1. No category

Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 1 of 53
R L E D I N CLERK'S OFFICE
U.S.D.C-Atlanta
2013
m
UNITED STATES DISTRICT COURT
JAMES N ^ ^ FOR THE NORTHERN DISTRICT OF GEORGIA
UNITED STATES OF A M E R I C A ex rel, SCOTT
M . ROSS, M.D.,
vs.
CIVIL A C T I O N NO. 09-5752
F A M I L Y D E R M A T O L O G Y OF
P E N N S Y L V A N I A , P . C , P A U L A N E L S O N , M.D.,
FAMILY DERMATOLOGY, P.C, PAULA
FILED UNDER SEAL
IFALSE CLAIMS ACT -OUI TAMI
N E L S O N , M.D., d/b/a N E L S O N
DERMATOPATHOLOGY A N D PATHOLOGY
JURY DEMAND IS MADE
LABORATORY; DATABASED, INC, YINKA
ADESOKAN,FAMILY DERMATOLOGY
M A N A G E M E N T , INC.; F A M I L Y
D E R M A T O L O G Y M A N A G E M E N T OF N O R T H
CAROLINA, LLC; FAMILY DERMATOLOGY
STAFFING OF P E N N S Y L V A N I A , I N C ;
F A M I L Y D E R M A T O L O G Y M A N A G E M E N T OF
P E N N S Y L V A N I A , INC . (f/k/a F A M I L Y
M A N A G E M E N T OF P E N N S Y L V A N I A , INC);
F A M I L Y D E R M A T O L O G Y OF N E W JERSEY,
P . C ; F A M I L Y BILLING SERVICES, INC.;
ADEGBOYEGA ADESOKAN; ADEYEMI
ADESOKAN
FIRST AMENDED OUI T A M COMPLAINT
COMES NOW, SCOTT M . ROSS, M.D.,, ("Relator") in the above-styled action,
by and through his counsel of record, P I E T R A G A L L O , GORDON, A L F A N O , BOSICK
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 2 of 53
A N D RASPANTI, L L P , and W I L B A N K S & BRIDGES, L L P , and states that this is an
action brought on behalf of the United States of America by Relator against F A M I L Y
D E R M A T O L O G Y OF P E N N S Y L V A N I A , P . C , P A U L A N E L S O N , M . D . , F A M I L Y
DERMATOLOGY,
P.C,
DERMATOPATHOLOGY
PAULA
NELSON,
A N D PATHOLOGY
M.D.,
d/b/a
LABORATORY;
NELSON
DATABASED,
I N C , Y I N K A A D E S O K A N , F A M I L Y D E R M A T O L O G Y M A N A G E M E N T , INC.; and
FAMILY
DERMATOLOGY
FAMILY DERMATOLOGY
MANAGEMENT
STAFFING
OF N O R T H
CAROLINA, L L C ,
OF P E N N S Y L V A N I A , I N C ; F A M I L Y
D E R M A T O L O G Y M A N A G E M E N T OF P E N N S Y L V A N I A , I N C , F A M I L Y BILLING
SERVICES,
INC., A D E G B O Y E G A A D E S O K A N , and A D E Y E M I A D E S O K A N
pursuant to the Qui Tarn provisions ofthe Civil False Claims Act, 31 U.S.C. § 3729-33.
I.
INTRODUCTION
1.
Qui Tarn Relator Scott M . Ross, M . D . ("Ross" or "Relator") brings this
action on his own behalf and on behalf of the United States of America to recover civil
damages and penalties under the False Claims Act, 31 U.S.C. § 3729, et seq., against
Defendants, Family Dermatology Of Pennsylvania, P . C , Paula Nelson, M . D . ("Nelson"),
Family Dermatology, P . C , Paula Nelson, M.D., D / B / A Nelson Dermatopathology And
Pathology
Laboratory
("Nelson
Dermatopathology
Laboratory");
Databased,
Inc.
("Databased"), Yinka Adesokan ("Adesokan"), Family Dermatology Management, Inc; and
Family Dermatology Management Of North Carolina, L L C , Family Dermatology Staffing of
Pennsylvania, Family Dermatology Management of Pennsylvania, Inc., Family Billing
Services, Inc., Adegboyega Adesokan, and Adeyemi Adesokan (collectively referred to as
"Defendants").
2.
Relator's allegations relate to illegal self-referral and kickback arrangements
designed and orchestrated by Defendants, beginning on or before January 1, 2003, for the
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purpose of directing to tliemselves and tlieir various businesses lucrative referrals of patients
insured by the Medicare and Medicaid programs.
3.
Defendants illegal self-referral and kickback arrangements include, but are
not limited to, a carefully orchestrated scheme wherein Defendants Family Dermatology, P . C ,
Paula Nelson and Yinka Adesokan would: (1) purchase small dermatology practices from
dermatologists across the United States, (2) hire those dermatologists to stay-on as
independent contractors; and (3) mandate that these dermatologists employed by, or
confracting with. Family Dermatology (which was owned by Defendant Paula Nelson, M.D.)
refer and direct all pathology work to Nelson Dermatopathology and Pathology Laboratory
(which also was owned and operated by Defendant Paula Nelson, M.D.).
4.
Physicians who reftised, or questioned whether it was legal, to refer all their
patients' pathology work to Nelson Dermatopathology and Pathology Laboratory were
terminated from ftiture employment with Family Dermatology practices, lost substantial
income, or were otherwise targeted for retahation.
5.
Referrals by any of the Family Dermatology practices, or any of its
physician employees or independent confractors, to Nelson Dermatopathology and Pathology
Laboratory violated the Stark Law and the federal Anti-Kickback Statute.
6.
Defendants Paula Nelson and Yinka Adesokan also utilized their company
Defendant Databased, Inc., as another means to illegally induce referrals of patients insured by
the Medicare and Medicaid programs to Nelson Dermatopathology and Pathology Laboratory.
7.
Databased, Inc. sells a comprehensive practice management and elecfronic
medical records system tailored especially to dermatology practices. As part of the scheme of
Nelson and Adesokan to receive lucrative referrals for dermatopathology services, Databased
3
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would offer its comprehensive practice management and electronic records to dermatology
practices across the United States at a steep discount.
After a few months, once those
dermatology practices became dependent on the Databased practice management and records
system, Adesokan would threaten to increase the price of that system by 85% unless they
agreed to refer all of their dermatopathology work to Nelson Dermatopathology and
Pathology Laboratory. Dermatology practices that referred their dermatopathology work to
Nelson Dermatopathology and Pathology Laboratory continued to enjoy the discounted price
for the use of the Databased practice management and records system.
8.
Referrals by any of the dermatology practices using the Databased, Inc.
practice management and records system to Nelson Dermatopathology and Pathology
Laboratory violated the federal Anti-Kickback Statute.
9.
Defendants also have, since at least January 1, 2003, violated the federal
False Claims Act (federal FCA), 31 U.S.C. § 3729 et seq.
Knowing that they were
ineligible for the payments demanded due to violations of federal and state anti-kickback
statutes, and due to violations of the Stark Law, these Defendants submitted, or caused to be
submitted, claims for reimbursement to Medicare, Medicaid, and other federal and state
health care programs related to these illegal patient referrals, and they created or used false
records in support of these false claims.
10.
A l l Defendants participated in the illegal kickback scheme, and so violated
the federal F C A , 31 U.S.C. § 3729(a)(3), by conspiring to defraud the federal govemment
by getting false or fraudulent claims allowed or paid by Medicare, Medicaid, and other
federal and/or state fiinded health programs.
4
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11.
The defendants' business model encourages the physicians in Family
Dermatology practices to perform unnecessary services, including taking biopsies from
patients when they are not medically necessary.
12.
Defendant Paula Nelson does not have sufficient personnel to properly
perform the Dermatopathology services for all of the thousands of referrals from the 53
Family Dermatology practice locations nationwide.
IL
JURISDICTION AND VENUE
13.
This Court has jurisdiction over this action pursuant to 28 U.S.C. § 1331
and 31 U.S.C. § 3732(a) and 3730(b). This Court has jurisdiction to entertain a qui tarn
action. Relator is an "original source" and otherwise authorized to maintain this action in
the name of the United States as contemplated by the Civil False Claims Act, 31 U.S.C. §
3729-33.
14.
Relator has made voluntary disclosures to the United States Govemment
prior to the filing of this lawsuit and has filed a Disclosure Statement with the United
States Govemment as required by 31 U.S.C. § 3730(b)(2)
15.
Venue is appropriate as to each Defendant, in that one or more of
Defendants can be found in, reside in, and/or transact business in this judicial district.
Additionally, acts proscribed by 31 U.S.C. § 3729 have been committed by one or more
of the Defendants in this judicial district. Within the meaning of 28 U.S.C. § 1391(c) and
31 U.S.C. § 3732(a), venue is proper.
5
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 6 of 53
III.
THE PARTIES
16.
The Qui Tarn Relator is SCOTT M . ROSS, M.D. ("Relator" or "Ross").
He is a resident of the State of Minnesota. Relator Ross is a Board Certified
dermatologist, licensed in the states of Minnesota and Arizona. He has a private
dermatology practice in Minneapolis, Minnesota. He has personal and independent
knowledge of the factual allegations contained in this complaint and brings this action as
an "original source".
17.
Defendant P A U L A N E L S O N , M.D. ("Nelson") is a resident of Atlanta,
Georgia. She is a licensed and Board Certified dermatologist and dermatopathologist in
the State of Georgia and other states. She is the sole shareholder and CEO of Defendant
F A M I L Y D E R M A T O L O G Y , P.C. She is also PRESIDENT of Defendant F A M I L Y
DERMATOLOGY
FAMILY
OF P E N N S Y L V A N I A , P . C , S E C R E T A R Y
DERMATOLOGY
of D E F E N D A N T
M A N A G E M E N T , I N C , and sole shareholder and
DIRECTOR of F A M I L Y D E R M A T O L O G Y OF N E W JERSEY P . C Defendant Nelson
also
operates
a
pathology
laboratory
under
the
business
name
"NELSON
D E R M A T O P A T H O L O G Y A N D P A T H O L O G Y L A B O R A T O R Y " , located in Lilbum,
Georgia.
18.
D E F E N D A N T A D E Y I N K A ("YINKA") A D E S O K A N (Adesokan") is a
resident of Atlanta, Georgia. Said defendant is the husband of defendant P A U L A
N E L S O N . He is CFO and S E C R E T A R Y of defendant F A M I L Y D E R M A T O L O G Y ,
P.C. He also holds the positions of CFO and C E O for defendant D A T A B A S E D , I N C
and defendant F A M I L Y D E R M A T O L O G Y M A N A G E M E N T , I N C
PRESIDENT and TREASURER
He is also
of both defendants F A M I L Y D E R M A T O L O G Y
6
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MANAGEMENT
OF P E N N S Y L V A N I A ,
INC. and F A M I L Y
DERMATOLOGY
STAFFING OF P E N N S Y L V A N I A , INC.
19.
In addition to his role with Family Dermatology, defendant Y I N K A
A D E S O K A N is also the CEO of defendant D A T A B A S E D , INC., a Georgia for profit
corporation.
Defendant D A T A B A S E D ,
formed
in
December
1998,
seUs a
comprehensive practice management and electronic medical records system tailored
especially to dermatology practices.
20.
Defendant P A U L A N E L S O N owns and operates or has owned and
operated the following 53 current Family Dermatology practices and 6 former Family
Dermatology practices:
i.
In Florida:
ii. Family Dermatology of Clearwater
iii. Family Dermatology of Palm Harbor
ii.
In Georgia:
• Family Dermatology of Athens
• Family Dermatology of Atlanta - Boulevard N E
• Family Dermatology of Atlanta - St. Joseph
• Family Dermatology of Atlanta - Northside (former location)
• Family Dermatology of Austell
• Family Dermatology of Camp Creek
• Family Dermatology of Cartersville
• Family Dermatology of Conyers
• Family Dermatology of Conyers - Milstead
7
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 8 of 53
• Family Dermatology of Conyers - Rockdale
• Family Dermatology of Douglasville
• Family Dermatology of Dunwoody
• Family Dermatology of East Point
• Family Dermatology of Fayetteville
• Family Dermatology of Lilbum
• Family Dermatology of Marietta
• Family Dermatology of Peachtree City
• Family Dermatology of Norcross
• Family Dermatology of Rome - Redmond
• Family Dermatology of Rome
• Family Dermatology of Sandy Springs (former location)
• Family Dermatology of Smyma
In Pennsylvania:
• Family Dermatology of Ardmore
• Family Dermatology of Bala Cynwyd
• Family Dermatology of Bustleton
• Family Dermatology of Downingtown
• Family Dermatology of Havertown
• Family Dermatology of Hazleton
• Family Dermatology of Laurys Station
• Family Dermatology of McCandless (former location)
• Family Dermatology of New Hope
8
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 9 of 53
• Family Dematology of Norristown
• Family Dermatology of Reading
• Family Dermatology Roosevelt Boulevard
• Family Dermatology of Roxborough
• Family Dermatology of Sellersville
• Family Dermatology of Somerton
• Family Dermatology of Uniontown
• Family Dermatology of Warrington
• Family Dermatology of Wyndmoor (former location)
iv.
In Maryland:
• Family Dermatology of Chevy Chase
• Family Dermatology of Eldersburg
• Family Dermatology of Westminster
• Family Dermatology of Cockeysville
V.
In Massachusetts:
• Family Dermatology of Brookline
• Family Dermatology of West Roxbury
vi.
In Nebraska:
• Family Dermatology of Fremont (former location)
• Family Dermatology of Lincoln (former location)
V.
In New Jersey:
• Family Dermatology of Freehold
• Family Dermatology of Colts Neck
9
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• Family Dermatology of Moorestown
• Family Dermatology of Tumersville
vi.
In North Carolina:
• Family Dermatology of Wilmington
• Family Dermatology of Rocky Point
• Family Dermatology of Southport
vii.
In South Carolina:
• Family Dermatology of Hilton Head
• Family Dermatology of Piedmont
21.
DEFENDANTS P A U L A N E L S O N A N D Y I N K A A D E O S K A N own and
operate the following current or former Family Dermatology entities: F A M I L Y
D E R M A T O L O G Y P . C , F A M I L Y D E R M A T O L O G Y OF P E N N Y L S V A N I A , P . C ,
FAMILY DERMATOLOGY MANAGEMENT INC, FAMILY DERMATOLOGY
MANAGEMENT
OF
PENNSYLVANIA
INC,
FAMILY
DERMATOLOGY
STAFFING OF P E N N S Y L V A N I A , I N C , F A M I L Y D E R M A T O L O G Y OF N O R T H
C A R O L I N A , L L C , and F A M I L Y D E R M A T O L O G Y OF N E W JERSEY P . C
22.
DEFENDANT
FAMILY DERMATOLOGY,
P . C ("FD-GA") is a
Georgia professional medical corporation located at 629 Beaver Ruin Road N W , Suite B ,
Lilbum, Georgia 30047. The registered agent for service of process of said defendant is
Y I N K A A D E S O K A N , at the above address in Lilbum, Georgia.
23.
FD-GA was registered in North Carolina as a foreign corporation on
September 23, 2008. FD-GA was registered in South Carolina as a foreign corporation on
10
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November 20, 2008.
FD-GA was administratively dissolved in Soutli Carolina on
February 13,2012.
24.
D E F E N D A N T F A M I L Y D E R M A T O L O G Y OF P E N N S Y L V A N I A , P.C.
("FD-PA"), is a Pennsylvania professional medical corporation, owned and operated by
its sole shareholder, defendant P A U L A N E L S O N . Its president is defendant P A U L A
N E L S O N , whose address is listed with the State of Pennsylvania at 1803 Pine Street,
Philadelphia, Pennsylvania 19103. Its registered agent is National Registered Agents, Inc.
upon whom service can be made is at 600 N . 2d Street, Harrisburg, Pennsylvania 17101.
25.
FD-PA is registered as a foreign corporation in North Carolina, Florida,
and Maryland. Its legal status was forfeited in Maryland on November 15, 2012 for
failure to file a property retum for 2012. Its legal status was also revoked in Florida on
September 28, 2012 for failure to file an annual report.
26.
D E F E N D A N T F A M I L Y D E R M A T O L O G Y M A N A G E M E N T , INC. is a
Georgia for profit corporation, whose principal office is located at 629 Beaver Ruin
Road, Suite B, Lilbum, Georgia 30047. The registered agent for service of process of said
defendant is Y I N K A A D E S O K A N , at the above address in Lilbum, Georgia. It was
administratively dissolved on September 8, 2010.
27.
DEFENDANT
FAMILY
DERMATOLOGY
MANAGEMENT
OF
P E N N S Y L V A N I A , INC. (f/k/a F A M I L Y M A N A G E M E N T OF P E N N S Y L V A N I A ,
INC) is a Pennsylvania corporation, owned and operated by defendants P A U L A
NELSON,
M . D . and Y I N K A A D E S O K A N . Its president
is defendant Y I N K A
A D E S O K A N , whose registered address with the State of Peimsylvania is 1803 Pine
Street, Philadelphia, Pennsylvania 19103.
11
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28.
F A M I L Y D E R M A T O L O G Y M A N A G E M E N T OF P E N N S Y L V A N I A ,
INC. was registered as a foreign corporation in Florida and Massachusetts.
Its legal
status was revoked in Florida on September 28, 2012 for failure to file an annual report.
29.
Upon
information
and
belief.
Defendants
operated
FAMILY
D E R M A T O L O G Y M A N A G E M E N T , INC. (GA) as a means to pay salaries or perform
other administrative
functions for various Family Dermatology office locations
throughout the country. It was administratively dissolved in 2010.
30.
Upon information and
belief,
Defendants
also
utilize F A M I L Y
D E R M A T O L O G Y M A N A G E M E N T OF P E N N S Y L V A N I A , INC. to perform the
submission and billing of claims for physicians at Family Dermatology associated
practices, as well as the submission and billing of professional and pathology lab services
of the Nelson Dermatopathology and Pathology Laboratory.
31.
DEFENDANT
FAMILY
DERMATOLOGY
STAFFING
OF
P E N N S Y L V A N I A , INC. is a Pennsylvania corporation, owned and operated by
Defendants P A U L A N E L S O N , M . D . and Y I N K A A D E S O K A N . Its president is
Defendant
YINKA
ADESOKAN,
whose registered
address with the
State of
Pennsylvania is 1803 Pine Street, Philadelphia, Pennsylvania 19103.
32.
DEFENDANT
FAMILY
DERMATOLOGY
STAFFING
OF
P E N N S Y L V A N I A is registered as a foreign corporation in Maryland, Massachusetts, and
New Jersey. Its legal status was forfeited in Maryland on November 15, 2012 for failure
to file a property retum for 2012. Its legal status was also revoked in Florida on
September 28, 2012 for failure to file an annual report.
12
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33.
Upon
infomiation
and
belief,
Defendants
operated
FAMILY
D E R M A T O L O G Y STAFFING OF P E N N S Y L V A N I A , INC. to perfomi administrative
fiinctions including hiring non-physician support
staff for the various Family
Dermatology practices.
34.
DEFENDANT
FAMILY
DERMATOLOGY
MANAGEMENT
OF
N O R T H C A R O L I N A , L L C , is a North Carolina for profit limited liability corporation,
whose principal office is located at 319 South Sharon Amity Road, Suite 230, Charlotte,
North Carolina 28211. The registered agent for service of process of said defendant is
Marc R. Gordon, at the above address in Charlotte, North Carolina.
It was
administratively dissolved on September 2, 2010 for failing to file an annual report.
35.
D E F E N D A N T F A M I L Y D E R M A T O L O G Y OF N E W JERSEY, P . C
("FD-NJ") is a New Jersey professional corporation owned and operated by its sole
shareholder. Defendant P A U L A N E L S O N . Defendant P A U L A N E L S O N is also its sole
director. Its registered agent is Jed Kombluh upon whom service can be made at 22 West
Broad Street HopeweU, New Jersey 08525.
36.
D E F E N D A N T D A T A B A S E D I N C ("Databased") is a Georgia for profit
corporation, whose principal office is located at 629 Beaver Ruin Road, Suite B, Lilbum,
Georgia 30047. The registered agent for service of process of said defendant is YESfKA
A D E S O K A N , at the above address in Lilbum, Georgia.
37.
Defendants' 53 Family Dermatology practices in Georgia, Pennsylvania,
North Carolina, South Carolina, Maryland, Massachusetts, Florida, and New Jersey use
the Databased practice management and electronic medical records system.
38.
DEFENDANT D A T A B A S E D I N C also seUs its comprehensive practice
13
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management and electronic medical records system to dermatology practices across the
United States that are not owned by Defendant Nelson or any of Defendants' associated
Family Dermatology entities.
39.
DEFENDANT
F A M I L Y BILLING
SERVICES,
INC. is a Georgia
corporation, whose principal office is 3502 Estates Lane Smjma, G A 30080.
The
registered agent for service of process of said defendant is Defendant A D E Y E M I
A D E S O K A N , at the above address in Smyma, GA.
40.
GA.
DEFENDANT A D E G B O Y E G A A D E S O K A N is a resident of Smyma,
Defendant A D E G B O Y E G A A D E S O K A N ,
the brother of defendant Y I N K A
A D E S O K A N , is the CFO for defendant F A M I L Y BILLING SERVICES, Inc.
41.
DEFENDANT A D E Y E M I A D E S O K A N , a resident of Smyma, G A , is
the wife of defendant A D E G B O Y E G A A D E S O K A N and sister-in-law to defendant
Y I N K A A D E S O K A N . Defendant A D E Y E M I A D E S O K A N holds the position of CEO
and Secretary of defendant F A M I L Y B I L L I N G SERVICES, INC.
42.
Upon information and belief, F A M I L Y BILLING SERVICES, INC. may
be involved with the submission and billing of claims of dermatologists who contract to
use Y I N K A A D E S O K A N ' s Databased Practice Management and Electronic Medical
Records service. Upon information and belief, F A M I L Y BILLING SERVICES, INC.
may also be involved in the submission and billing of claims for the professional and
pathology lab services of the Nelson Dermatopathology and Pathology Laboratory.
IV.
Background on Federal Health Care Programs
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43.
In 1965, Congress enacted Title XVIII of the Social Security Act, which
established the Medicare Program to provide health insurance for the elderly and
disabled. Medicare is a health insurance program for: people age 65 or older; people
under age 65 with certain disabilities; and people of all ages with end-stage renal disease
(permanent kidney failure requiring dialysis or a kidney transplant).
44.
Medicare has two parts: Part A , the Basic Plan of Hospital Insurance; and
Part B, which covers physicians' services and certain other medical services not covered
by Part A.
45.
Medicare Part A (Hospital Insurance) helps cover inpatient care in
hospitals, including critical access hospitals, and skilled nursing facilities (not custodial
or long-term care). Medicare Part A also helps cover hospice care and some home health
care.
46.
Medicare Part B (Medical Insurance) helps cover doctors' services and
outpatient care. It also covers some other medical services that Part A doesn't cover (i.e.,
physical and occupational therapist services, etc.). Part B helps pay for covered health
services and supplies when they are medically necessary.
47.
Payments from the Medicare Program come from a trustfraud- known as
the Medicare Trust Fund - which is ftmded through payroll deductions taken from the
work force, in addition to govemment contributions. Over the last forty years, the
Medicare Program has enabled the elderly and disabled to obtain necessary medical
services from medical providers throughout the United States.
15
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48.
The Medicare Program is administered through the United States
Department of Health and Human Services ("HHS") and, specifically, the Centers for
Medicare and Medicaid Services ("CMS"), an agency of HHS.
49.
Much of the daily administration and operation of the Medicare Program
is managed through private insurers under contract with the federal govemment
(particularly CMS).
50.
Under Medicare Part A , contractors serve as "fiscal intermediaries,"
administering Medicare in accordance with mles developed by the Health Care Financing
Administration ("HCFA").
51.
Under Medicare Part B, the federal govemment contracts with insurance
companies and other organizations known as "carriers" to handle payment for physicians'
services in specific geographic areas. These private insurance companies, or "Medicare
Carriers", are charged with and responsible for accepting Medicare claims, determining
coverage, and making pajmients from the Medicare Trast Fund.
52.
The principal fimction of both intermediaries and carriers is to make and
audit payments for Medicare services to assure that federal funds are spent properly.
53.
To participate in Medicare, providers must assure that their services are
provided economically and only when, and to the extent they are medically necessary.
Medicare will only reimburse costs for medical services that are needed for the
prevention, diagnosis, or treatment of a specific illness or injury.
V. T H E APPLICABLE LAW
A.
Stark Law - Overview
16
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54.
Under Stark law, a physician has a financial relationship with an entity i f
he has either an ownership (or investment) interest in the entity or a compensation
arrangement with the entity. 42 U.S.C. §1395nn(a)(2). A n ownership or investment
interest in the entity may be an equity interest, a debt relationship or indirect ownership
through controlling entities.
55.
A "compensation arrangemenf means any arrangement involving any
remuneration between a physician (or an immediate family member of such physician)
and the entity. 42 U.S.C. §1395nn(h)(l)(A). Stark law defines "remuneration" broadly
to include any remuneration received by a physician directly or indirectly, overtly or
covertly, in cash or in kind. 42 U.S.C. §1395nn(h)(l)(B). Stark law excludes from the
definition of "compensation arrangement"
certain arrangements involving
only
remuneration consisting of:
•
Forgiveness of amounts owed for inaccurate or mistakenly performed
tests or procedures, or the correction of minor billing errors;
•
Provision of items, devices, or supplies that are used solely to collect
specimens or order procedures for entity; and
•
Certain payments from insurers to physicians on a fee-for-service
basis. 42 U.S.C. § 1395nn(h)(l)(A) and (C).
56.
As originally adopted in 1989, Stark law applied only to physician
referrals to clinical laboratories in which they had a financial interest.
Congress
significantly expanded the scope of the referral prohibition in 1993. Stark law now
prohibits referrals for "designated health services," which include clinical laboratory,
physical therapy, occupational therapy, radiology, radiation therapy, durable medical
17
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equipment and supplies, home health, outpatient prescription drugs, and all inpatient and
outpatient hospital services. 42 U.S.C. §1395nn(h)(6).
•
Forgiveness of amounts owed for inaccurate or mistakenly performed tests
or procedures, or the correction of minor billing errors;
•
Provision of items, devices, or supplies that are used solely to collect
specimens or order procedures for the entity; and
•
Certain payments from insurers to physicians on a fee-for-service basis.
42 U.S.C. §1395nn(h)(l)(A) and (C).
57.
In contrast to the Federal Anti-Kickback Statute, Stark law is only a civil
prohibition. A Stark law violation is not a crime in and of itself However, a violation of
Stark law may also constitute a violation of other applicable statutes, which could result
in a criminal prosecution. Stark law is a strict liability statute that is violated whenever a
prohibited referral is made or a claim is submitted based on that prohibited referral,
regardless of whether the health care provider intended, knew or should have known that
the law prohibited the actions it took.
58.
As of January 1, 1995, Stark law legislation applied to patient referrals by
physicians with a prohibited fmancial relationship for the "designated health services,
which included inpatient and outpatient hospital services. See 42 U.S.C. § 1395(h)(6); 42
U.S.C. §1395nn.
59.
Stark law broadly defines prohibited financial relationships to include any
"compensation" paid directly or indirectly to a referring physician.
60.
Unless an exception applies, a physician cannot refer, and an entity
receiving a prohibited referral is prohibited from billing Medicare for the services.
18
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Qualifying as a group practice under Stark law is not itself an exception, but it enables
physicians to be eligible for certain exceptions to the ownership and compensation
arrangement prohibitions.
61.
As further explained herein. Defendants do not qualify for the in-office
ancillary services exception because (1) they do not qualify as a "group practice" and (2)
they do not operate their laboratory in the "same building" as a bona-fide physician
practice.
62.
A group of physicians cannot provide "designated health services",
including clinical laboratory, within the practice unless it qualifies as a group practice and
meets the in-office ancillary services exception.
63.
As further explained herein, none of the Defendants' conduct at issue in
this Amended Qui Tarn Complaint qualifies for Stark Law exceptions.
64.
Stark law defines a group practice as follows: "The term 'group practice'
means a group of 2 or more physicians legally organized as a partnership, professional
corporation, foundation, not-for-profit corporation, faculty practice plan, or similar
association."
65.
To be a valid group practice under Stark law, the group practice must meet
six elements: (i) each physician-member performs the full range of services that he/she
routinely provides; (ii) the physician-member services are billed under a billing number
assigned to the group; (3) overhead expenses and income are predetermined by the group;
(4) no physician-member directly or indirectly receives compensation based on the
volume or value of the referrals by the physician; (5) physician-members each conduct at
least 75-percent of the physician-patient encounters; and (6) meets other applicable
19
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standards imposed by regulation. 42 U.S.C. § 1395nn (h)(4).
66.
Moreover, a group practice operating in more than one state is considered
a single legal entity only if: (1) the states in which the group is operating are contiguous;
(2) the legal entities are absolutely identical as to ownership, governance and operation,
and (3) the organization into multiple entities is necessary to comply with state licensing
laws.
67.
To qualify as a "member of a group" for purposes of Stark, a physician
must be an owner or employee of the group practice. Independent contractors who work
in a group practice are considered "physicians in the group".
68.
As fiirther explained herein, the Family Dermatology practices and entities
do not qualify as a group practice under Stark because (1) the Family Dermatology
practices are not owned and operated by a single legal entity and (2) independent
contractor physicians perform the vast majority of the physician-patient encounters at
Family Dermatology practices. In order to qualify as a group practice, rather than owners
or employees.
69.
To qualify for the in-office ancillary services exception, the "designated
health services", including clinical laboratory services, must have been fiimished in either
(1) the "same building" where the referring physician or another physician in the same
qualifying group practice famishes substantial physician services that are unrelated to the
fiimishing of other "designated health services" and the receipt of "designated health
services" must not be the primary reason the patient comes into contact with the
physician group; or (2) a "centralized building" that is used by the qualifying group
practice for the provision of some or all of the group's designated health services.
20
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70.
To meet the "same building" requirement, one of three tests must be
satisfied. Specifically, a designated health service is considered to be fiimished in the
same building for purposes of the in-office ancillary services exception if:
i.
(1) (i) The referring physician or his/her qualifying group practice has
an office in the building that is normally open to patients at least thirtyfive hours per week and (ii) the referring physician or one or more
physician members of the physician's qualifying group practice
regularly practices medicine and famishes physician services to
patients in that office at least thirty hours per week - with some
services unrelated to the provision of "designated health services" for
purposes of Stark.
ii.
(2) (i) The patient receiving the designated health services usually
receives physician services from the referring physician or another
physician member of his or her qualifying group practice,
(ii) the
building is one in which the referring physician or one or more
physician members of the referring physician's qualifying group
practice owns or rents an office that is normally open to patients at
least eight hours per week; and (iii) the referring physician regularly
practices medicine and famishes physician services to patients in that
office at least six hours per week with at least some services unrelated
to the provision of "designated health services" for purposes of Stark.
iii.
(3) (i) The building is one in which the referring physician or one or
more physician members of the referring physician's qualifying group
21
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practice owns or rents an office tliat is normally open to patients at
least eight hours per week; (ii) the referring physician or one or more
physician members of the referring physician's qualifying group
practice regularly practices medicine and fiimishes physician services
in that office at least six hours per week - with some services unrelated
to the provision of "designated health services"; and (iii) the referring
physician is present and orders the designated health services during a
patient visit on the premises, or the referring physician or a physician
member of the referring physician's qualifying group practice is
physically present while the designated health service is being
fiimished during regular office hours.
71.
A "centralized building" for purposes of the in-office ancillary services
exception to Stark, means all or part of a building that is owned or leased on a full-time
(24/7) basis, for a term of not less than 6 months by a qualifying group practice, and that
is used exclusively by the qualifying group practice.
72.
Additionally, to qualify for the in-office ancillary services exception to
Stark, the "designated health services" must be billed either (i) under a billing number
assigned to the physician performing or supervising the services; (ii) under a billing
number assigned to the referring or supervising physician's qualifying group practice; or
(iii) under a billing number assigned to an entity that is wholly owned by the performing
or supervising physician or his or her qualifying group practice.
B.
Federal Anti-Kickback Act ("AKA") - Overview
73.
The Federal Anti-Kickback Act makes it a crime to knowingly and
22
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willfully offer, pay, solicit or receive any remuneration to induce a person:
(1)
to refer an individual to a person for the fiimishing of any item or service
covered under a federal health care program; or
(2)
to purchase, lease, order, arrange for or recommend any good, facility,
service, or item covered under a federal health care program. 42 U.S.C.
§1320a-7b(b)(l)and (2).
74.
The term "any remuneration" encompasses any kickback, bribe, or
rebate, direct or indirect, overt or covert, in cash or in kind. 42 U.S.C. §1320a-7b(b)(l).
Any ownership interest or compensation arrangement that constitutes a financial
relationship under Stark would also constitute remuneration as defined by the A K A ,
unless a kickback safe harbor applies.
75.
offense.
Knowing and willful conduct is a necessary element of this criminal
42 U.S.C. §1320a-7b(b)(l).
A n act is willful i f "the act was committed
voluntarily and purposely, with the specific intent to do something the law forbids, that is
with a bad purpose, either to disobey or disregard the law." United States v. Starks, 157
F.3d 833, 837-8 (ll*^ Cir. 1998).
The statute has been interpreted to cover any
arrangement where one purpose of the remuneration was to obtain money for the referral
of services or to induce further referrals. United States v. Kats, 871 F.2d 105 (9* Cir.
1989); United States v. Greber, 760 F.2d 68 (3d Cir.), cert, denied, 474 U.S. 988 (1985).
Violation of the statute constitutes a felony punishable by a maximum fine of $25,000,
imprisonment up to five years, or both. Any party convicted under the A K A must be
excluded {i.e., not allowed to bill for any services rendered) from Federal health care
programs for a term of at least five years. 42 U.S.C. § 1320a-7(a)(l). Even without a
23
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conviction, i f tlie Secretary of HHS finds administratively that a provider has violated the
A K A , the Secretary may exclude the provider from the Federal health care programs for
a discretionary period, and may impose administrative sanctions of $50,000 per kickback
violation. 42 U.S.C. • 1320a-7(b).
76.
HHS has published safe harbor regulations that define practices that are
not subject to the anti-kickback statute because such practices would unlikely result in
fraud or abuse. See 42 C.F.R. §1001.952. The safe harbors set forth specific conditions
that, i f met, assure entities involved of not being prosecuted or sanctioned for the
arrangement qualifying for the safe harbor. However, safe harbor protection is only
afforded to those arrangements that precisely meet all of the conditions set forth in the
safe harbor. As will hereafter appear, Defendants have failed to comply with the required
conditions to qualify for such safe harbor protections.
C.
The False Claims Act - Overview
77.
Title 31 U S C A Section 3729 of the Federal False Claims Act provides as
follows:
"(a) Liability for Certain Acts(1) IN GENERAL- Subject to paragraph (2), any person who—
(A)
knowingly presents, or causes to be presented, a
false or fraudulent claim for payment or approval;
(B)
knowingly makes, uses, or causes to be made or
used, a false record or statement material to a false
or fraudulent claim;
(C)
conspires to commit a violation of
(A), (B), (D), (E), (F), or (G);
(D)
has possession, custody, or control of property or
money used, or to be used, by the Government and
24
subparagraph
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 25 of 53
knowingly delivers, or causes to be delivered, less
than all of that money or property;
(E)
is authorized to make or deliver a document
certifying receipt of property used, or to be used, by
the Government and, intending to defraud the
Government, makes or delivers the receipt without
completely knowing that the information on the
receipt is true;
(F)
knowingly buys, or receives as a pledge
obligation or debt, public property from an
or employee of the Government, or a member
Armed Forces, who lawfully may not sell or
property; or
(G)
knowingly makes, uses, or causes to be made
used, a false record or statement material to
obligation to pay or transmit money or property
the Government,
or knowingly
conceals
knowingly and improperly avoids or decreases
obligation to pay or transmit money or property
the Government,
of an
officer
of the
pledge
or
an
to
or
an
to
is liable to the United States Govemment 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 (28 U.S.C. 2461 note; Public Law
104-410), plus 3 times the amount of damages which the
Government sustains because of the act of that person.
(2)
REDUCED DAMA GES- Ifthe court finds that—
(A)
the person committing the violation of this
subsection furnished officials of the United States
responsible for investigating false claims violations
with all information known to such person about the
violation within 30 days after the date on which the
defendant first obtained the information;
(B)
such person fully cooperated with any
investigation of such violation; and
(C)
at the time such person furnished the United States
with the information about the violation, no
criminal prosecution, civil action, or administrative
25
Government
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 26 of 53
action had commenced under this title with respect
to such violation, and the person did not have
actual knowledge
of the existence
of an
investigation into such violation, the court may
assess not less than 2 times the amount of damages
which the Government sustains because of the act of
that person.
(3) COSTS OF CIVIL ACTIONS- A person violating this
subsection shall also be liable to the United States
Government for the costs of a civil action brought to
recover any such penalty or damages.
VI.
ALLEGATIONS
A.
Background of Defendants' Operations
78.
On or about November 18, 1997, Defendants Paul Nelson and Yinka
Adesokan formed Defendant Family Dermatology, P.C., a Georgia professional
corporation, which operated dermatology practice(s) in the area surrounding Atlanta,
Georgia.
79.
Defendants Nelson and Yinka Adesokan quickly grew the operations of
Family Dermatology, P.C., by purchasing other dermatology practices in Georgia,
Pennsylvania, North Carolina, South Carolina, Florida, Maryland, Massachusetts, and
New Jersey. Defendants Nelson and Adesokan would then operate these dermatology
practices under the "Family Dermatology" label through a variety of corporate entities,
real and imagined.
80.
Defendants Nelson and Yinka Adesokan formed various corporate entities
within Georgia, Peimsylvania, North Carolina, South Carolina, Florida, Maryland,
Massachusetts, and New Jersey for the purpose of owning and operating the dermatology
practices they acquired in those states. These corporations included, but were not limited
26
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to: Defendant Family Dermatology of Pennsylvania, P . C , Family Dermatology, P . C ,
Family Dermatology of New Jersey, P . C , and Family Dermatology Management of
North Carolina, L L C
81.
Defendant Nelson is the Chief Executive Office of Defendant Family
Dermatology, P . C , President of Defendant Family Dermatology of Pennsylvania, P.C.
and the Secretary of Defendant Family Dermatology Management, Inc. Defendant
Nelson also is the sole shareholder and director of Family Dermatology of New Jersey,
P.C.
82.
As stated above, Defendant Paula Nelson is the owner and operator of all
Family Dermatology practices throughout the states of Florida, Georgia, Maryland,
Massachusetts, Pennsylvania, New Jersey, North Carolina, and South Carolina.
83.
Defendant Yinka Adesokan, who is the husband of Defendant Nelson, is
the Chief Financial Officer and Secretary of Defendant Family Dermatology, P . C , and
the Chief Executive Officer and Chief Financial Officer of Defendant Family
Dermatology Management, Inc. He is also the President and Treasurer of both Defendant
Family Dermatology Management of Pennsylvania, Inc. and Defendant Family
Dermatology Staffing of Pennsylvania, Inc.
84.
After
purchasing
a
dermatology
practice.
Defendants
Family
Dermatology, P . C , Nelson and Adesokan Family Dermatology, P . C , Nelson and
Adesokan would contract with the dermatologist who sold them the practice to stay-on
and continue to work for them as an independent contractor.
Defendants Family
Dermatology, P . C , Nelson, and Adesokan would pay these independent contractor
physicians compensation based on a percentage of the "net collections" by the Family
27
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Dermatology practice where they worked.
85.
The Defendants defined "net collections" to mean all amounts received by
the dermatology practice related to the professional services by the independent
contractor physician, but not ancillary services.
86.
The defendants'
business
model, which
compensates
independent
contractor dermatologists at acquired practices based on the volume or value of
procedures
performed,
encourages
over-utilization
of
dermatology
and/or
dermatopathology services. For example, i f a physician performs a biopsy, there is a fee
for the biopsy in addition to the office visit fee. Relator leamed from the defendants'
employee, Waylon, who trained Relator's staff to use Databased software, that a Family
Dermatology practice in Philadelphia was over-utilizing pathology services by
conducting a biopsy on every patient (for example, 50 a day) versus normal rate of 5 per
day. Each specimen obtained through biopsy is retumed to Dr. Nelson's pathology lab.
87.
Applying this business model, defendants have used a sliding pay scale to
compensate the dermatologists at each of the Family Dermatology locations operated by
Dr. Nelson, based on that practice's total revenue. Specifically, defendants will pay the
dermatologist between 45% and 60% of the practice's net collections. Professional fees
eamed at each location will be higher when the dermatologists perform biopsies to send
specimens to Dr. Nelson's pathology lab. In this way, physicians at defendants' practices
are incentivized to over-utilize dermatology and/or dermatopathology services in order to
generate more revenue for the dermatology office location, and therefore a higher
compensation for themselves.
88.
In addition, defendant Yinka Adesokan informed Relator that he could
28
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monitor, on a real-time basis, the number of procedures performed at each dermatology
office, and that he could then contact the dermatologists in order to increase the number
of procedures performed that would yield pathology referrals to Dr. Paula Nelson's lab.
89.
Utilizing this model. Defendants Family Dermatology, P . C , Nelson and
Adesokan rapidly grew their business to include 53 dermatology practice locations
throughout the United States, including in Georgia, Pennsylvania, North Carolina, South
Carolina, Florida, Maryland, Massachusetts, and New Jersey.
90.
In addition to owning and operating Family Dermatology practice
locations, Defendant Nelson also operates a thriving dermatopathology practice. Dr.
Nelson performs pathology services doing business as "Nelson Dermatopathology and
Pathology Laboratory". According to Georgia corporate records, there is no distinct legal
entity called "Nelson Dermatopathology and Pathology Laboratory." Additionally, there
is neither an N P l nor a provider number for Nelson Dermatopathology and Pathology
Laboratory.
Therefore, independent contractor dermatologists at Family Dermatology
office locations refer pathology specimens to a lab that has a direct financial relationship
with Dr. Nelson, the person who pays their independent contractor compensation.
91.
Dr. Nelson has represented that she operates or has operated the Nelson
Dermatopathology and Pathology Laboratory from various locations in Georgia: one
located at 5755 Dupree Drive, N W , Suite 110, Atlanta G A and a lab located in the
basement of Dr. Nelson's home. Until early 2010, the Nelson Dermatopathology and
Pathology Laboratory was listed as located at 755 Mount Vemon Highway, Suite 250,
Atlanta, Georgia.
While, the 755 Mount Vemon Highway location of Nelson
Dermatopathology and Pathology Laboratory purports to be within the same building as
29
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the Atlanta-Northside location of Defendant Family Dermatology, P . C , based on
Relator's observation and investigation, since at least early 2010, no laboratory operated
out of this location.
92.
From at least March 2010, the Nelson Dermatopathology and Pathology
Laboratory has operated out of 5755 Dupree Drive, N W , Suite 110, Atlanta G A .
Although there is an adjacent suite in this same building (Suite 120) that is identified as a
Family Dermatology location, there is no bona fide Family Dermatology physician
practice in this building.
93.
This purported office at 5755 Dupree Drive lacks appropriate ftimiture, is
perpetually dark and locked, has no waiting area, and has no receptionist.
Based on
Relator's observation and investigation, the 5755 Dupree Drive location is not a bonafide Family Dermatology office and no patients receive treatment there.
94.
Upon information and belief, Defendants operated a sham office out of the
5755 Dupree Drive location in order to facially satisfy the "same building" requirement
for the in-office ancillary services exception to the Stark law
95.
Based on pathology reports
issued from defendants,
the Nelson
Dermatopathology and Pathology Laboratory utilizes the services of at least four
dermatopathologists, Defendant Nelson, Klaus Sellheyer, M D , Scott Acker, M D , and
Robert Allen M D . Until early 2010, the Nelson Dermatopathology and Pathology Lab
utilized the services of L i Ma, M.D., Ph.D.
Other than Defendant Nelson, however, it is
unlikely that any of the dermatopathologists
listed as practicing at the Nelson
Dermatopathology and Pathology Laboratory are or were involved in reviewing,
analyzing, and issuing reports on the numerous pathology specimens and slides sent from
30
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every Family Dermatology practice. They either have no association with Family
Dermatology or have full-time positions in academia in other states.
Thus, Relator
believes that Defendant Nelson is not providing appropriate pathology services for the
thousands of pathology referrals she receives weekly from independent contractor
dermatologists at Family Dermatology offices.
B.
Relator Ross' Discovery of
Kickbacks and False Claims
Defendants' Illegal Self-Referrals,
96.
In 2008, Defendant Adesokan approached Relator Ross in regards to
purchasing Relator Ross's dermatology practice. The sale was negotiated and an Asset
Purchase Agreement and Physician's Service Agreement were signed on May 1, 2008 by
Relator Ross and by Dr. Nelson.
97.
According to the terms of the Asset Purchase Agreement, Defendant
Family Dermatology of Georgia, P.C. agreed to pay Relator Ross $450,000, in the form
of a loan from Relator Ross to Family Dermatology, P . C , which was required to be
repaid within four years, with an interest rate of 8% per annum.
98.
Defendant Nelson also contracted for Relator Ross to provide professional
services as an independent contractor, to continue providing dermatology services at the
purchased practice location on behalf of Defendants Nelson and Family Dermatology,
P.C
99.
Defendant Nelson and Relator Ross entered into a Professional Services
Agreement, on or about May 1, 2008, memorializing Relator Ross' relationship to Family
Dermatology as an independent contractor. According to the terms of that Professional
Services Agreement, Relator Ross was to be compensated a base amount equal to 45%
and up to 60% of his "net collections," as that term was defined in the agreement. The
31
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agreement provided tliat net collections were based on professional dermatology services
and included ancillary services such as pathology services.
100.
Shortly after signing the Asset Purchase and Professional Services
Agreements, Defendant Adesokan informed Relator Ross that he was required to refer all
his pathology services for his patients to Defendant Nelson's pathology laboratory in
Atlanta, Georgia. Relator Ross objected to this requirement.
101.
For many years. Relator Ross had sent his tests to a pathology laboratory
that was located in close proximity to his office. Relator Ross believed that this practice
saved time and money.
Dr. Ross saw no need to abandon his historically effective
practices in order to send his pathology services across the country to Defendant Yinka
Adesokan's wife in Atlanta, Georgia. As of a resuh of this refusal and other
disagreements, Defendants terminated the purchase of Relator Ross's practice, as well as
his Professional Services Agreement.
102.
Relator made numerous inquiries regarding the purchases by Dr. Nelson
of other dermatology practices across the country. Relator discovered that other
physicians who sold their practices to Defendant Nelson were also required to send all
their pathology tests to Defendant Nelson's laboratory in Atlanta. Each of these
physicians had entered into independent physician services agreements with Defendant
Nelson as recently as the end of 2011. For example, as recently as November 2011,
Relator spoke with a Maryland dermatologist who confirmed that when he sold his
practice to Dr. Nelson, he was expected to refer all pathology tests to Dr. Nelson's
laboratory.
103.
These dermatologists also entered into independent contractor agreements
32
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that were similar to Dr. Ross' agreement with Defendant Nelson and Family
Dermatology. In particular, other dermatologists agreed to provide professional medical
services (dermatology) to patients of Family Dermatology on behalf of Defendant Nelson
as an independent contractor. Their physician services agreements provided that the
selling physician would receive as base compensation a percentage of the net collections
of the practice, with a bonus for increase in net collections. These compensation
arrangements were based on the individualized revenue and expenses of each location
and were not pooled as a group with the other affiliated Family Dermatology locations of
Defendant Nelson.
104.
For example, the term "net collections" was defined in Dr. Ross'
professional services agreement with Dr. Nelson to include all amounts received by the
dermatology practice related to the provision of professional services by Dr. Ross,
excluding ancillary services.
105.
Rather than obtain a Medicare or Medicaid group practice number for
each of these purchased medical practices, Defendants had each physician practice
continue to bill Medicare and Medicaid under their individual physician National
Physician Provider Numbers. However, the Defendants had payments remitted directly
to Defendant Nelson in Atlanta, Georgia.
106.
In fact, the definition of "net collections" in Defendant's professional
services agreement presumes that Dr. Nelson (d/b/a/ Family Dermatology) would receive
fimds through the independent contracting physician's provider number ("related to the
provision of professional services"), which would include ancillary services. However, in
the agreement. Dr. Nelson specifically subtracts any amounts received from the
33
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independent contractor dermatologists' compensation calculation, collections related to
"ancillary" (pathology) services.
107.
Thus, Relator believes that Dr. Nelson, as the owner and operator of
Family Dermatology locations, billed Medicare and Medicaid using individual
dermatologist provider numbers, rather than using a group provider number as required to
qualify as a "group practice".
108.
The affiliated and owned satellite offices of Defendant Nelson fail to meet
the clear and specific legal definition of a "group practice" under Stark law and therefore
do not qualify for any relevant exception to Stark law. Thus, the referrals described above
made by individual dermatologists at Family Dermatology locations to Defendant
Nelson's laboratory constitute a prohibited referral arrangement under the Stark laws
cited herein.
C.
Defendants Nelson and Adesokan Illegally Direct Lucrative Referrals
of Dermatopathology Services to Nelson Dermatopathology
109.
Defendants have engaged in a scheme to illegally direct lucrative referrals
of dermatopathology services, including services paid for by Medicare and Medicaid, to
Nelson Dermatopathology, the pathology laboratory owned and operated by Defendant
Paula Nelson.
110.
Defendants scheme of directing dermatopathology referrals to Nelson
dermatopathology included, but was not limited to, the following: (1) Mandating that the
53 Family Dermatology practices across the United States refer all of their
dermatopathology work to Nelson Dermatopathology; and (2) Mandating that all
dermatology practices that utilize the Databased comprehensive practice management
and electronic medical records system refer all of their dermatopathology work to Nelson
34
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 35 of 53
Dermatopathology.
i. Defendants Illegally Mandate that all Family Dermatology
Physicians
Refer
Pathology
Services
to
Nelson
Der matop athology
111.
Defendants Nelson and Adesokan utilized their respective ownership and
leadership positions position within the various Family Dermatology entities described
above, to require that dermatologists associated as independent contractors at the many
(53) Family Dermatology practices throughout the United States, to refer all of their
dermatopathology services to Defendant Nelson and Nelson Dermatopathology and
Pathology Laboratory.
112.
Dermatologists, such as Relator Ross, who either refiised to refer all of
their patients to Nelson Dermatopathology and Pathology Laboratory, or questioned the
legality of such an obvious self-referral by Defendants Nelson and Adesokan, were either
terminated or faced other forms of retaliation, including the cancellation of the sale of
their dermatology practice to Family Dermatology.
113.
Defendants have utilized this scheme to direct the referral of thousands of
dermatopathology services, including many paid for by Medicare and Medicaid, to
Defendant Nelson and Nelson Dermatopathology and Pathology Laboratory.
114.
Each and every referral of dermatopathology services by a Family
Dermatology physician that was paid for by Medicare and/or Medicaid violates the Stark
Law, because Defendant Nelson, and her husband (Defendant Adesokan), are mandating
such referrals to Defendant Nelson's own dermatopathology laboratory.
115.
None of the exceptions to the Stark Law apply to Defendants' conduct as
alleged in this Amended Qui Tarn Complaint.
35
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 36 of 53
ii. Defendants' Scheme Does Not Qualify for any Stark
Exception and Defendants Do Not Qualify as a "Group
Practice".
116.
As described above, Defendants operated a sham office at the 5755
Dupree Drive address in order to appear to satisfy the in-office ancillary services
exception to the Stark Law.
However, no legitimate physician practice was located at
this address. Furthermore, even at their previous location (755 Mount Vemon Highway),
Defendants did not qualify for the in-office ancillary services exception.
117.
Defendants do not qualify for the in-office ancillary services exception to
the Stark Law because (1) they do not qualify as a "group practice" for purposes of the
Stark Law and (2) because the Nelson Dermatopathology and Pathology Laboratory is
not operated in the "same building" as a genuine Family Dermatology practice.
118.
Defendants do not qualify as a "group practice" under the Stark Law
because:
i.
The Family Dermatology practices and lab are not owned by a single
legal entity. For example. Dr. Ross' practice was purchased by Family
Dermatology of Georgia, P.C., which is not even a legal entity
registered with the Georgia Secretary of State. B y contrast, Family
Dermatology of Pennsylvania, P.C. was
the
purchaser
of a
dermatology practice located in Chevy Chase, Maryland in 2011. In
addition, as described in detail above, Defendants created a number of
different legal entities across the nation, in non-contiguous states, to
purportedly purchase and operate the dermatology practices. These
entities are also not identical with respect to govemance - for instance,
Bamidele Agbowyu is Secretary of FD-PA, but is not an officer with
36
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 37 of 53
FD-GA. Physician "members" do not provide at least 75% of the
patient care encounters in the Family Dermatology practices. Rather,
Defendants' business method is to purchase a dermatology practice
through one of its various legal entities and then contract with the
dermatologists practicing at that location to work at that location as
independent contractors.
Thus, independent contractor physicians
provide the vast majority of the patient care services in the Family
Dermatology practices nationwide. These independent
contractor
physicians carmot qualify as members of a group practice because they
are not owners or employees.
119.
Because Defendants do not qualify as a "group practice", they cannot
satisfy the "centralized building" requirement of the in-office ancillary services
exception. To qualify, the designated health service must be performed in a building that
is owned or leased on a full-time basis by a group practice. Defendants also cannot
satisfy the "same building" requirements of the in-office ancillary services exception for
the reasons stated in detail fiirther herein.
iii. Defendants Do Not Qualify for the In-Office Ancillary
Services Exception.
120.
In addition to failing the "group practice" requirements of Stark,
Defendants cannot qualify for the in-office ancillary services exception to Stark, because
they have not operated the Nelson Dermatopathology and Pathology Laboratory in the
"same building" as a bona-fide physician practice.
121.
Lab-workers have been observed at the laboratory operated at 5755
Dupree Drive Atlanta, GA. However, based on Relator's observation and investigation.
37
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 38 of 53
no Family Dermatology physicians practice at the 5755 Dupree Drive address and no
patients
receive treatment there.
Rather,
the
suite
adjacent to
the
Nelson
Dermatopathology Laboratory is perpetually dark and locked, has no waiting area or
receptionist, and lacks appropriate fumiture for a physician office. Instead, Defendants
occupied an empty suite adjacent to its dermatopathology lab in order to create the
appearance that the lab was in the "same building" as a physician practice.
122.
Since no patients receive treatment at the 5755 Dupree Drive location.
Defendants cannot satisfy any one of the three tests of the "same building" element of the
in-office ancillary services exception.
123.
Thus, each and every referral for dermatopathology services by Family
Dermatology physicians to the Nelson Dermatopathology and Pathology Laboratory
violates the Stark Laws.
ii. Defendants Illegally Mandate that all Dermatologists Utilizing
Defendant Databased's Practice Management System Refer
Pathology Services to Nelson Dermatopathology
124.
Defendants have also illegally mandated that all dermatology practices
that utilize Defendant Databased's Practice Management and Electronic Medical Records
System, including those not owned by Family Dermatology, refer all of their
dermatopathology work to Nelson Dermatopathology.
125.
Defendant Databased offers its Practice Management and Electronic
Medical Records System to dermatology practices across the country at a steep discount,
which in some cases is approximately 85% less than the trae retail price of that system.
126.
As a result of this steep discount. Defendant Databased has, upon
information and belief, been successful in getting numerous dermatology practices, not
38
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 39 of 53
owned by Family Dermatology, to use its Practice Management and Electronic Medical
Records System.
127.
After a few months, once these dermatology practices have become
completely reliant upon Defendant Databased's Practice Management and Electronic
Medical Records System, Defendant Adesokan would inform these practices that the
price for continuing to use the Databased system will immediately increase by 85%
unless they agree to refer their pathology services to Defendant Nelson and Nelson
Dermatopathology and Pathology Laboratory.
128.
Defendant Adesokan explained the price increase to one dermatology
practice in a January 4, 2007 email by stating that Databased's "associated Laboratory
Nelson Dermatopathology" has renewed its commitment to "subsidize the use of this
software for its customers by paying 85%) of the cost." Adesokan also explained in that
email that "this is for customers who send a good portion of their pathology to Nelson
Dermatopathology Laboratory."
129.
Dermatology practices that did not agree to send their pathology services
to Defendant Nelson and Nelson Dermatopathology Laboratory had to either: (1) pay the
new, 85% more-expensive rate for using the Databased system; (2) find another
pathology laboratory to pay 85% of the user fees for the Databased system; or (3) fmd
another Practice Management and Electronic Medical Records System.
130.
Faced with the substantial disruption and loss of income that would result
from losing access to the Databased system, many of the dermatology practices that
utilized the Databased system, upon information and belief, agreed to Defendant
Adesokan's demand to refer pathology services to Defendant Nelson and Nelson
39
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 40 of 53
Dennatopathology Laboratory.
131.
Defendants have utilized this scheme to direct the refenal of thousands of
pathology services, including those paid for by Medicare and Medicaid, to Defendant
Nelson and Nelson Dermatopathology Laboratory.
132.
Each and every refenal by a Family Dermatology physician of
dermatopathology services that were paid for by Medicare and/or Medicaid violates the
federal Anti-kickback
Statute,
because Defendants
paid the
referring Family
Dermatology independent contractor physicians substantial compensation (in the form of
compensation for professional services and the purchase money for their dermatology
practice) to induce them to refer dermatopathology services to Defendant Nelson and
Nelson Dermatopathology and Pathology Laboratory.
133.
None of the safe-harbors to the Anti-Kickback Statute apply to
Defendants' conduct as alleged in this Amended Qui Tarn Complaint.
134.
Each and every refenal of pathology services, paid for by Medicare and/or
Medicaid, from dermatology practices utilizing Defendant Databased's system and
Nelson Dermatopathology Laboratory violates the Stark Law, because Defendants
Adesokan and Nelson mandated and directed those refenals to Defendant Nelson's
dermatopathology laboratory.
135.
None of the exceptions to the Stark Law apply to Defendants' conduct as
alleged in this Amended Qui Tarn Complaint.
136.
Each and every refenal of pathology services, paid for by Medicare and/or
Medicaid, from dermatology practices utilizing Defendant Databased's system to Nelson
Dermatopathology Laboratory violates the federal Anti-kickback Statute, because
40
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 41 of 53
Defendants paid tlie referring physicians substantial sums of money (in the form of the
85% discount of the price for using the Databased Practice Management and Electronic
Medical Records System) to induce them to refer dermatopathology services to
Defendant Nelson and Nelson Dermatopathology and Pathology Laboratory.
137.
None of the safeharbors to the Anti-Kickback Statute apply to Defendants'
conduct as alleged in this Amended Qui Tarn Complaint.
D.
Billing for Services Not Provided
138.
During a tour of the defendants' home in February of 2008, Relator was
informed that the bulk of the pathology services performed by Nelson Dermatopathology
and Pathology Lab are performed in a lab located in the basement of the home of Paula
Nelson and Yinka Adeoskan. This amounts to thousands of specimen slides each week.
139.
Relator received a pathology report dated May 17, 2008 from defendants
which shows that, at most, two pathologists worked for Nelson Dermatopathology and
Pathology Lab at that time. The pathologists listed on the May 17, 2008 report were
defendant Paula Nelson, M D and L i Ma, M D
140.
Nelson
Relator also received a pathology report dated March 16, 2010 from the
Dermatopathology and Pathology Lab.
This
lab
report
listed four
dermatopathologists: Defendant Paula Nelson, M D ; Scott Acker, M D ; Klaus Sellheyer,
M D ; and Robert Allen, M D . Dr. L i M a was no longer listed as practicing at the Nelson
Dermatopathology and Pathology Lab.
141.
The dermatopathologists hsted on the May 17, 2008 and March 16, 2010
reports are either no longer associated with Family Dermatology or have fiiU-time
positions in academia in other states.
41
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 42 of 53
142.
For example, Dr. L i Ma, who was hsted on the May 17, 2008 pathology
report, is no longer identified as a pathologist working at defendant's lab. Dr. L i M a was
not listed on the March 16, 2010 Dermatology report and is not listed as a provider on
defendant's website. He is no longer associated with the Nelson Dermatopathology and
Pathology Laboratory. Instead, Dr. L i M a practices as a senior dermatopathologist at
Southeastern Pathology Associates. Dr. L i M a was also listed as registered agent L i M a
Family Dermatology and Dermatopathology L.L.C., which was administratively
dissolved on September 16, 2010.
143.
The
dermatopathologists
listed
as
affiliated
with
Nelson
Dermatopathology and Pathology on the March 16, 2010 pathology report are either
primarily occupied in academia outside of Georgia or appear to have no association with
Family Dermatology at all.
144.
For example, Dr. Klaus Sellheyer, M D , is a Clinical Professor of
Dermatology at the Cleveland Clinic Lemer College of Medicine in Ohio. Dr. Sellheyer
is also an author of numerous scholarly articles regarding dermatological issues. Given
his position as both a professor and author, it is highly unlikely that Dr. Sellheyer is
regularly and consistently reviewing pathology specimens and creating pathology reports
for the patients referred to Nelson Dermatopathology and Pathology Laboratory.
145.
In addition. Dr. Scott Acker, who was listed as a dermatopathologist on
the March 16, 2010 pathology report, is a Visiting Professor at both Tulane University's
Department of Dermatology in New Orleans, Louisiana as well as Louisiana State
University's Department of Dermatology in Baton Rouge, Louisiana. Dr. Acker also
served as an Associate Professor of Dermatology at the University of Alabama in
42
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 43 of 53
Birmingham, Alabama until 2008. Dr. Acker also operates his own practice, Acker
Dermatopathology, in Birmingham, Alabama. Thus, it is extremely unlikely that Dr.
Acker is regularly reviewing the numerous pathology specimens and slides sent to the
Nelson Dermatopathology and Pathology Lab and creating the required lab reports.
146.
li
is
also
highly unlikely
that
Robert
Allen,
M D , the
third
dermatopathologist listed on the March 16, 2010 report, is regularly reviewing the
massive number of dermatology specimens
and slides referred to the Nelson
Dermatopathology and Pathology Lab. There no Robert Allen listed as a provider on the
Family Dermatology website. Relator could not identify a dermatopathologist by the
name of Robert Allen in the state of Georgia. In fact, the only Robert Allen, M D
practicing in Atlanta is an oncologist/hematologist with Atlanta Hematology and
Oncology Associates P.C.
147.
Defendant Paula Nelson could not properly perform dermatopathology
and/or pathology services on all of the specimens received from the 53 Family
Dermatology practices across the country, given the sheer number of referrals. Dr.
Nelson's lack of frill time, qualified professionals to regularly perform pathology services
would lead to billing for services not provided and to quality of care issues. Specifically,
there were far too many dermatology specimens being referred by dermatologists
throughout the country to the Nelson Dermatopathology and Pathology Laboratory for
Paula Nelson to examine herself
148.
Given
the
massive
number
of
referrals
sent
to
the
Nelson
Dermatopathology and Pathology Lab from each Family Dermatology practice
throughout the country and the lack of professional dermatopathologists at the Nelson
43
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 44 of 53
Dermatopathology and Pathology Lab to review the referred specimens and slides, it is
highly unlikely that defendants provide appropriate pathology services.
Upon
information and belief, defendants are billing Medicare and/or Medicaid for services not
provided.
COUNT ONE
VIOLATION OF STARK STATUTE
(42 U.S.C. §1395(nn) etseq.)
149.
Paragraphs 1 through 96 are incorporated into Count One as i f hilly set
forth herein.
150.
Defendants' conduct described herein constituted a violation of Stark law,
42 U.S.C. §l395(nn) et seq.
151.
Defendants Nelson and Adesokan utilized their respective ownership and
leadership positions position within Defendants Family Dermatology, P . C , Family
Dermatology of Pennsylvania, P . C , Family Dermatology Management, Inc, Family
Dermatology of New Jersey, P . C , Family Dermatology Management of Pennsylvania,
Inc., Family Dermatology Staffing of Pennsylvania, Inc., and Family Dermatology
Management of North Carolina, L L C , to require that all dermatologists, including many
independent contractor dermatologists practicing at the 53 Family Dermatology practice
locations refer all of their dermatopathology services to Defendant Nelson and Nelson
Dermatopathology and Pathology Laboratory.
152.
Each and every referral of dermatopathology services by a Family
Dermatology physician that were paid for by Medicare and/or Medicaid violates the Stark
Law, because Defendant Nelson, and her husband (Defendant Adesokan), are mandating
such referrals to Defendant Nelson's dennatopathology laboratory.
44
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 45 of 53
153.
Defendants have also illegally mandated that all dermatology practices
that utilize Defendant Databased's Practice Management and Electronic Medical Records
System, including those not owned by Family Dermatology, refer all of their
dermatopathology work to Dr. Nelson's pathology lab. Each and every referral of
pathology services to Govemment healthcare programs, including but not limited to.
Medicare and/or Medicaid, by dermatologists utilizing Defendant Databased's system or
by dermatologists who are independent contractors at Family Dermatology locations to
Nelson Dermatopathology and Pathology Laboratory, violates the Stark Law, because
Defendant Nelson has a fmancial relationship with these referring physicians and Dr.
Nelson has directed those referrals to her dermatopathology lab.
154.
None of the exceptions to the Stark Law apply to Defendants' conduct as
alleged in this Amended Qui Tarn Complaint.
155.
Defendants have intentionally and systematically billed the Govemment
for services provided through prohibited referrals.
156.
Absent an exception, the dermatologists working at Family Dermatology
locations cannot refer "designated health services", including clinical laboratory services
to Dr. Nelson's pathology lab.
157.
Defendants submitted claims to Medicare based on prohibited referrals
and, in so doing, falsely certified compliance with Stark law.
158.
The Stark law violations which occurred and continue to occur create
strict liability for the Defendants. The violation of Stark law is not based on what the
Defendants intended, knew or should have known. There is no scienter component of a
Stark law violation.
45
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 46 of 53
WHEREFORE, Relator requests the following relief:
A.
Judgment against the Defendants in an amount equal to a refund of all
Medicare claims paid for DHS, that resulted from an illegal referral,
pursuant to 42 U.S.C. § 1395nn(g)
B.
Imposition of sanctions
against
Defendants, including denials of
payments, and refunds of claims pursuant to 42 U.S.C. § 1395nn(g);
C.
Imposition of penalties up to $15,000 for each Stark Law violation;
D.
His attorneys' fees, costs, and expenses; and
E.
Such other relief as the Court deems just and appropriate.
COUNT TWO
VIOLATION OF ANTI-KICKBACK ACT
(42 U.S.C. §1320fa)-7(b) etseq.)
159.
Paragraphs 1 through 108 are incorporated into Count Three as i f fully set
forth herein.
160.
Defendants' conduct described herein constituted a violation of the Anti-
Kickback Act, 42 U.S.C. § 1320(a)-7(b) etseq.
161.
Each and every referral by a Family Dermatology physician of
dermatopathology services that were paid for by Medicare and/or Medicaid violates the
federal Anti-kickback Statute, because Defendants paid the referring independent
contractor physicians substantial sums of money (in the form of compensation and the
purchase money for their dermatology practice) to induce them to refer dermatopathology
services to Defendant Nelson and Nelson Dermatopathology and Pathology Laboratory.
162.
Each and every referral of pathology services, paid for by Medicare and/or
Medicaid, dermatology practices utilizing Defendant Databased's system and Nelson
46
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 47 of 53
Dermatopathology Laboratory violates the federal Anti-kickback Statute, because
Defendants paid the referring physicians substantial sums of money (in the form of the
85% discount of the price for using the Databased Practice Management and Electronic
Medical Records System) to induce them to refer dermatopathology services to
Defendant Nelson and Nelson Dermatopathology and Pathology Laboratory.
163.
None of the safeharbors to the Anti-Kickback Statute apply to Defendants'
conduct as alleged in this Amended Qui Tarn Complaint.
164.
The Federal Anti-Kickback Act makes it a crime to knowingly offer, pay,
solicit or receive any remuneration to induce a person to refer a person for the furnishing
of any service covered under a federal healthcare program.
165.
Unlike the Stark law offence referenced above, knowing and willful
conduct is a necessary element of the criminal kickback offense.
166.
The providing of discounted services in exchange for illegal referrals as
described previously in this Complaint constituted an illegal inducement for the
Defendants. The same factual predicates giving rise to the Stark violation also constitute
a violation of the Federal Anti-Kickback Act.
167.
As a direct result of Defendants' conduct as alleged herein, Govemment
payers, including Medicare and Medicaid, and the taxpayers of the United States have
been directly damaged.
WHEREFORE, Relator requests the following relief:
A.
Judgment against the Defendants in an amount equal to up to three times
the amount of the improper remuneration at issue;
B.
Imposition of penalties of up to $50,000 for each kickback violation;
47
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 48 of 53
C.
His attorneys' fees, costs, and expenses;
D.
Such other relief as the Court deems just and appropriate.
COUNT THREE
VIOLATION OF THE FALSE CLAIMS ACT
(31 U.S.C. §3729)
168.
Paragraphs 1 through 117 are incorporated into Count Three as i f fully set
forth herein.
169.
Defendants' violations of the federal Anti-kickback Statute, as described
herein, give rise to liability under the federal False Claims Act.
170.
As a prerequisite to participating in federally-flinded health care programs,
Defendants expressly certified (or, through their participation in a federally fiinded
program, impliedly certified) their compliance with the federal Anti-Kickback Statute.
171.
Defendants violated the federal False Claims Act by submitting claims, or
causing the submission of claims, for reimbursement from federal health care programs,
including Medicare and Medicaid, knowing that they were ineligible for the payments
demanded due to federal Anti-Kickback Statute violations.
172.
Defendants' violations of the Stark Law, as described herein, give rise to
liability under the federal False Claims Act.
173.
Defendants directed and mandated the referral of Medicare patients for
DHS to Defendant Nelson and Nelson Dermatopathology Laboratory, an entity with
which they had a financial relationship, in violation of the Stark Law, 42 U.S.C. §
1395nn.
48
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 49 of 53
174.
Claims submitted by the Defendants for Medicare funds that are tainted by
the Defendants' Stark Law violations constitute violations of the federal False Claims
Act, 31 U.S.C. § 3729(a)(1), as amended
175.
Claims submitted by the Defendants or by the dermatologists practicing at
a Family Dermatology location for dermatology, dermatopathology, or pathology
services that were unnecessary constitute violations of the False Claims Act, 31 U.S.C.
3729(a)(1), as amended.
176.
Claims submitted by the defendants for dermatopathology or pathology
services that were not appropriately provided constitute violations of the False Claims
Act, 31 U.S.C. 3729(a)(1), as amended.
177.
Defendants knowingly caused to be made or used false records or
statements, including, i.e., the false certifications and representations of compliance with
the federal Anti-Kickback Statute which Defendant caused to be made when it submitted
the false claims for payment, the Medicare enrollment forms, to get false or fraudulent
claims (those related to referrals tainted by violations of the federal Anti-Kickback statute
and the Stark Law) paid or approved constitute violations of the federal False Claims Act,
31 U.S.C. § 3729(a)(2).
178.
Defendants, through their concerted efforts to direct the referral of
lucrative pathology services to Defendant Nelson and Nelson Dermatopathology
Laboratory, conspired to defraud the federal govemment by getting false or fraudulent
claims (those related to referrals tainted by violations of the federal Anti-Kickback statute
and the Stark Law) allowed or paid by the govemment in violation of the federal False
Claims Act, 31 U.S.C. § 3729(a)(3).
49
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 50 of 53
179.
A l l of the Defendants' conduct described in this Complaint was knowing,
as that term is used in the federal False Claims Act.
WHEREFORE, Relators pray for judgment against Defendants as follows:
A.
Defendants be ordered to cease and desist from submitting and/or causing
the submission of any more false claims or in any way from otherwise
violating 31 U.S.C. §3729 etseq..
B.
That judgment be entered in Relator's favor and against Defendants in the
amount of each and every false or fraudulent claim and so multiplied as
provided by 31 U.S.C. §3729(a), plus a civil penalty of not less than Five
Thousand, Five Hundred ($5,500.00) Dollars nor more than Eleven
Thousand ($11,000.00) Dollars per claim, as provided by 31 U.S.C.
§3729(a), to the extent such multiplied penalties shall fairly compensate
the United States of America for losses resulting from the various schemes
undertaken by Defendants together with penalties for specific claims to be
identified at trial after full discovery;
C.
That Relators be awarded the maximum amount allowed pursuant to the
Stark law, Anti-Kickback Act and False Claims Act as cited and
referenced herein.
D.
That judgment be granted for Relators and the United States and against
Defendants for any costs, including, but not limited to, court costs, expert
fees and all attorneys' fees incurred by Relators in the prosecution ofthis
suit; and
E.
That Relator and the United States be entitied to any and other relief that
50
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 51 of 53
they are enthled to, whether by law or equity;
Demand for Jury Trial
Pursuant to Rule 38 of the Federal Rules of Civil Procedure, qui tarn Plaintiff
hereby demands a trial by jury.
This 24th day o f A p r i l , 2013.
Respectfully submitted,
Counsel for Relator
W I L B A N K S & BRIDGES, L L P
By; (^m^yp^/i^
—
TYRONE M . B R F p E S ^
^
Georgia Bar No. ^ 1 5 0 0
Marian B. Wilbanks
Georgia Bar No. 758223
3414 Peachtree Road, N E , Suite 1075
Atlanta, Georgia 30326
Tel; (404) 842-1075
Fax: 404-842-1075
mbw@wilbanks-bridgeslaw.com
Pietragallo, Gordon, Alfano, Bosick & Raspanti, L L P
Marc S. Raspanti, Esquire
Michael S. Morse, Esquire
PA Bar Nos. 41350; 80507
1818 Market Street,
Suite 3402
Philadelphia, P A 19103
Tel: (215) 988-1427 | Fax: (215) 981-0082
http://www.Pietragallo.com
2313578-V6
51
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 52 of 53
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF GEORGIA
UNITED STATES OF A M E R I C A ex rel, SCOTT
M . ROSS, M.D.,
vs.
CIVIL A C T I O N NO. 09-5752
F A M I L Y D E R M A T O L O G Y OF
P E N N S Y L V A N I A , P . C , P A U L A N E L S O N , M.D.,
FAMILY DERMATOLOGY, P.C, PAULA
FILED UNDER SEAL
[FALSE CLAIMS ACT -OUI TAMI
NELSON, M.D., d/b/a N E L S O N
DERMATOPATHOLOGY AND PATHOLOGY
JURY DEMAND IS MADE
L A B O R A T O R Y ; D A T A B A S E D , INC., Y I N K A
ADESOKAN,FAMILY DERMATOLOGY
M A N A G E M E N T , INC.; F A M I L Y
D E R M A T O L O G Y M A N A G E M E N T OF N O R T H
CAROLINA, L L C ; F A M I L Y D E R M A T O L O G Y
STAFFING OF P E N N S Y L V A N I A , INC.;
F A M I L Y D E R M A T O L O G Y M A N A G E M E N T OF
P E N N S Y L V A N I A , INC . (f/k/a F A M I L Y
M A N A G E M E N T OF P E N N S Y L V A N I A , INC);
F A M I L Y D E R M A T O L O G Y OF N E W JERSEY,
P . C ; F A M I L Y BILLE^^G SERVICES, I N C ;
ADEGBOYEGA ADESOKAN; ADEYEMI
ADESOKAN
C E R T I F I C A T E OF S E R V I C E
Case 1:11-cv-02413-AT Document 29 Filed 04/24/13 Page 53 of 53
I, Tyrone M . Bridges, certify tliat the foregoing Relator's First Amended Qui Tam were
served on this date, by mailing a true and correct copy thereof, by first class mail, postage
prepaid to:
Honorable Eric Holder
Attorney General of the United States
950 Pennsylvania Avenue, N W
Washington, DC 20530
Amy L. Berne, Esq.
Chief Assistant United States Attomey
U . S. Attomey's Office
Atlanta Civil Division
600 Richard B. Russell Federal Building
75 Spring Street SW, Suite 400
Atlanta, G A 30303
Christopher J. Huber, Esq.
U . S. Attorney's Office
Atlanta Civil Division
600 Richard B. Russell Federal Building
75 Spring Street SW, Suite 400
Atlanta, G A 30303
Emily E. Shingler, Esq.
Atlanta Civil Division
600 Richard B. Russell Federal Building
75 Spring Street SW, Suite 400
Atlanta, G A 30303
Dated: This 24th day of April, 2013.
Tyrone M . Bridges, lsq7
Wilbanks & BridgeslELP
Monarch Plaza
3414 Peachtree Rd., N E , Suite 1075
Atlanta, Georgia 30326
(404) 842-1075
Counsel for Relator