Purchasers of the medication Intuniv have settled a years-old class action against drugmaker Shire PLC and manufacturer Actavis over allegations that the companies struck an anti-competitive deal to delay the production of a generic version of the attention-deficit/hyperactivity disorder drug.
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The class is represented by Lauren G. Barns, Thomas Sobol, Abbye Ognibene, Claudia Morera and Rachel Downey of Hagens Berman Sobol Shapiro LLP, Steve Shadowen, Richard Burnell and Tina Miranda of Hilliard Shadowen LLP, John Radice, Kenneth Pickle, Clark Craddock and April Lambert of Radice Law Firm PC, Joseph Meltzer and Terence Ziegler of Kessler Topaz Meltzer & Check LLP, Sharon Robertson and Donna Evans of Cohen Milstein Sellers & Toll PLLC, Linda Nussbaum and Peter Moran of Nussbaum Law Group PC, Peter Kohn and Joseph Lukens of Faruqi & Faruqi LLP, David Sorensen and Caitlin Coslett of Berger Montague PC, and Joseph Vanek, Paul Slater, David Germaine and John Bjork of Sperling & Slater LLC.
Help for lawyers in dealing with legal data challenges has come, thanks to corporate and law firm leaders who founded a new industry framework called Legal Data Intelligence. And at least one U.S. senator is questioning Amazon and Walmart’s use of new tech to create “dynamic pricing” that may harm consumers.
These are some of the stories in corporate legal news you may have missed in the past week.
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Whistleblowing Work Is Fueling Law Firm Growth
Over her two decades with federal financial regulatory agencies, Cohen Milstein Sellers & Toll PLLC attorney Christina K. McGlosson saw increased appreciation of the value of information provided by whistleblowers.
Today, there is wide recognition of how an insider’s expertise can help build a case and fight fraud, she recently told Law360 Pulse. As a result, she said, “everyone wants those whistleblowers. Everyone wants that data.”
The increasing visibility of whistleblowers and a growing array of incentives designed to bring them forward are fueling legal work, both for attorneys like McGlosson who represent whistleblowers and for those who counsel businesses. New practices focused on whistleblower work have set up shop in recent months, and the U.S. Department of Justice is working on a pilot program aimed at filling gaps in existing federal whistleblower initiatives.
McGlosson recently joined her firm’s whistleblower practice after serving as acting director of the whistleblower office at the Commodity Futures Trading Commission. An expert on the Dodd-Frank Act and other federal securities laws, she previously helped create and structure the U.S. Securities and Exchange Commission’s whistleblower office, and firm leaders said she will help Cohen Milstein expand its ability to represent people who expose corporate fraud.
Over her two decades with federal financial regulatory agencies, Christina K. McGlosson saw increased appreciation of the value of information provided by whistleblowers.
Today, there is wide recognition of how an insider’s expertise can help build a case and fight fraud, she recently told Law360 Pulse. As a result, she said, “everyone wants those whistleblowers. Everyone wants that data.”
McGlosson recently joined her firm’s whistleblower practice after serving as acting director of the whistleblower office at the U.S. Commodity Futures Trading Commission. An expert on the Dodd-Frank Act and other federal securities laws, she previously helped create and structure the U.S. Securities and Exchange Commission’s whistleblower office, and firm leaders said she will help Cohen Milstein expand its ability to represent people who expose corporate fraud.
More than a decade after a global financial crisis and the Bernie Madoff Ponzi scheme led to the establishment of two whistleblower award programs in the U.S., more U.S. regulators and other agencies worldwide are seeing the benefits of paying individuals for helpful information, signaling a change in momentum on the debate.
Regulators both inside and outside the U.S. in recent years have adopted or are looking to establish their own cash-for-tips programs, as existing ones in the U.S. become a mainstream part of enforcement efforts.
In early March the U.S. Justice Department said it would start a pilot program that would pay whistleblowers who tell prosecutors about corporate crime, adding a new incentive to attract more tipsters to aid in the government’s enforcement efforts. A similar whistleblower award program has been proposed by lawmakers for the Consumer Financial Protection Bureau.
Observers believe that the Justice Department established the pilot program, in part, after seeing the value whistleblowers are bringing to enforcement cases, based on the number of referrals prosecutors have received from the SEC and CFTC, according to Christina McGlosson, the former acting director for the CFTC’s whistleblower program and now a special counsel at law firm Cohen Milstein Sellers & Toll. She noted that the whistleblower tips accounted for one-third of all active CFTC enforcement investigations in fiscal year 2023.
A Monrovia-based nursing home chain that was the subject of a 2021 LAist investigation has reached a $7 million settlement over allegations that it falsely billed the government for Medicare during a COVID waiver program.
The Department of Justice and the state of California alleged the chain routinely submitted Medicare claims for residents, saying they needed skilled nursing care for an acute injury or illness even when they didn’t need that level of care. They claimed the company would submit claims for residents for simply being exposed to COVID.
As part of the settlement agreement, ReNew Health will pay $6,841,727 to the federal government and $242,273 to the state of California, plus interest.
The backstory
In order to free up hospital beds during the COVID pandemic, the federal government waived a requirement that nursing home residents needed to have been hospitalized for at least three days in order to qualify for skilled care reimbursements through Medicare. Those payments are often much higher than standard nursing home care, which involves help with daily living activities like bathing or eating.
The federal and state investigation into ReNew Health Group started after whistleblowers filed a lawsuit under the False Claims Act in October 2020. The case was under seal until a settlement was reached last month.
“The government has done an exceptional job in using its enforcement powers to recover money and programs that were instituted during the COVID pandemic,” said Ray Sarola, an attorney at Cohen Milstein Sellers & Toll, which represented the whistleblowers. “But cases like this show that whistleblowers are also a very important and critical part of that process.”
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A troubled history
ReNew Health has owned, operated or provided administrative services to over two dozen facilities across the state, many of them in Southern California. An LAist investigation in 2021 documented the chain’s troubled history of patient care and found it was operating facilities even after the state deemed the owner of the chain unfit to do so.
The California Department of Public Health’s denial letters to ReNew owner Crystal Solorzano cited a long list of serious issues at her facilities and said she submitted a fraudulent college transcript. The complaint in the federal and state case includes details about Solorzano that LAist previously reported.
The Biden Administration’s desire to intensify antitrust enforcement transcends its own litigation, with the Department of Justice and Federal Trade Commission making arguments helpful to private plaintiffs at a record pace.
All but two of the 51 statements of interest and amicus briefs submitted by the DOJ and FTC since President Biden’s inauguration have advanced positions in antitrust disputes beneficial to the plaintiff, according to analysis by GCR USA and Docket Navigator.
That shift in focus marks a notable increase from the Trump Administration, in which 62% of its 63 interventions in antitrust cases took positions beneficial to complainants.
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Pitching the Agencies
Most statements of interest and amicus briefs do not take a formal stance on the merits of the complaint but rather zero in on particular legal questions.
But such interventions can significantly boost complaints, according to Daniel McCuaig, who advises plaintiffs in antitrust damages claims.
“Those are often the tricky questions of antitrust doctrine that courts not infrequently get wrong or at least a little bit wrong,” the Cohen Milstein Sellers & Toll partner and former DOJ attorney said.
Private litigants typically pitch the Antitrust Division to get involved – and although courts might not always side with the government’s position, they take its arguments seriously, McCuaig said.
“They come into court with more credibility than any other litigant – especially when they’re not involved in the litigation,” he added.
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One-sided?
Plaintiffs’ lawyer McCuaig said it is risky for the DOJ or FTC to file briefs that take defendant-friendly positions.
Those briefs are on the record forever – and the government can expect litigants to throw them back at it if they conflict with a future case. Meanwhile, the antitrust defence bar is not necessarily enthralled with the Biden Administration’s use of amicus briefs
Redfin disclosed to regulators on Monday that it will pay $9.25 million to end claims that it caused home sellers to pay inflated commissions under rules set by the National Association of Realtors, allowing the company to exit a class action that ensnared several brokerage firms.
The online real estate listings platform told the U.S. Securities and Exchange Commission it had entered into a settlement term sheet last week to resolve allegations that it conspired with NAR by following the rules, making Redfin the latest company to sign deals to leave the litigation after the trade group agreed to pay $418 million earlier this year.
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The plaintiffs are represented by Steve Berman, Nathan Emmons, Jeannie Evans and Rio S. Pierce of Hagens Berman Sobol Shapiro LLP, Michael S. Ketchmark, Scott A. McCreight and Ben H. Fadler of Ketchmark & McCreight PC, Brandon J.B. Boulware, Jeremy M. Suhr and Erin D. Lawrence of Boulware Law LLC, Matthew L. Dameron and Eric L. Dirks of Williams Dirks Dameron LLC, Benjamin D. Brown, Daniel Silverman, Robert A. Braun and Brian E. Johnson of Cohen Milstein Sellers & Toll PLLC, and Marc M. Seltzer, Beatrice C. Franklin, Matthew R. Berry, Floyd G. Short, Alexander W. Aiken and Steven G. Sklaver of Susman Godfrey LLP.
In what’s apparently the first False Claims Act (FCA) settlement over alleged misuse of COVID-19 waivers, ReNew Health Group and ReNew Health Consulting Services, a nursing facility and skilled nursing facility (SNF) company, and two of its executives have agreed to pay $7.084 million, the U.S. Department of Justice (DOJ) said April 26.[1] According to the settlement, ReNew billed Medicare nursing home residents under the Part A SNF benefit based on their exposure to COVID-19 from March 1, 2020, to June 31, 2022, and justified it with waivers—including the waiver of the three-day qualifying inpatient hospital stay—although they allegedly didn’t require skilled care.[2] For example, when a kitchen worker at one California nursing facility got COVID-19, nine residents were shifted to the SNF even though they didn’t test positive, the whistleblowers alleged in the complaint that set the case in motion.[3]
This appears to be the first false claims settlement for alleged misuse of COVID-19 waivers as opposed to abuse of COVID-19 relief funds more broadly, said attorney Ray Sarola, with Cohen Milstein Sellers & Toll PLLC, which represented Bay Area Whistleblower Partners.
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Two Waivers Are at Heart of ReNew Allegations
The allegations in the FCA complaint began with the COVID-19 public health emergency and its waivers for SNFs with patients affected by COVID-19. The SNF waivers, which expired May 11, 2023, at the end of the public health emergency (PHE), were designed to make it easier for people to be admitted to SNFs and free up space in hospitals for COVID-19 patients. According to CMS, one of the waivers provided “temporary emergency coverage of SNF services without a qualifying hospital stay.” Another waiver authorized “a onetime renewed SNF coverage without first having to start and complete a 60-day ‘wellness period’ (that is, the 60-day period of non-inpatient status that is normally required in order to end the current benefit period and renew SNF benefits).”[4]
CMS noted the waivers don’t apply if ongoing SNF care is unrelated to the PHE and providers are still required to abide by all other SNF requirements.
According to the complaint, ReNew allegedly responded to the waivers “by treating them as a blank check to bill Medicare for nearly every resident at its facilities.” Within a week of CMS announcing the waivers, Renew started its alleged scheme to bill Part A for skilled nursing or therapy services for residents who didn’t need them.
Medicare has specific requirements for Part A SNF coverage. Patients must require skilled nursing care or rehabilitation every day to address conditions that were treated in an acute-care hospital during a qualifying stay or at a SNF after treatment for the condition at the hospital. Medicare only covers services that are reasonable and necessary, and the waivers didn’t change fundamental medical necessity requirements. As CMS said in a waiver FAQ, “A COVID-19 diagnosis would not in and of itself serve to qualify a Medicare beneficiary for coverage under the Medicare Part A SNF benefit. That’s because coverage isn’t based on particular diagnoses or medical conditions, but rather on whether the beneficiary meets the statutorily prescribed SNF level of care definition of needing and receiving skilled services on a daily basis which, as a practical matter, can only be provided in a SNF on an inpatient basis.”
‘I’m Praying the Waiver Ends’
Discussions about the waivers started with ReNew’s regional director of operations at the time. He allegedly was told the purpose of the waivers was to ensure Medicare coverage for people who require skilled care but whose treatment is affected by the pandemic. He and others at ReNew were informed by their Medicare billing consultant that the waivers applied “under certain circumstances” and that residents still were required “to meet the qualifications to be skilled under Part A first and foremost. Just having Part A is not an acceptable reason…” But the director of operations allegedly still requested a list of all Medicare-eligible residents at ReNew facilities.
By the end of March, top management had weekly “COVID calls” to talk about the “desire to ‘skill’ all residents,” the complaint alleged. Most ReNew facilities, especially in Southern California, had started billing virtually all residents to Part A.
For example, a utilization review nurse consultant for ReNew said that under the waivers, its Orinda facility would expand the Part SNF benefit to include “observation” of 25 residents who might have been exposed to COVID-19, but there’s allegedly no provision for observation in the waivers. “By the end of April, all ReNew facilities were engaging in this practice,” the complaint alleged.
Apparently, this didn’t sit well with everybody. When ReNew’s facility in Silicon Valley added 38 residents to the SNF benefit, the senior vice president of revenue management said, “I’m praying the waiver ends,” according to the complaint.
The billing consultant again raised concerns about the company’s alleged “misuse” of COVID-19 waivers in July. “I am continuing to express my concern about picking up the patients who are not positive nor showing symptoms of covid just because a staff person at one facility is positive,” the consultant allegedly wrote. “I am not sure that being potentially ‘exposed’ to covid is a condition that requires a skilled level of care. Also just because a resident has days available doesn’t precipitate the start of a benefit period. I am also concerned that it seems the residents who have days available are receiving ‘skilled care’ because they have days available.”
- Last of three pacts rolls in prior two settlements in case
- Up to 9,385 workers will be paid from $6.6 million fund
A beauty products supplier and three staffing agencies will pay more than $11 million to end a decade-old lawsuit alleging a practice of racial preferences disfavoring Black workers for temporary assignments.
The third of three separate settlement agreements was preliminarily approved by the US District Court for the Northern District of Illinois on Monday. Under that pact, Vee Pak, Inc., Vee Pak, LLC—which does business as Voyant Beauty, and Staffing Network Holdings LLC will pay roughly $6.4 million into a settlement fund, and up to $4.5 million in attorneys’ fees and costs. That settlement fund will be combined with prior settlements reached with Personnel Staffing Group LLC for $135,000 and with Alternative Staffing Inc. for $93,000 to build a $6.6 million overall fund, according to the memorandum of law seeking preliminary settlement approval.
Attorneys for the workers “estimate that there may be as many as 9,385 total individuals in the” subclasses certified in connection with the three settlements, the memo said. The $6.6 million settlement fund will also be used to pay $10,000 or $15,000 service awards to workers who served as class representatives, the costs of the claims administration process, and “the employer’s share of payroll taxes,” according to the memo.
The subclasses include all Black laborers who sought work assignments between January 2011 and Oct. 21, 2013, or Dec. 31, 2015, and weren’t assigned on one or more occasions to work at Vee Pak, the memo said.
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Cohen Milstein Sellers & Toll PLLC, National Legal Advocacy Network, and Hughes Socol Piers Resnick Dym Ltd. represent the workers. Goldstine, Skrodzki, Russian, Nemec & Hoff Ltd. and McDermott Will & Emery LLP represent Vee Pak. Korey Richardson LLP represents Staffing Network.
The Spring 2024 issue of the Shareholder Advocate, our quarterly securities litigation and investor protection newsletter, features:
- Carol Gilden and Jan Messerschmidt on the Pluralsight litigation settlement
- Carol Gilden and Molly Bowen on the shareholder derivative lawsuit aiming to hold Abbott accountable for baby formula contamination
- Aaron Marks on antitrust litigation as a tool for multi-employer health funds to recover damages for inflated prescription prices
- Molly Bowen and Richard Lorant on how books and records demands can inform shareholder derivative actions
- Jay Chaudhuri on implications of the SEC’s pay-to-play rule for this election season
- A profile of Jaclyn Weiner