case, United States ex rel. Eisenstein v. City of New York , the United States Supreme Court considered whether, when the government declines to intervene or otherwise actively participate in a qui tam action under

666-737: A clinical affiliation with the Sidney Kimmel Medical College of Thomas Jefferson University . Overlook is accredited by the Joint Commission for Accreditation of Health Care Organizations or JCAHO. Overlook is a member of the American Hospital Association ; and is a member of the Hospital Quality Alliance. Overlook Hospital is non-profit. In 2007, the foundation began a campaign to raise $ 100 million, according to

740-543: A complaint from whistleblower Jerry H. Brown II, the US Government filed suit against Maersk for overcharging for shipments to US forces fighting in Iraq and Afghanistan. In a settlement announced on 3 January 2012, the company agreed to pay $ 31.9 million in fines and interest, but made no admission of wrongdoing. Brown was entitled to $ 3.6 million of the settlement. The largest healthcare fraud settlement in history

814-424: A copy of a complaint in a secret whistleblower suit that was under seal. In 2017, bio-pharmaceutical giant Celgene Corporation paid $ 240 million to settle allegations it sold and marketed its drugs Thalomid and Revlimid off-label in U.S. ex rel. Brown v. Celgene , CV 10-03165 (RK) (C.D. Cal.). In 2021, A South Carolina pain management company was ordered to pay $ 140 million under the False Claims Act after

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888-475: A defendant is liable if it submits a false claim to the government based on its own knowledge and subjective beliefs — not what an objectively reasonable person may have thought. In a 2024 case, Murray v. UBS Securities, LLC , et al. 601 U. S. ____ (2024), a unanimous U.S. Supreme Court endorsed a lower burden of proof for whistleblowers, holding that whistleblowers do not need to prove that an employer acted with "retaliatory intent" in order to be protected under

962-499: A different law, the Federal Food, Drug, and Cosmetic Act ; the intersection occurs when off-label marketing leads to prescriptions being filled and bills for those prescriptions being submitted to Medicare/Medicaid. As of 2019, over 72% of all federal FCA actions were initiated by whistleblowers. The government recovered $ 62.1 billion under the False Claims Act between 1987 and 2019 and of this amount, over $ 44.7 billion or 72%

1036-555: A director of the Overlook Hospital Foundation. Donations help Overlook "expand from being a local institution to a regional medical center." There is an Overlook Hospital Foundation Board with trustees who serve on three-year terms. Atlantic Health owns an insurance company in the Cayman Islands entitled AHS Insurance Limited whose purpose is to pay claims against its hospitals. Overlook Hospital runs

1110-472: A false claim had to be presented directly to the Federal government, or if it merely needed to be paid with government money, such as a false claim by a subcontractor to a prime contractor. The Court found that the claim need not be presented directly to the government, but that the false statement must be made with the intention that it will be relied upon by the government in paying, or approving payment of,

1184-591: A group practice with a total of seven or eight doctors. While the original partnership "team" was known as Summit Health, the group practice was organized as the Lawrence-Bensley Medical Group, but eventually readopted the Summit name. Lawrence enrolled in Columbia University's College of Physicians and Surgeons at the age of 15. He became a surgeon, founder of Overlook Hospital , and a resident of Murray Hill . Bensley

1258-477: A relator to recover, in addition to his award for reporting fraud, double damages plus attorney fees for any acts of retaliation for reporting fraud against the government. This provision specifically provides relators with a personal claim of double damages for harm suffered and reinstatement. Under the False Claims Act, the Department of Justice is authorized to pay rewards to those who report fraud against

1332-422: A reporter wrote: "the bills of patients who have health insurance or who can otherwise pay are marked up 33 percent, the surcharge going to pay for charity care;" in contrast, Overlook, which has a wealthier client base, only had a 6 percent charity markup. As a result, Overlook operated with a surplus while St. Joseph's was cash-strapped. Since Overlook could pay suppliers on time, it qualified for discounts based on

1406-553: A separate penalty for each violation of the statute. Under the Civil Penalties Inflation Adjustment Act, False Claims Act penalties are periodically adjusted for inflation. In 2020, the penalties range from $ 11,665 to $ 23,331 per violation. Certain claims are not actionable, including: There are unique procedural requirements in False Claims Act cases. For example: In addition, the FCA contains an anti-retaliation provision, which allows

1480-506: Is an abbreviated form of the Latin legal phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur ("he who brings a case on behalf of our lord the King, as well as for himself") In a qui tam action, the citizen filing suit is called a "relator". As an exception to the general legal rule of standing , courts have held that qui tam relators are "partially assigned" a portion of

1554-428: Is not a "party" for FRAP 4 purposes, and therefore, petitioner's appeal filed after 30 days was untimely. In a 2016 case, Universal Health Services, Inc. v. United States ex rel. Escobar , the United States Supreme Court sought to clarify the standard for materiality under the FCA. The court unanimously upheld the implied certification theory of FCA liability and strengthened the FCA's materiality requirement. In

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1628-437: Is the federal government's primary litigation tool in combating fraud against the government. The law includes a qui tam provision that allows people who are not affiliated with the government, called "relators" under the law, to file actions on behalf of the government. This is informally called " whistleblowing ", especially when the relator is employed by the organization accused in the suit. Persons filing actions under

1702-488: Is the safest and most expeditious way I have ever discovered of bringing rogues to justice." In the massive military spending leading up to and during World War II , the US Attorney General relied on criminal provisions of the law to deal with fraud, rather than using the FCA. As a result, attorneys would wait for the Department of Justice to file criminal cases and then immediately file civil suits under

1776-599: The FDA . ChloraPrep is the commercial name under which CareFusion produced the drug chlorhexidine , used to clean the skin before surgery. In 2017, this case was called into question and was under review by the DOJ because the lead attorney for the DOJ serving as Assistant Attorney General in the case, Jeffery Wertkin, was arrested by the FBI on January 31, 2017, for allegedly attempting to sell

1850-637: The Galloping Hill Golf Course through Kenilworth and Roselle Park. The New Jersey Department of Transportion , which owns the railbed, has been working to clear it in anticipation of possible future trail use. 40°42′44″N 74°21′15″W  /  40.7123°N 74.3542°W  / 40.7123; -74.3542 William Henry Lawrence, Jr. Summit Health is a for-profit, multi-specialty medical practice headquartered in Berkeley Heights, New Jersey . The company

1924-636: The Medicaid program. The California False Claims Act was enacted in 1987, but lay relatively dormant until the early 1990s, when public entities, frustrated by what they viewed as a barrage of unjustified and unmeritorious claims, began to employ the False Claims Act as a defensive measure. In 1995, the State of Texas passed the Texas Medicaid Fraud Prevention Act (TMFPA), which specifically aims at combating fraud against

1998-894: The "quantity of its purchases" while the urban hospital had to pay extra charges. On June 21, 2012, the U.S. Department of Justice announced that AHS Hospital Corp., Atlantic Health System Inc., and Overlook Hospital agreed to pay the United States $ 8,999,999 to settle allegations that they violated the False Claims Act by allegedly overbilling Medicare . The settlement is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. The settlement regards allegations that Overlook Hospital, owned and operated by AHS Hospital Corporation, and Atlantic Health Systems Inc., overbilled Medicare for patients who were treated on an inpatient basis when they should have been treated as either observation patients or on an outpatient basis. The settlement partially resolves

2072-482: The Act stand to receive a portion (15–30%, depending on certain factors) of any recovered damages . As of 2019, over 71% of all FCA actions were initiated by whistleblowers. Claims under the law have typically involved government health care programs (Medicare, Medicaid and TriCare), military, or other government spending programs. FCA actions dominate the list of largest pharmaceutical settlements . Between 1987 and 2019,

2146-557: The Court. In this time, the department decides whether it will pursue the case. If the case is pursued by DOJ, the amount of the reward is less than if the Department of Justice had decided not to pursue the case and the plaintiff/relator continues the lawsuit himself. However, the success rate is higher in cases that the Department of Justice decides to pursue. Technically, the government has several options in handing cases. These include: In practice, there are two other options for

2220-612: The D&;B Corporation. In 2013, Summit Medical Group established the Summit Medical Group Foundation, a nonprofit organization operating in the segments of health promotion, medical research and medical education. In 2014, Summit Medical Group launched a new management company, Summit Health Management (SHM). SHM offers consulting and management services to physician practices in the United States. In 2019, Summit Medical Group merged with CityMD. In 2021,

2294-453: The Department of Justice: There is case law where claims may be prejudiced if disclosure of the alleged unlawful act has been reported in the press, if complaints were filed to an agency instead of filing a lawsuit, or if the person filing a claim under the act is not the first person to do so. Individual states in the U.S. have different laws regarding whistleblowing involving state governments. The U.S. Internal Revenue Service (IRS) takes

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2368-570: The Eleventh Circuit ruling in U.S. ex rel. Hopper v. Solvay Pharms., Inc. (2009) were both appealed to the U.S. Supreme Court . The Court denied certiorari for both cases, however, declining to resolve the divergent appeals court decisions. In 2009, the American Civil Liberties Union (ACLU), Government Accountability Project (GAP) and OMB Watch filed suit against the Department of Justice challenging

2442-431: The FCA, a practice decried as "parasitic" at the time. Congress moved to abolish the FCA but at the last minute decided instead to reduce the relator's share of the recovered proceeds. The law was again amended in 1986, again due to issues with military spending. Under President Ronald Reagan 's military buildup, reports of massive fraud among military contractors had become major news, and Congress acted to strengthen

2516-532: The FCA. The first qui tam case under the amended False Claims Act was filed in 1987 by an eye surgeon against an eye clinic and one of its doctors, alleging unnecessary surgeries and other procedures were being performed. The case settled in 1988 for a total of $ 605,000. However, the law was primarily used in the beginning against defense contractors . By the late 1990s, health care fraud began to receive more focus, accounting for approximately 40% of recoveries by 2008 Franklin v. Parke-Davis , filed in 1996,

2590-405: The False Claims Act on March 2, 1863, 12  Stat.   696 . Because it was passed under the administration of President Abraham Lincoln , the False Claims Act is sometimes referred to as the "Lincoln Law". Importantly, a reward was offered in what is called the qui tam provision, which permits citizens to sue on behalf of the government and be paid a percentage of the recovery. Qui tam

2664-510: The False Claims Act, $ 2.2 billion of which were generated by whistleblowers. Since 2010, the federal government has recovered over $ 37.6 billion in False Claims Act settlements and judgments. In 2020, the DOJ recovered $ 2.2 billion from FCA cases: $ 1.6 billion of that total was from cases filed under the FCA. Qui tam whistleblowers received a total of $ 309 million in whistleblower rewards in 2020. The Act establishes liability when any person or entity improperly receives from or avoids payment to

2738-426: The False Claims Act, including: The False Claims Act has a detailed process for making a claim. Mere complaints to the government agency are insufficient to bring claims under the Act. A complaint (lawsuit) must be filed in a U.S. District Court (Federal court) in camera (under seal). The Department of Justice (DOJ) must thence investigate within 60 days, but it often enjoys several months' worth of extensions by

2812-405: The False Claims Act, the United States is a "party" to the suit for purposes of Federal Rule of Appellate Procedure 4(a)(1)(A) (which requires that a notice of appeal in a federal civil action generally be filed within 30 days after entry of a judgment or order from which the appeal is taken). The Court held that when the United States has declined to intervene in a privately initiated FCA action, it

2886-667: The Federal government. The Act prohibits: The statute provides that anyone who violates the law "is liable to the United States Government for a civil penalty of not less than $ 5,000 and not more than $ 10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990, plus 3 times the amount of damages which the Government sustains because of the act of that person." The False Claims Act requires

2960-632: The Fraud Enforcement and Recovery Act of 2009 (FERA) was signed into law. It includes the most significant amendments to the FCA since the 1986 amendments. FERA enacted the following changes: With this revision, the FCA now prohibits knowingly (changes are in bold): On March 23, 2010, the Patient Protection and Affordable Care Act (also referred to as the health reform bill or PPACA) was signed into law by President Barack Obama . The Affordable Care Act made further amendments to

3034-485: The Ninth Circuit Federal Court of Appeals and is an exception to the general legal rule for standing. In a 2007 case, Rockwell International Corp. v. United States , the United States Supreme Court considered several issues relating to the "original source" exception to the FCA's public-disclosure bar. The Court held that (1) the original source requirement of the FCA provision setting for

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3108-490: The Sarbanes-Oxley Act. The Supreme Court found that a whistleblower needs only to prove that their actions in making a whistleblower complaint were a "contributing factor" in the employer's unfavorable action. The unanimous opinion found that liability hinges on a defendant's “knowledge and subjective beliefs” — not what an objective, reasonable person would have thought — at the time they submitted their claims to

3182-546: The Texas Medicaid Program, which provides healthcare and prescription drug coverage to low-income individuals. The Texas law enacts state qui tam provisions that allow individuals to report fraud and initiate action against violations of the TMFPA, imposes consequences for noncompliance and includes whistleblower protections. In Australia, The Treasury Laws Amendment (Enhancing Whistleblower Protections) Act ,

3256-578: The UK more than £24 billion a year. In the context of anti-corruption, the paper acknowledged that there was a need to not only target serious and organised criminals but also support those who seek to help identify and disrupt serious and organised criminality. Three UK agencies, the Department for Business, Innovation and Skills , the Ministry of Justice and the Home Office , were tasked with considering

3330-559: The acquisition of Summit Health. Summit Health traces its beginnings to October 1919, when co-founders William H. Lawrence, MD, and Maynard G. Bensley, MD established the company as Summit Medical Group in Summit, New Jersey . The two had met in the United States Army's World War I Ambulance Company 33, which Lawrence had organized, and which was later headed by Bensley. Lawrence attained the rank of Major, and Bensley attained

3404-467: The age of 95. His wife, Helen Flemer Plunkett, who performed a community medicine auxiliary role, died July 5, 2007, at the age of 108. They were married in 1938. In 1950, Lawrence and Bensley expanded to a second location at 120 Summit Avenue in Summit, New Jersey. In 2003, Summit Medical Group signed a lease for a 42-acre office complex in Berkeley Heights, New Jersey, that formerly housed

3478-721: The case for a US-style False Claims Act in the UK. In July 2014, the Financial Conduct Authority and the Bank of England Prudential Regulation Authority recommended Parliament enact strong measures to encourage and protect whistleblowers, but without offering whistleblower rewards, rejecting the US model. Under Rule 9(b) of the Federal Rules of Civil Procedure , allegations of fraud or mistake must be pleaded with particularity. All appeals courts to have addressed

3552-449: The company was renamed Summit Health, and Summit Medical Group Foundation was subsequently renamed Summit Health Cares. As of April 2022, Summit Health includes more than 200 satellite offices across northern New Jersey and New York. In November 2022, Walgreens Boots Alliance 's primary-care-center subsidiary, Village Practice Management agreed to buy Summit Health in a deal worth nearly $ 9   billion, including debt. The acquisition

3626-515: The constitutionality of the "seal provisions" of the FCA that require the whistleblower and the court to keep lawsuits confidential for at least 60 days. The plaintiffs argued that the requirements infringe the First Amendment rights of the public and the whistleblower, and that they violate the separation of powers , since courts are not free to release the documents until the executive branch acts. The government moved for dismissal, and

3700-594: The course of justice in legal proceedings that were concerned with the title to land. This act is still in force today in the Republic of Ireland , although in 1967 it was extinguished in England. The idea of a common informer bringing suit for damages to the Commonwealth was later brought to Massachusetts , where "penalties for fraud in the sale of bread [are] to be distributed one third to inspector who discovered

3774-623: The district court granted that motion in 2009. The plaintiffs appealed, and in 2011 their appeal was denied. In 2004, the billing groups associated with the University of Washington agreed to pay $ 35 million to resolve civil claims brought by whistleblower Mark Erickson, a former compliance officer, under the False Claims Act. The settlement, approved by the UW Board of Regents, resolved claims that they systematically overbilled Medicaid and Medicare and that employees destroyed documents to hide

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3848-494: The federal government and are not convicted of a crime related to the fraud, in an amount of between 15 and 25 (but up to 30% in some cases) of what it recovers based upon the whistleblower's report. The relator's share is determined based on the FCA itself, legislative history, Department of Justice guidelines released in 1997, and court decisions. False Claims Act Amendments ( Pub. L.   99–562 , 100  Stat.   3153 , enacted October 27, 1986 ) On May 20, 2009,

3922-734: The fraud and the remainder for the benefit of the town where the offense occurred." Other statutes can be found on the colonial law books of Connecticut , New York , Virginia and South Carolina . The American Civil War (1861–1865) was marked by fraud on all levels, both in the Union north and the Confederate south. During the war, unscrupulous contractors sold the Union Army decrepit horses and mules in ill health, faulty rifles and ammunition, and rancid rations and provisions, among other unscrupulous actions. In response, Congress passed

3996-574: The government recovered more than $ 62 billion under the False Claims Act. Qui tam laws have history dating back to the Middle Ages in England . In 1318, King Edward II offered one third of the penalty to the relator when the relator successfully sued government officials who moonlighted as wine merchants. The Maintenance and Embracery Act 1540 of Henry VIII provided that common informers could sue for certain forms of interference with

4070-411: The government's legal injury, thereby allowing relators to proceed with their suits. U.S. Senator Jacob M. Howard , who sponsored the legislation, justified giving rewards to whistle blowers, many of whom had engaged in unethical activities themselves. He said, "I have based the [ qui tam provision] upon the old-fashioned idea of holding out a temptation, and ‘setting a rogue to catch a rogue,’ which

4144-482: The government. As of 2020, 29 states and the District of Columbia have false-claims laws modeled on the federal statute to protect their publicly funded programs from fraud by including qui tam provisions, which enables them to recover money at state level. Some of these state False Claims Act statutes provide similar protections to those of the federal law, while others limit recovery to claims of fraud related to

4218-818: The issue of whether Rule 9(b) pleading standards apply to qui tam actions have held that the heightened standard applies. The Fifth Circuit , the Sixth Circuit , the Seventh Circuit , the Eighth Circuit , the Tenth Circuit , and the Eleventh Circuit have all found that plaintiffs must allege specific false claims. In 2010, the First Circuit decision in U.S. ex rel. Duxbury v. Ortho Biotech Prods., L.P. (2009) and

4292-654: The old railbed through Springfield , Union , Kenilworth and ending at the southwest edge of Roselle Park at the Cranford border. A northern portion of the rail trail on the RVRR main line is under construction as the Summit Park Line, with a footbridge over Morris Avenue installed in October 2022. In parallel, advocates have been pushing for immediate development of the portion south of Route 22 , running past

4366-468: The original-source exception to the public-disclosure bar on federal-court jurisdiction is jurisdictional; (2) the statutory phrase "information on which the allegations are based" refers to the relator's allegations and not the publicly disclosed allegations; the terms "allegations" is not limited to the allegations in the original complaint, but includes, at a minimum, the allegations in the original complaint as amended; (3) relator's knowledge with respect to

4440-417: The pondcrete fell short of the direct and independent knowledge of the information on which the allegations are based required for him to qualify as an original source; and (4) the government's intervention did not provide an independent basis of jurisdiction with respect to the relator. In a 2008 case, Allison Engine Co. v. United States ex rel. Sanders , the United States Supreme Court considered whether

4514-528: The position that, for Federal income tax purposes, qui tam payments to a relator under FCA are ordinary income and not capital gains . The IRS position was challenged by a relator in the case of Alderson v. United States; and, in 2012, the U.S. Court of Appeals for the Ninth Circuit upheld the IRS' stance. As of 2013, this remained the only circuit court decision on tax treatment of these payments. In

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4588-416: The practice. The fraud settlement, the largest against a teaching hospital since the University of Pennsylvania agreed to pay $ 30 million in 1995, ended a five-year investigation that resulted in guilty pleas from two prominent doctors. The whistleblower was awarded $ 7.25M. In 2010, a subsidiary of Johnson & Johnson agreed to pay over $ 81 million in civil and criminal penalties to resolve allegations in

4662-476: The rank of Captain, in their participation in the ambulance company. Lawrence was in charge of the unit for a year until he became ill in 1918, and Bensley then led it until it was disbanded a year later. The teamwork they experienced as army medical staff led them to try to replicate the idea in civilian life, and they founded the first team medicine practice in New Jersey in 1919. In 1931, they expanded into

4736-813: The tobacco industry and carbon pricing schemes. In October 2013, the UK Government announced that it was considering the case for financially incentivising individuals reporting fraud in economic crime cases by private sector organisations, in an approach much like the US False Claims Act. The 'Serious and Organised Crime Strategy' paper released by the UK's Secretary of State for the Home Department sets out how that government plans to take action to prevent serious and organised crime and strengthen protections against and responses to it. The paper asserted that serious and organised crime costs

4810-438: The unlawful marketing of its drug Rapamune for uses that were not FDA-approved and potentially harmful. In 2014, CareFusion paid $ 40.1 million to settle allegations of violating the False Claims Act by promoting off label use of its products in the case United States ex rel. Kirk v. CareFusion et al., No. 10-2492. The government alleged that CareFusion promoted the sale of its drug ChloraPrep for uses that were not approved by

4884-435: Was a result of a merger between Summit Medical Group and CityMD . It is now owned by Walgreens-owned VillageMD. Summit Health is led by Chairman and CEO Jeffrey Le Benger, MD. In 2016, Le Benger was named #8 in the "NJBiz Health Care Power 50 list" – a publicized ranking of the leaders of New Jersey healthcare organizations, state policymakers and legislators . In January 2023, Walgreens-owned VillageMD completed

4958-457: Was approved by the Food and Drug Administration, (i.e., " off-label " uses)." It also states that "certain of these uses were not medically accepted indications for which State Medicaid programs provided coverage" and that as a result "OMJPI knowingly caused false or fraudulent claims for Topamax to be submitted to, or caused purchase by, certain federally funded healthcare programs. In response to

5032-571: Was completed in January 2023. Among its 67, Summit Health has four main operational locations: Summit Health has additional affiliations and partnerships with the following: 40°40′40″N 74°24′44″W  /  40.677712°N 74.412122°W  / 40.677712; -74.412122 False Claims Act The False Claims Act of 1863 ( FCA ) is an American federal law that imposes liability on persons and companies (typically federal contractors ) who defraud governmental programs. It

5106-425: Was from qui tam cases brought by relators. In 2014, whistleblowers filed over 700 False Claims Act lawsuits. In 2014, the Department of Justice had its highest annual recovery in False Claims Act history, obtaining more than $ 6.1 billion in settlements and judgments from civil cases involving fraud and false claims against the government. In fiscal year 2019, the Department of Justice recovered over $ 3 billion under

5180-515: Was made by GlaxoSmithKline in 2012 when it paid a total of $ 3 billion to resolve four qui tam lawsuits brought under the False Claims Act and related criminal charges. The claims include allegations Glaxo engaged in off-label marketing and paid kickbacks to doctors to prescribe certain drugs, including Paxil, Wellbutrin and Advair. In 2013, Wyeth Pharmaceuticals Inc ., a pharmaceutical company acquired by Pfizer, Inc . in 2009, paid $ 490.9 million to resolve its criminal and civil liability arising from

5254-570: Was originally from Hamburg, New York (born in Buffalo ), the son of a local banker, George A. Bensley, and Margaret Woodruff. He attended the University of Michigan and the University of Buffalo , from which he received his medical degree in 1910. He started practicing medicine as a surgeon and general practitioner , but became an obstetrician in 1931. He lived in Summit and Maplewood, New Jersey . Bensley died on March 23, 1985, at

5328-478: Was passed in December 2018 and went into effect in 2019. The law expanded protections for whistleblowers, allowing them to report misconduct anonymously, as well as applying anti-retaliation protections to additional kinds of whistleblowers. Importantly, the law does not provide for rewards for whistleblowers. There have been calls since 2011 for legislation modeled on the False Claims Act and for their application to

5402-499: Was privately owned. In the 1960s, doctors experimented with new techniques; in one instance, doctors authorized use of alcoholic beverages to delay the onset of contractions of a pregnant woman. The Valerie Fund Children's Center was established in 1977. When it opened, it was the first of its kind in New Jersey. By 1987, it had three doctors, three resident nurses, a social worker and support staff. It treats "youngsters with various forms of cancer and rare blood disorders." Overlook began

5476-415: Was the first case to apply the FCA to fraud committed by a pharma company against the government, due to bills submitted for payment by Medicaid / Medicare for treatments that those programs do not pay for as they are not FDA-approved or otherwise listed on a government formulary. FCA cases against pharma companies are often related to off-label marketing of drugs by drug companies, which is illegal under

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