Kentucky Hospital to Pay over $10 million to Resolve False Claims Act Allegations

Lexington- Nov. 22, 2019 – The United States has settled a federal False Claims Act case brought by Robert Stone, against Jewish Hospital & St. Mary’s Healthcare, Inc. doing business as Pharmacy Plus and Pharmacy Plus Specialty.

Under the terms of the settlement, Jewish Hospital has agreed to pay the United States more than $10.1 million to resolve allegations that it defrauded Medicare in multiple ways, including by submitting claims to Medicare Part B for prescription drugs that did not meet the requirement for being reasonable and necessary to the treatment of the patient and by providing patients with free blood glucose testing supplies and waiving their co-payments and deductibles for insulin, in violation of the federal Anti-Kickback Statute.

Mr. Stone, a licensed pharmacist who was working at Jewish Hospital, brought Jewish Hospital’s fraud to the attention of the government by filing a qui tam complaint under the False Claims Act. Under the False Claims Act, a private citizen (known as a “relator”) who suspects or knows of fraud against the government can act as a whistleblower and file a sealed complaint on behalf of the government. If the case is successful, the relator is entitled to a share of the government’s recovery. Here, Mr. Stone received $1.85 million from the government.

Starting more than two years before he filed his False Claims Act complaint, Mr. Stone brought his concerns to his superiors, but his efforts at compliance were fruitless. “When they failed to make corrections, I filed my qui tam lawsuit so the United States whose Medicare program was being defrauded could take action,” Mr. Stone emphasized. He added, “I am very grateful to my attorneys Bob Thomas, Suzanne Durrell, and David W.S. Lieberman for their expertise, guidance, and support, and to the government attorneys and investigators for their commitment to my case.”

Mr. Stone’s attorneys commended the outstanding efforts of their client and the government prosecutors. Ms. Durrell and Mr. Thomas applauded “Mr. Stone’s tenacious efforts to stop the fraud and his willingness to risk coming forward. As a pharmacist and an insider, he not only recognized the fraud, but could explain it clearly and persuasively to us and to the government prosecutors.” Mr. Lieberman stressed the skillful work done by Assistant U.S. Attorney William F. Campbell of the Western District of Kentucky, and Department of Justice Trial Attorney Harin C. Song. “The United States aggressively pursued every avenue and worked collaboratively with us to obtain the best possible outcome.”

The Whistleblower Law Collaborative is also grateful for the assistance provided by Brian Vines of Hare Wynn | Accident & Injury Lawyers in Lexington.

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