United States of America et al v. Davita Health Care Partners et al

District of Massachusetts, mad-1:2016-cv-11840

COMPLAINT against All Defendants, filed by David Gonzalez, United States of America.

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5 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF THE DISTRICT OF MASSACHUSETTS) UNITED STATES OF AMERICA, ex rei,) STATE OF CALIFORNIA, ex reI.,) STATE OF COLORADO, ex reI.,) STA TE OF CONNECTICUT, ex rei,) STATE OF DELAWARE, ex reI.,) CASE NO.: DISTRICT OF COLUMBIA, ex rei,) STATE OF GEORGIA, ex rei,) STATE OF HAWAII, ex rei,) STATE OF ILLINOIS, ex reI.,) COMPLAINT STATE OF INDIANA, ex reI.,) FILED UNDER SEAL STATE OF IOWA, ex reI.,) PURSUANT TO STATE OF LOUISIANA, ex reI.,) 3 i U.S.c. §3730(b)(2) STATE OF MARYLAND, ex reI.,) COMMONWEALTH OF MASSACHUSETTS, ex reI.,) JURYTRIAL STATE OF MICHIGAN, ex rei.,) DEMANDED STATE OF MINESOTA, ex rei,) STATE OF MONTANA, ex rei.,) STATE OF NEVADA, ex rei.,) STATE OF NEW JERSEY, ex rei.,) STATE OF NEW MEXICO, ex reI.,) STATE OF NEW YORK, ex rei,) STATE OF NORTH CAROLINA, ex reI.,) STATE OF OKLAHOMA, ex rei,) STATE OF RHODE ISLAND, ex rei.,) STATE OF TENNESSEE, ex rei,) STATE OF TEXAS, ex rei.,) STATE OF VERMONT ex rei.,) COMMONWEALTH OF VIRGINIA, ex rei., and) STATE OF WASHINGTON, ex rei.,) DAVID GONZALEZ) I 1700 Old Columbia Pike, #709)) Silver Spring, MD 20904)) Plaintiff- Relator,)) BRIGING THIS ACTION ON BEHALF) OF THE UNITED STATES OF AMERICA,) THE STATES OF CALIFORNIA, COLORAO,) CONNECTICUT, DELAWARE, GEORGIA,) HAWAII, ILLINOIS, INDIANA, IOWA,) LOUISIANA, MARYLAND, MICHIGAN,) I 5 MINESOTA, MONT ANA, NEVADA,) NEW JERSEY, NEW MEXICO, NEW YORK,) NORTH CAROLINA, OKLAHOMA,) WASHINGTON,) RHODE ISLAND, TENNESSEE, TEXAS, VERMONT) THE COMMONWEALTH OF MASSACHUSETTS,) THE COMMONWEALTH OF VIRGINIA, and) c/o) THE DISTRICT OF COLUMBIA) UNITED STATES ATTORNEY) JOHN JOSEPH MOAKLEY)) UNITED STATES COURTHOUSE) I COURTHOUSE WAY, SUITE 2300) BOSTON, MA,022IO)) ATTORNEY GENERAL OF) THE UNITED STATES) U.S. Deparent of Justice) 10th and Constitution Avenue, N.W.) Washington, DC 20530)) CALIFORNIA) ATTORNEY GENERAL FOR THE STATE OF) P.O. Box 944255) Sacramento, CA 94244-2250) COLORADO)) ATTORNEY GENERAL FOR THE STATE OF) 13 00 Broadway 9th Floor) Denver, CO 80203)) CONNECTICUT 55 Elm Street)) ATTORNEY GENERAL FOR THE STATE OF) Hartford, CT 06 i 06) DELAWARE)) ATTORNEY GENERAL FOR THE STATE OF) 820 N. French Street) Wilmington, DE 19801)) ATTORNEY GENERAL FOR THE) DISTRICT OF COLUMBIA) 44 i 4th Street NW, Suite 1060 N) Washington, DC 20001) 2 5 GEORGIA) ATTORNEY GENERA FOR THE STATE OF) 40 Capitol Square, SW)) Atlanta, GA 30334) HAWAII) A TTORNEY GENERAL FOR THE STATE OF) 425 Queen Street) Honolulu, HI 96813)) ILLINOIS) ATTORNEY GENERAL FOR THE STATE OF) i 00 West Randolph Street) Chicago, IL 6060 i)) INDIANA) ATTORNEY GENERAL FOR THE STATE OF) Indiana Governent Center South) 302 W. Washington St., 5th Floor)) Indianapolis, IN 46204) INDIANA) INSPECTOR GENERAL FOR THE STATE OF) 3 i 5 WEST OHIO STREET) Indianapolis, IN 46202)) IOWA) ATTORNEY GENERAL FOR THE STATE OF) 1305 E. Walnut Street, 2nd Floor) Des Moines, IA 503 i 9)) L~S~A) ATTORNEY GENERAL FOR THE STATE OF) i 885 North 3rd St) Baton Rouge, LA 70802))) MARYLAND) ATTORNEY GENERAL FOR THE STATE OF) 200 St. Paul Place) Baltimore, MD 212202)) ATTORNEY GENERA FOR THE) COMMONWEAL TH OF MASSACHUSETTS) One Ashburon Place) Boston, MA 02108-1518) 3 5 MICHIGAN)) ATTORNEY GENERA FOR THE STATE OF) G. Mennen Williams Building, 7th Floor) 525 W. Ottwa St.) P.O. BoxMI30212 Lansing, 48909))) MINNESOTA) ATTORNEY GENERAL FOR THE STATE OF) 1400 Bremer Tower) 445 Minnesota Street) St. Paul, MN 55101) MONTANA)) ATTORNEY GENERAL FOR THE STATE OF) Justice Building, Third Floor) 2 I 5 North Sanders P.O. Box 201401)) Helena, MT 59620-1401) NEVADA) ATTORNEY GENERAL FOR THE STATE OF) 100 Nort Carson Street) Carson City, NY 89701))) NEW JERSEY) ATTORNEY GENERAL FOR THE STATE OF) Richard 1. Hughes Justice Complex) 8th Floor, West Wing) 25 Market Street) Trenton, NJ 08625-0080) MEXICO NEW Box 1508)) ATTORNt:Y GENERAL FOR THE STATE OF) PO Santa Fe, NM 87504-1508)) NEW YORK) ATTORNEY GENERAL FOR THE STATE OF) i 20 Broadway, 24th Floor) New York, NY 10271))) ATTORNEY GENERAL FOR THE STATE OF) NORTH CAROLINA) 4 5 900 I Mail Service Center) Raleigh, NC 27699-9001)) OKLAHOMA 313 NW 21st St)) ATTORNEY GENERAL FOR THE STATE OF) Oklahoma City, OK 73 105)) ATTORNEY GENERAL FOR THE STATE OF) RHODE ISLAND) i 50 South Main Street) Providence, RI 02903)) A TTORNEY GENERAL AND REPORTER FOR THE) STATE OF TENNESSEE) 425 5TH TN Nashville, Avenue 37243)) TEXAS) ATTORNEY GENERAL FOR THE STATE OF) PO Box 12548) Austin, TX 787 i 1-2548))) ATTORNEY GENERAL FOR THE) iMontpelier, 09 State Street COMMONWEAL TH OF VERMONT)) Vermont 05609)) ATTORNEY GENERAL FOR THE) COMMONWEALTH OF VIRGINIA) Offce of the Attorney General) 900 East Main Street) Richmond, Virginia 23219)) WASHINGTON) ATTORNEY GENERAL FOR THE STATE OF) 1125 Washington Street, SE) P.O. Box 40100) v.) Olympia, W A 98504) DAVIT A HEALTH CARE PARTNERS))) DA VITA KIDNEY CARE) 2000 i 6th Street) Denver, Colorado 80202) 5 5) FRESENIUS MEDICAL CAR NORTH AMERICA) FRESENIUS KIDNEY CARE) 920 Winter Street) Waltham, MA 02451)) AMERICAN KIDNEY FUND) 11921 Rockville Pike #300,) Rockville, MD 20852) JOHN DOE 1-100)) DEFENDANTS.))) i. This is an action filed under the qui tam provisions of the Federal False Claims Act, 3 I U.S.c. Sec. 3729, et seq., by Plaintiff-Relator David Gonzlez, in the name of the United States and the governents of California, Colorado, Connecticut, Delaware, the Distrct of Columbia, Georgia Hawaii, Ilinois, Indiana, Iowa, Louisiana, Marland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, Nort Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and himself to recover penalties and damages arising from the Defendants knowing direction of payments for End Stage Renal Services in a maner, which creates illegal remuneration and kickbacks and thereby false claims to the above listed governents. 2. Accordingly, Plaintiff-Relator files this action to recover penalties and damages on behalf of himself and the above-listed governments. I. JURISDICTION AND VENUE 3. This action arises under the Federal False Claims Act, 3 i U.S.C. §§ 3729, et seq. 6 5 4. This Cour maintains subject matter jurisdiction over this action pursuant to 3 I U.S.C. § 3732(a) and 28 U.S.c. § 1331, and supplemental and pendant jurisdiction. 5. Plaintiff-Relator also brings this action on behalf of the governents of Californa, Colorado, Connecticut, Delaware, the District of Columbia, Georgia, Hawaii, Ilinois, Indiana, Iowa, Louisiana, Marland, Massachusetts, Michigan, Minnesota, Montaa, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Vermont, Virginia and Washington, hercinafter referred to collectively as "the States." 6. Plaintiff- Relator brings this action on behalf of the States for the Defendant's violations of CaL. Gov't Code §§ 12650 et seq.; Colo. Rev. Stat. §§ 25.4-4-303.4 et seq.; Conn. Gen. Stat. §§i 7b-30Ia--1 7b-301p (2010 supplement); DeL. Code Ann. Tit.6. §§ 1201 et seq.; D.C. Code §§ 2-38i.01 et seq.; Ga. Code. Ann. §§ 49-4-168 et seq., Haw. Rev. Stat. An. §§ 661-21 et seq.; 740 Il Compo Stat. An. 175/1 et seq.; Ind. Code §§ 5-11-5.5 et seq.; Iowa Code § 685.1 et seq.; La. Rev. Stat. An. §§ 6:438.1 et seq.; Md. Code Ann. Health-Gen. §§ 2-601 et seq.; Md. Code Ann. Gen. ProVo §§ 8-101 et seq.; Mass. Ann. Laws ch.12, §§ 5 et seq., Mich. Compo Laws. Servo §§ 400.601 et seq.; Minn. Stat. §§ 15C.01 et seq., Mont. Code An. §§ 17-8-401 et seq.; Nev. Rev. Stat. Ann. §§ 357.010 et seq.; N.J. Stat. Ann. §§ 2A: 32C-I et seq.; N.M. Stat. An. §§ 27-14-1 et seq.; N.M. Stat. An. §§ 44-9-1 et seq. N.Y. State Fin. Law §§ 188 et seq.; N.C. Gen. Stat. §§ 1-605 et seq., Okla. Stat. tit. 63, §§ 5053 et seq.; R.I. Gen. Laws §§ 9-i.l-1 et seq.; Tenn. Codc An. §§ 4-18-101 et seq.; Tenn. Code Ann. §§ 71-5-181 et seq. 1993; Tex. Hum. Res. Code Ann. §§ 36.001 et seq.; Va. Code Ann. §§ 8.01-216.1 et seq, 32 VSA §§ 630 et seq.; RCW 74.66.005 et seq. 7 5 7. These laws hereinafter are collectively referred to as the "State False Claims Acts" 8. Jurisdiction over claims arising under the State False Claims Acts is also conferred by 3 I U.S.c. § 3732(b) in that the transactions and or occurences described, which violate the State False Claims Acts involve a common nucleus of facts as, and are related to, those that violate the Federal False Claims Act. 9. Venue is proper in this jurisdiction pursuant to 31 U.S.C. § 3732(a) because at least one Defendant maintains an offce in this district, and regularly transacts business in this district and did so at all times relevant to this Complaint. The False Claims Act confers nationwide jursdiction and at lcast one of the Defendants resides or regularly transacts business in this district. II. PARTIES 10. Plaintiff-Relator David Gonzalez, of 11700 Old Columbia Pike, #709, Silver Spring, MD 20904, worked for the American Kidney Fund for twelve years, until October 20, 2015, when he was forced out of the organization for questioning the practices detailed herein. He scrved as an "HIPP" or Health Insurance Premium Program, Patient Services Coordinator. 1 i. There have been no prior public disclosures of allegations or transactions that are the subject of this Complaint as defined by thc term "publicly disclosed" under 3 i U.S.c. § 3730(e)(4)(A). 12. Mr. Gonzalez is an original source of all the allegations contained in this Complaint within the meaning of 31 U.S.c. § 3730(e)(4)(B). Mr. Gonzalez has independent knowledge of all the information contained herein, and voluntarily provided such 8 5 information to the United States and the above listed States prior to fiing an action in Court. 13. Defendant Da Vita Health Care Parters is a forte 500 health care company traded on the New York Stock Exchange and the parent company of DaVita Kidney Care (hereinafter collectively "Da Vita"). The company maintains headquarers at 2000 I 6th Street Denver, Colorado 80202. DaVita provides End Stage Renal Services including dialysis treatment. Its website includes a service whereby a patient seeking dialysis treatment can search by zip code and find a Da Vita provider in any state in the United States as well as in Washington, DC. DaVita claims to operate or provide administrative services at more than two thousand outpatient dialysis centers in the United States and Da Vita regularly conducts business and has caused to be submitted some of the false claims at issue in this case in this district. 14. Defendant Fresenius Medical Care provides Dialysis to almost three hundred thousand patients worldwide. International Headquarers are at 61346 Bad Homburg v.d. H. Germany, with subsidiaries including Fresenius Medical Care North America and Fresenius Kidney Care (hereinafter all referred to as "Fresenius") headquartered at 920 Winter Street Waltham, MA 02451. Fresenius also operates in all 50 states and the District of Columbia. Fresenius regularly conducts business and has caused to be submitted some of the false claims at issue in this case in this district. i 5. Defendant, American Kidney Fund CAKF") of 11921 Rockville Pike #300, Rockville, MD, 20852 is a non-profit "501(c)(3)" corporation. The AKF raises money and provides public serviccs including providing free screenings for kidney disease, education and advocacy on kidney related issues. The majority of funds raised by the AKF, however, go 9 5 to provide payment assistance for patients who need dialysis treatment for kidney conditions. The AKF's latest IRS Form 900 disclosure shows it obtained gross receipts of more than $275,000,000 in 2015. The AKF caused to be submitted some of the false claims at issue in this case in this distrct. i 6. In addition, the Plaintiff-Relator brings these claims against John Doe Defendants 1-100 which include, but are not limited to, six companies listed anonymously as Company A, Company B, Company C, Company D, Company E and Company F who along with the AKF are referred to as the "Requestors," in the 1997 Advisory Opinion 97-1 discussed fully below. The AKF 20 i 5 IRS form 990 lists anonymous contributions from its six largest contributors, each such contributor providing a minimum of $6,000,000 with the largest contribution exceeding $ i 00,000,000. II. FACTUAL ALLEGATIONS A. Introduction i 7. The allegations in the above paragraphs are hereby re-alleged and set forth fully as above. i 8. The Plaintiff-Relator worked for the American Kidney Fund CAKF") for twelve years as a "HIPP" or Health Insurance Premium Program, Patient Services Coordinator. He discovered, that while the organization was set up to be a charity and certainly did provide funds on behalf of needy dialysis patients, the Defendants knowingly violated requirements that had been in place to ensure funds provided to the AKF and used to secure government health insurance and make copayments, did not become illegal remuneration and kickbacks. i 9. The intentional violations were committed in concert between the two largest dialysis providers in the world (i.e., Fresenius and DaVita) and AKF, thereby creating illegal 10 5 referrals and payments under the Anti-Kickback Statute, 42 U.S.c. § 1320a-7b. B. OIG Requirements to create a fair payment structure and avoid kickbacks. 20. The allegations in the above paragraphs are hereby re-alleged and set fort fully as above. 21. In 1997, AKF and several anonymous providers made certin representations to obtain an advisory opinion from the Departent of Health and Human Services, Offce of Inspector General ("OIG") on how to manage funds so as to avoid creating illegal incentives .to any par in the process. It was plain that paying money to those who choose which dialysis treatment provider to use would otherwise be considered illegal remuneration. 22. The AKF and several anonymous dialysis providers made specific material representations about how they would conduct themselves to the OIG, and the OIG relied on those representations in rendering its advisory opinion. 23. The representations made by the AKF and several providers were stated in an advisory opinion issued in 1997 by the U.S. Department of Health and Human Services, Offce of Inspector General ("OlG") which, based on those representations, placed specific conditions on the conduct of the AKF and any of the providers who made donations for the purpose of providing patient assistance. 24. The 1997 OIG advisory opinion made clear its purpose was to determine if there was a structure under which such payments would not create kickbacks: We are writing in response to your request for an advisory opinion, which we accepted pursuant to 42 C.F.R. § 1008.41 on April 11, 1997. Your request asks whcther donations by renal dialysis providers to an independent 501(c)(3) charitable organzation for the purose of fuding a program to pay for Supplementa Medical Insurance Program ("Medicare Part B") or Medicare Supplementar Health Insurance ("Medigap") premiums for financially needy Medicare beneficiaries with end-stage renal disease, where such beneficiaries may be receiving treatment from 11 5 the donor-dialysis providers (The "Proposed Arrangement") would constitute grounds for the imposition of a civil moneta penalty under Section 23 i (h) of the Health Insurance Portbility and Accountability Act of 1996 ("HIP AA"). OIG, Advisory Opinon 97- i, p. i. 25. The AKF and the other six so called "Requestors" listed as Company A, Company B, Company C, Company D, Company E and Company F in the OIG Advisory Opinion 97- i made representations to the Offce of Inspector General, which are recounted in the opInion. 26. Defendants DaVita and Fresenius are believed to have been among the providers that anonymously also sought the opinion. 27. Additionally, Defendants DaVita and Fresenius each have been major contrbutors to the AKF and are aware ofOIG Advisory Opinion 97-1 going forward. 28. Each Defendant that provided fuding to AKF was required to ensure that the OIG Advisory Opinion 97- J and other requirements to prevent illegal kickbacks were followed and to be sure that any funds paid to AKF and subsequently received by patients from the AKF were not illegal remuneration. 29. The OIG Advisory Opinion discussed the makeup of board members and committees within the AKF and how that was done to insulate the AKF from any specific companies who were also requestors of the opinion, or donors to the AKF, but who had former executives serving with the AKF. In addition, the OIG noted: AKF's Health Insurance Premium Program ("HIPP") provides financial assistace to financially needed ESRD (End Stage Renal Dialysis J patients for the costs of medicine, transporttion, and health insurance premiums, including Medicare Par Band Medigap Premiums. Assistance is available to all eligible patients on an equal basis. In general, eligibility for participation in AKF's assistance programs requires a physician certification, a referral letter signed by a social worker or administrator at 12 5 a dialysis provider, and an individual Patient Grant Application. The Patient Grant Application requires patients to provide detailed financial information for their entire household. While a patient can apply directly to AK for a grant, most applications are submitted on the patient's behalf by dialysis providers or social workers employed by a dialysis provider. All determinations are made by AKF employees who have no financial interest in the companies or other dialysis providers and are based on their good faith assessment that the applicant is in financial need and eligible for assistance. Because of AKF's limited financial resources, an AKF patient assistance grant is provided for a specific time period. Upon expiration of the period, the patient must submit another grant application. Grant requests are reviewed on a first-come, first served basis to the extent funding is available. OIG, Advisory Opinion 97-1, pp. 3-4 (emphasis added). 30. This was the status of the program according to the OIG as stated by the requestors prior to acceptance of their proposal to the Offce of Inspector General. 31. The Requesters including the AKF and the unnamed companies wanted to expand the program and the OIG reported in a section of the report entitled "The Proposed Agreement" that: AKF proposes to expand significantly its patient assistance grants to financially needy ESRD (End Stage Renal Dialysis J patients for payment of medical insurance premiums through HIPP. Additional funding will be donated primarily by the companies. OIG, Advisory Opinion 97-1, p.4. 32. While medical social workers could assist patients in identifYing "all available sources of assistance..." that still precluded the companies from advertising the availability of the possibility of financial assistance to the public or disclosing to individual patients they refer that such members contributed to the AKF to fund these grants. See OIG, Advisory 13 5 Opinion 97-1, p.4. 33. Specific promises to keep the AKF decision-making and the funders separate were made par of the requirements of this opinion, including: AKF will continue to use its current procedures in assessing the financial need and eligibility of all patients, whether self referred or referred by the Companies, or other non-donor dialysis providers. Determination will be made solely on AKF's good faith assessment of a patient's financial need. AKF staff involved in awarding patient grants will not take the identity of the referring facility or the amount of any provider's donation into consideration when assessing patient applications or making grant determinations. Under the Proposed Agreement, the Companies wil be free to determine whether to make contributions to AKF and, if so, how much to contribute. All the Companes have certified that they wil not track the amount that AKF pays on behalf of patients dialyzing at their facilities in order to calculate future contributions. However, in calculating their contributions to AK, the Companies have indicated that they may consider what they would have otherwise paid on behalf of financially needy patients utilizing their facilities... The Companies will not disclose to each other, or other dialysis providers, the amount or method of calculating their respective contributions to AKF, and AKF wil not disclose one Company's contrbution to another company or to other dialysis providers. Contributions will be made without any restrictions or conditions placed on the donation. The Companies have acknowledged that "contributions. . . will be gifts without any guarantee or promise on the part of AKF that patients referred to AKF for possible financial assistance with their insurance premiums will receive such assistance. AKF's discretion as to the uses of contributions will be absolute, independent, and autonomous." OIG, Advisory Opinion 97-1, pp. 4-5. 34. Not surprisingly, based upon, and explicitly subject to, these representations by the AKF and the providers, the OIG determined that the proposed scheme would not constitute illegal remuneration: ... while the premium payments by AKF may constitute remuneration to beneficiaries, they are not likely to influence patients to order or receive services from particular providers. To the contrar, the insurance coverage purchased by AKF will follow a patient regardless of which providcr the 14 5 patient selects, thereby enhancing patient freedom of choice in health care providers. OIG, Advisory Opinion 97-1, p.5. 35. In addition in 1998, the OIG issued an advisory opinion following similar reasoning forming the basis for an unnamed dialysis provider and an uramed charity to provide assistance to patients. The charity could receive funds and the provider could donate, but such payments to patients and donations could not be tracked to the provider. See OIG, Advisory Opinion, 98-17. 36. In 2002, the OIG considered whether to change this structure and whether an exception to the requirement should be allowed for dialysis providers to support premium payments for patients directly. See 67 Fed. Reg. 236 (Dec. 9, 2002). 37. Although the proposed exception purorted to limit such payments to those patients whom the providers could determine to be needy and to providers that did not regularly parake in such payments, the OIG rejected this proposed rule stating: First the direct payment of supplemental premiums by ESRD providers for financially needy patients caries the same potential for abuse as the provision of free or below market rate goods or services by any other health care provider. ..In short, the exception would promote the very conduct the statute prohibits: the offering of remuneration to influence the selection of a provider. Moreover, patients would not only be influenced to select ESRD facilities that buy them supplemental health insurance, but would be "locked in" to those facilities, since changing facilities would jeopardize their supplemental insurance for all services, including substantial non-ESRD services. Second, creating an exception for direct premium payments by ESRD providers would create demands for additional exceptions for comparable payments by other health care providers and would potentially increase federal expenditues and Medigap premiums. We can discern no rational basis--and Congress has provided no guidance--for distinguishing between providers paying premiums for ESRD patients and providers paying premiums for other chronically ill, financially needy patients, such as patients with cancer, diabetes, or congestive heart disease. Nor can we 15 5 discern any rational bases for distinguishing among types of benefits provided to Medicare and Medicaid benefièiares or among categories of sick beneficiares. Absent congressional guidance, attempting to draw such distinctions would necessarly result in arbitrar stadards and would undermine the statute. It is to a provider's financial advantage (i) to pay the Medigap premium whenever the premium is less than the expected copayments and (ii) to pay the Part B premium whenever the premium is less than the expected Par B payments. Thus, the insurer will always lose money on these policies, as the amount paid out to the provider will always exceed the premiums received. This phenomenon-adverse selection-will likely cause insurers to raise premiums for all other enrollees to cover the losses. For this reason, the health insurance industry objected to the proposed exception. 67 Fed. Reg. 236, pp. 72897-8 (Dec. 9,2002). 38. Notably, in rejecting this proposed rule the OIG relied on the representations of AKF and Companies A-F, who submitted the request that resulted in OIG Advisory Opinion 97-1, that the arangements between these providers and the AKF were independent and operating lawfully, when the OI G concluded: Finally, we are not persuaded that a special exception for ESRD premium payments is needed. Financially needy dialysis patients are already receiving, and will continue to receive, supplemental health insurance support through funding arangements with AKF or comparable independent nonprofit organizations. These arangements are lawful, are apparently effcient, and minimize the potential for abuse. ¡d. 39. In 1997, when the opinion sought by the AKF, was issued, the charity reported assisting i 2,000 patients with End Stage Renal Dialysis and receiving some $5,000,000 in donations. It has been almost twenty years since then, and the AKF has grown considerably, to an entity with $275,000,000 in gross receipts in 2015. 40. The AKF provided funds to support treatment for 93,000 patients in 2015, a large portion of those funds were used to pay for Medicare Par B payments or Medigap payments or 16 5 to paricipate in some form of insurance to cover co-payments with public health plans of some kid thereby facilitating governent payments to the providers. C. Defendants Wilfully Violated the OIG's Requirements and Used Kickbacks. 41. The allegations in the above paragraphs are hereby re-alleged and set fort fully as above. 42. The Plaintiff-Relator leared that the Defendants eventually violated virtally every material representation made to obtain the OIG advisory opinion, which thereby became essential requirements to avoid liability for paying kickbacks. 43. Plaintiff-Relator leared that specific providers were involved in the process with the AKF as well, in direct violation of the requirements of the Advisory Opinion, thereby creating a scheme, which provided illegal remuneration to patients and created incentives for, if not conditions requiring, those patients to use only those providers who contributed to the fund rather than those who do not. 44. Indeed, the coverage did not follow the patient, but was subject to the provider's donations, which were tracked by the AKF. 45. In fact, the improper processes put into place, which violate the OIG Opinion came as a result of complaints by Fresenius and DaVita to the AKF. 46. These facts demonstrate that Defendants are knowingly violating the restrictions imposed by the OIG to avoid kickbacks. 47. The Plaintiff-Relator's position put him into regular and direct contact with many offcials of the AKF. For example, Dennis Cooper was the Relator's direct supervisor and was the HlPP manager. Mr. Cooper reported to Jeremy Abundy, Director of Patient Services. 17 5 48. Gwen Dewberr was Mr. Abundy's boss and served as Senior Director of Patient Services. Jack Curingham was the Director of Financial Analysis. David Frazer was the Vice President of Patient Services during the majority of the Relator's experience at AKF. Mike Spigler became involved in the process when David Frazer left the AKF in mid-2015, and quickly became aware of the operation. 49. Plaintiff-Relator observed that all of these AKF offcials acted contrary to the restrictions made by the OIG. 50. Many of the practices became more blatat as time went on, but as early as 2008 and 2009 the AKF was pressed for fuds. 5 i. As a result, the AKF would have to suspend sending fuding for patients. Officials of the AKF including Dennis Cooper and Gwen Dewberr had conversations in front of the Plaintiff-Relator when they discussed Fresenius's and DaVita's reaction to this situation. 52. Defendants Fresenius and Da Vita asked the AKF why it was running out of funding as early as 2007. 53. The AKF consistently went to these market leaders to obtain additional funding. According to these conversations, DaVita and Fresenius were asking why the AKF was letting all the providers use the program, when they were the ones providing most of the fuds. 54. The issue of Da Vita and Fresenius being upset that they had to pay when other providers were not was a regular topic of discussions between Gwen Dewberr and Dennis Cooper. 55. The Plaintiff-Relator overheard Dennis Cooper and Gwen Dewberr openly discussing that Fresenius and DaVita were questioning why AKF was running out of funding for Fresenius' and DaVita's patients, when they were making contributions at least 10 times 18 5 between 2007 and 2009. Mr. Cooper twice mentioned this issue to Mr. Gonzlez directly in 2007. 56. Mr. Gonzalez was responsible for issuing checks to pay for patients' premium payments, so when the AKF was out of fuding, Cooper and Dewberr would instruct him not to issue checks. Once Fresenius or Da Vita or both would wire money for funding, the Plaintiff- Relator would then be instructed that he could resume issuing checks. 57. Contrary to the conditions set forth on page 5 of the Advisory Opinion 97-1, the AKF has been taing into account the identity of the contributors by tracking, which provider was paying them and how much, for several years. 58. Mr. Curingham stared formally tracking usage of the program in 2009. 59. Prior to this, Gwen Dewberr ordered the Plaintiff-Relator to record every contribution submitted by providers on a spreadsheet as well as record every patient's name and amount of the grant. With this information, she would label some providers as "Free Riders" because if the dollar amount of their patients' grant usage exceeded the contributions, then the spreadsheet would show that they were in the negative. 60. The AKF acted to restrict grants only to patients whose providers paid contributions, which is also in violation of the OIG's conditions. Cf, Advisory Opinion 97-1, p. 5. 61. Methodist Hospital in Texas confronted the then VP of patient services Carol Lynn Halal in a conference phone call in 2007 with Dennis Cooper in which David Gonzalez also participated. The lawyers for Methodist Hospital told the AKF that they were not required to fund the program and were not going to fund the program. 62. After this phone call Mr. Cooper told Mr. Gonzalez to make Methodist Hospital's applications disappear and said that Mr. Gonzalez should not process them. 19 5 63. That meant any patients seeking dialysis treatment from Methodist Hospital would not be able to obtain AKF support for insurance payments. At the time, the applications were made via facsimile transmission and AKF officials had no diffculty in making applications for providers who did not donate "disappear." 64. Of course, this is in direct contradiction of the requirement for the AKF to treat each application blindly and based on need on a first come first served basis, and not on whether the provider made a donation to AKF. 65. In 20 I 0, the AKF started a new grant management system which intensified this qui pro quo of patient support in exchange for donations. They created an online portal to accept applications for patients to receive funding. 66. However, they did not stop discriminating against certin providers as a result. If anything, the Internet application made it much easier to aggregate information about what providers were donating and how to implement a more stringent system to approve financial support of patients whose providers made donations to AKF. 67. The process of demanding funds from providers continued to intensifY. AKF officials would tell new smaller providers who did not want to contribute or the patients who went to such facilities that it would be best for the patients to go to Fresenius and Da Vita. 68. Thus, AKF began driving business to its large provider fuders instead of exercising autonomy as an independent charity. 69. Notably, Gwen Dewberr specifically used the term "pay to play" regarding this process in front ofthe Plaintiff-Relator on a regular basis between 2014 and 2015. 20 5 70. To fuher implement this scheme, the AKF set up a "blocked" list, which meant that any application from a patient using that provider would not receive fuds until such time as the provider contributed to the program. 71. The "blocked" list was referred to as such until 20 I 5, when an AK employee named Lynthia Wiliams, a Call Center Associate, took a call from a provider who had learned the provider was on this blocked provider list. The provider discovered they had been blocked and protested the action. The AKF's response was not to stop the practice, but to call the same list a "Training List" instead ofthe "blocked" list. 72. The so-called "training" involved a call scheduled regularly for Tuesdays in which AKF offcials would make it plain to the provider that they had to contribute to the AKF in order to have any of their patients receive funding. The substace of the training (which was really a quid pro quo solicitation of a donation in exchange for patient support) was the same regardless of whether the provider had been on a "blocked list" or a "training list. " 73. These "training calls" stared in approximately 2012 and this program was also referred to internally as the "Recoupment Effort." The providers on the list were also commonly referred to as the "inequitables." 74. Dealing with such providers was systematized into a collection schedule. Every Tuesday the AKF would have a call for up to two providers on the new or on the blocked list. The purpose of the call was to obtain funds from the provider that had not contributed. 75. This was all conducted with specific amounts required to be paid as donations by the providers. David Frazer, AKF Vice President of Patient Services and Kidney Education, 21 5 would use terms such as "you owe (a certin amount) for this year and you have not paid for last year." 76. The internal Grants Management System (GMS) had a report fuction so AKF officials could ru a report by specific provider name that would tell them how much fuding they had used based on all patient records associated with their facility name and amount of premium payments made on behalf of their patients. 77. Mr. Cunningham would often use the following analogy in the training calls in explaining to providers on the "blocked" list what they were required to do as far as the AKF was concerned: if you take out buckets of water from a pool and don't replenish it, then the well rus dr. Therefore, Mr. Cunningham would tell providers that AKF needed them to replenish 100% of what they take out, plus five and three quarers for overhead expenses. 78. The AK also did not comply with the OIG Advisory Option No. 97-1 requirements to allow the coverage to follow the patient. As a specific example, in 2014 the AKF initially blocked fuds to a patient who had previously been receiving them while that patient had been treated by a Fresenius branch in Florida because the new provider had not made a donation to AK. The patient had been transferred from the Fresenius branch to Indiana University Health Adult Dialysis Center in Indianapolis, IN, and the social worker wrote: We recently had a patient transfer to us from a Fresenius unit in Florida. This patient had been receiving AKF funding for her Medicare supplement, which she was completely unable to pay on her own. Now that she is our patient, will she have to lose this assistance? Since she is not a new AKF patient, can we get her into the system as a patient at our unit now and allow her to keep receiving AKF funding? She will definitely lose the policy without AKF assistance, so I just wanted to see what we are able to do. Just let me know what you think. Thank you! Heather Kenjorski 22 5 Patient Transfer Email correspondence with the Plaintiff-Relator. 79. Initially, Mr. Gonzlez replied by requesting patient information and telling Ms. Kenjorski to enter a new application. This is when she found her facility was not able to receive the funds for the patient. The social worker wrote back as follows: I am trying to input (patient name redacted) HIPP application on the AKF site and it won't allow me to do it. I have gotten the following message: "Your dialysis facility has not completed the proper GMS training which includes training of a financial representative. Please contact your dialysis administrator and/or financial representative to have this training completed. " What should I do about this? Is this training that I need to complete? Than you, Heather Kenjorski Id 80. Given that par of the rationale in the OIG Advisory Opinion was that funding would not influence the patient's decision as to which provider to use, and that the funding was supposed to follow the patient and not the provider, this is a direct example that the AKF was not following the requirements of that opinion. See OIG, Advisory Opinion 97-1, p. 5. 81. When that patient transferred from Fresenius to Indiana University Health the funding for the patient was denied so AKF could conduct "training" of the provider's "financial representative," which is how AKF characterized its demand that providers make donations in exchange for providing funding to the provider's patients. 82. The Plaintiff-Relator was paricularly sensitive to the rough treatment the AKF provided Kaiser Permanente. 23 5 83. In 2015, the AK blocked Kaiser Permanente and Jack Curingham would not tae a conference call with them until he was assured somebody on the call had authority to provide fuds to the AKF. This was a paricularly protracted collection that went on the entire last year the Plaintiff-Relator was working for the AKF. 84. The AK also knowingly favored Da Vita and Fresenius in violation of the OIG's Advisory Opinion's restrictions beyond using the training calls to obtain funds from competitors. The Plaintiff-Relator heard Jack Curingham and Dennis Cooper on phone calls directing social workers and patients to use Fresenius and Da Vita if the provider had not contributed to the AKF. He specifically heard them say this to providers several times between 2014 and 2015. D. Implications of Defendants' Knowing Violations. 85. The allegations in the above paragraphs are hereby re-alleged and set forth fully as above. 86. Any inducement to favor one provider over another by the AK would become illegal remuneration pursuat to OIG Advisory Opinion No. 97-1. Knowledge and paricipation by Da Vita, Fresenius and any of the John Doe Defendants in any such step implicates them in the scheme as welL. 87. These providers were prohibited from pressurIng the AKF to obtain funds from competitors, or contribute on any such basis without destroying the structue created in 1997 to make the entire program effectively a safe harbor from the Anti-Kickback Statute, pursuant to the terms of the OIG Advisory Opinion No. 97-1. However, both Da Vita and Fresenius knowingly violated these restrictions. 88. Indeed, given the size of the two companies (i.e., DaVita and Fresenius) who are leaders in the field, and who are major contributors to the AKF, it is not an exaggeration to say 24 5 that unestrained, the Defendants could exert control over virtly the entire ESRD provider market. 89. Defendants' adherence to the restrictions imposed by the OI G upon the AKF and providers regarding the operation of the fud was necessary to prevent such fuds from being illegal inducements in violation of the Anti-Kickback Statute. Such knowing violations by Defendants can also be violations ofthe False Claims Act as well. 90. Money given to patients under the AKF triggers vast amounts of payments to the providers charged for treatment through governent programs. The AKF may provide support for a Medicare par B premium of $104.90 per month as well as support for supplemental insurance to cover the 20% co-payment under Par B. That will cover a patient for the entire cost of ESRD treatment, which is generally 80% paid for by Medicare, for example. 9 i. It is fair to say that $ i 04.90 per month does not come close to paying the amount that the governent ends up paying for ESRD treatment to the average recipient of AKF funds. 92. It therefore makes economic sense for providers to paricipate in the program. Even if they spend 105.75% of what their patients receive in fuds to the AKF, the providers are able to charge the vast majority of their dialysis treatments to governent programs. That 105.75% is essentially a fractional cost of doing business for the providers to send some money to the patient so that the patient can obtain governent funding for dialysis treatment to be spent on the providers. 93. At the time Defendants submitted or caused to be submitted these false and fraudulent claims the Defendants knew that the governent insurance programs would refuse 25 5 payment for these claims if the requirements ofOIG Advisory Opinion No. 97-1 were not followed. 94. This implicates the treatment of thousands of governent-fuded dialysis patients in a kickback scheme thereby creating excessive damages and extensive numbers of individual false claims paid by the governent. iv. FEDERAL AND STATE FALSE CLAIMS ACT VIOLATIONS COUNT i Violations of3l U.S.c. § 3729(a)(1)(A) Submission of False Claims 95. The allegations in the above paragraphs are hereby re-alleged and set fort fully as above. 96. Solicitations made by the AK and or paid by Da Vita and Fresenius and any of the John Doe Defendants, based on any knowledge of patient fuding violates the structue set forth in the OIG Advisory Opinion 97-i. Such solicitations and payments are done knowingly in violation of that structure and affect the decision by the patient as to which provider of End Stage Renal Disease treatments they use. Each such payment therefore, creates illegal remuneration and violations of the Anti-Kickback Statute, which punishes both the payer and the solicitor of such funds: (1) Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind- (A) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be madc in whole or in part under a Federal health care program, or (B) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program, shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both. 26 5 (2) Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kid to any person to induce such person- (A) to refer an individual to a person for the fushing or aranging for the furshing of any item or service for which payment may be made in whole or in part under a Federal health care program, or (B) to purchase, lease, order, or arange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in par under a Federal health care program, shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.. 42 U.sc. § i 320a-7b(b). 97. Each such payment or solicitation made by the Defendants creates liability under the False Claims Act as the Anti-Kickback Statute provides: In addition to the penalties provided for in this section or section i 320a-7a of this title, a claim that includes items or services resulting from a violation of this section constitutes a false or fraudulent claim for purposes of subchapter II of chapter 37 of title 3 i. 42 U.S.C. § 1320a-7b(g). 98. These practices by Defendants DaVita, Fresenius, the John Doe Defendants and the AKF make a mockery of the OIG Advisory Opinion that was designed to separate the provision of charitable grant fuding to patients from the financial influence of the providers. This kickback scheme creates a circle of a quid pro quo solicitation of donations in exchange for payments and inccntives, which has been continually creating false claims in violation of the False Claims Act 31 U.S.C. § 3729(a)(l)(A) at the expense of governent programs. 99. Defendants knowingly violated the requirements of OIG Advisory Opinion No. 97- I, and Defendants were aware that compliance with those requirements was material to the 27 5 governent's decision to pay claims submitted or caused to be submitted by Defendants. 100. As a direct and proximate result of Defendants' knowing violations of the False Claims Act, the Defendants are liable to the United States for three times the amount of damages they have created to the United States as a result of submitting, or causing to submit, these false claims. 101. Each and every such violation of the Federal False Claims Act is also subject to a civil fine under the False Claims Act of between $5,500-$1 1,000, for conduct occuring prior to November 2, 2015, and a civil fine of between $10,781 and $21,563, for conduct occurring after November 2,2015. See 81 Fed. Reg. 42491 (June 30, 2016). In addition Defendants are liable for any increase as specified by the Federal Civil Penalties Infation Adjustment Act of 1990. Defendants are also liable for similar penalties for each violation of the State False Claims Acts. COUNT II Violations of31 U.S.c. § 3729(a)(1)(B) Use of False Statements or Records 102. The allegations in the above paragraphs are hereby re-alleged and set fort fully as above. 103. In submitting or causing to submit false claims the Defendants necessarily created false records and false statements including, but not limited to submitting bils to governent programs, which require adherence to the Anti-Kickback Statute and by maintaining that they were in compliance with laws and regulations regarding the provision of ESRD services. i 04. Defendants therefore violated the False Claims Act prohibition against USIng false records and statements under 31 U.S.C. § 3729(a)(1)(B). 28 5 105. The Defendants are liable to the United States for thee times the amount of damages they have created to the United States as a result of using false records and statements. i 06. Each and every such violation of the Federal False Claims Act is also subject to a civil fine under the False Claims Act of between $5,500-$11,000, for conduct occurng prior to November 2, 2015, and a civil fine of between $10,781 and $21,563, for conduct occuring after November 2, 2015. See 81 Fed. Reg. 42491 (June 30, 2016). In addition, Defendants are liable for any increase as specified by the Federal Civil Penalties Inflation Adjustment Act of i 990. Defendants are also liable for similar penalties for each violation of the State False Claims Acts. COUNT II Violations of CaL. Gov't Code §§ 12650 et seq. The California False Claims Act 107. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 108. This is a claim for treble damages and civil penalties under the CaL. Gov't Code §§12650 et seq. 109. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services. i 10. As a result, Defendants knowingly presented or caused to be presented false claims to the California Medicaid program (Medi-Cal), as well as programs funded by California and its political subdivisions, as defined under the California False Claims Act for health care plans oftheir employees. i i 1. Defendants knowingly accomplished these unlawfl acts by making, using or causing false records or statements to be used in support of false claims. 29 5 112. The California Medicaid Program and any additional program paying for ESRD services with California State funds or fuds from the political subdivisions of Californa were unaware of the falsity or fraudulent natue of the claims. Such claims otherwise would not have been paid. i 13. By reason of these payments California has been damaged and continues to be damaged in an amount to be determned at triaL. COUNT iV Violations of Colo. Rev. Stat. §§ 25.4-4-303.4 et seq. The Colorado False Claims Act 1 i 4. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. i i 5. This is an action for treble damages and civil penalties for violations of The Colorado False Claims Act, Colo. Rev. Stat. §§ 25.4-4-303.4 et seq. 116. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services. 117. As a result Defendants knowingly presented or caused to be presented false claims to the Colorado Medicaid program, and to programs funded by Colorado and its political subdivisions, to cover health care costs for their employees. i i 8. Defendants knowingly accomplished these unlawful acts by making, using or causing the use of false records or statements. 119. The Colorado Medicaid Program and any additional program paying for ESRD services with funds from the state of Colorado or its subdivisions were unaware of the falsity or fraudulent nature of the claims. Such claims otherwise would not have been paid. 30 5 120. By reason of these payments Colorado has been damaged and continues to be damaged in an amount to be determined at triaL. COUNT V Violations of Conn. Gen. Stat. §§ 17b-301a--17b-301p (2010 Supplement) The Connecticut False Claims Act 121. The allegations contained in the above paragraphs are hereby re-alleged as set fort fully above. 122. This is an action for treble damages and civil penalties for violations of the Connecticut False Claims Act, Conn. Gen. Stat. §§ I 7b-301a--l 7b-30Jp (2010 Supplement). 123. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services. 124. As a result Defendants knowingly presented or caused to be presented false claims to the Connecticut Medicaid program, and to programs funded by the state of Connecticut as well as its political subdivisions, to support the health care of their employees. 125. Defendants knowingly accomplished these unlawfl acts by making using or causing to the use of false records or statements. 126. The Connecticut Medicaid Program and any additional program paYIng for ESRD Services with Connecticut State fuds, or funds from a political subdivision of the State, were unaware of the falsity or fraudulent nature of the claims. Such claims otherwise would not have been paid. 127. By reason of these payments Connecticut has been damaged and continues to be damaged in an amount to be determined at triaL. COUNT VI Violations of DC Code, §§ 2-381.01 et seq. The District of Columbia False Claims Act 3i 5 128. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 129. This is an action for treble damages and civil penalties for violations of District of Columbia False Claims Act, DC Code §§ 2-381.01 et seq. 130. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services. 13 i. As a result Defendants knowingly presented or caused to be presented false claims to the District of Columbia's Medicaid program, and to programs paying for health care costs employees ofthe District of Columbia. 132. Defendants knowingly accomplished these unawful acts by making using or causing the use of false records or statements. 133. The District of Columbia's Medicaid Program, and any additional program paying for ESRD services with District of Columbia funds, were unaware of the falsity or fraudulent nature of these claims. Such claims otherwise would not have been paid. 134. By reason of these payments the District of Columbia has been damaged and continues to be damaged in an amount to be determined at triaL. VII COUNT Violations of DeL. Code Ann. tit. 6, §§ 1201 et seq. The Delaware False Claims and Reporting Act 135. The allegations contained in the above paragraphs are hcreby re-alleged as set forth fully above. 136. This is an action for treble damages and civil penalties for violations of Section 1201(a) of the Delaware False Claims and Reporting Act, DeL. Code Ann. tit. 6, §§ 1201 et seq. 32 5 13 7. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services. 138. As a result Defendants knowingly presented or caused to be presented false claims to Delaware's Medicaid program, and to programs fuded by the Governent of Delaware as defined under the Delaware False Claims and Reporting Act to include all political subdivisions and all Governent organizations. i 39. Defendants knowingly accomplished these unlawfl acts by making, using or causing the use of false records or statements. 140. The State of Delaware's Medicaid Program, and any additional program paYIng for ESRD services with fuds from political subdivisions of the State of Delaware or from the State of Delaware, were unaware of the falsity or fraudulent nature of these claims. i 41. Such claims otherwise would not have been paid. 142. By reason of these payments the State of Delaware has been damaged and continues to be damaged in an amount to be determined at triaL. COUNT VII Violations of O.C.G.A. § 23-3-120 (2012), et seq. The Georgia Taxpayer Protection False Claims Act 143. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. i 44. This is an action for treble damages and civil penalties for violations of The Georgia Taxpayer Protection False Claims Act, O.C.G.A. § 23-3-120 (2012), et seq. 145. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 33 5 146. Defendants therefore knowingly presented or caused to be presented false claims to the Georgia's Medicaid program. 147. The Georgia Medicaid Program was unaware of the falsity or fraudulent natue of the claims. Such claims otherwise would not have been allowed. 148. By reason of these payments the State of Georgia has been damaged and continues to be damaged in a substantial amount to be determined at trial in an amount to be determined at triaL. COUNT ix Violations of Haw. Rev. Stat. Ann. §§ 661-21 et seq. The Hawaii False Claims Act 149. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 150. This is an action for treble damages and civil penalties for violations of the Hawaii False Claims Act, Haw. Rev. Stat. Ann. §§ 661-21 et seq. 151. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 152. As a result Defendants knowingly presented or caused to be presented false claims to Hawaii's Medicaid program and to programs funded by Hawaii, and its political subdivisions, to pay health care costs for their employees. 153. Defendants knowingly accomplished these unlawful acts by making, using or causing to the used of false records or statements. 154. The Hawaii Medicaid Program, and any additional program paying for ESRD services with funds from Hawaii, or one of the political subdivisions of the State, were unaware of 34 5 the falsity or fraudulent natue of the claims paid. Such claims otherwise would not have been allowed. 155. By reason of these payments the State of Hawaii has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNT X Violations of 740 II. Compo Stat. Ann. 175/1 et seq. The Ilinois False Claims Act 156. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 157. This is an action for treble damages and civil penalties for violations of The Ilinois False Claims Act, 740 IlL. Compo Stat. Ann. 175/1 et seq. 158. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 159. As a result Defendants knowingly presented or caused to be presented false claims to the Ilinois' Medicaid program, and to programs fuded by the State of Ilinois as defined under the Ilinois False Claims Act including, but not limited to, political subdivisions and Muncipalities. 160. Defendants knowingly accomplished these unlawful acts by making, using or causing the use of false records or statements. 161. The Ilinois Medicaid Program, and any additional program using Ilinois Funds, or fuds from any subdivision of the State of Ilinois were unaware of the falsity or fraudulent nature of the claims. Such claims otherwise would not have been allowed. 35 5 162. By reason of these payments the State of Ilinois has been damaged and continues to be damaged in a substatial amount to be determined at triaL. COUNT XI Violations ofInd. Code §§ 5-11-5.5 et seq. The Indiana False Claims and Whistle blower Protection Act 163. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 164. This is an action for treble damages and civil penalties for violations of The Indiana False Claims Act, Ind. Code §§ 5-11-5.5 et seq. 165. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 166. As a result Defendants knowingly presented or caused to be presented false claims to the Indiana Medicaid program and to other programs fuded by the state of Indiana. i 67. Defendants knowingly accomplished these unlawful acts by making, using or causing the use of false records or statements. 168. The Indiana Medicaid Program and any additional Indiana programs paying for ESRD Services, were unaware of the falsity or fraudulent nature of the claims and paid those claims. Such claims otherwise would not have been allowed. 169. By reason of these payments the State ofIndiana has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNTXII Violations of Iowa Code § 685.1 et seq. The Iowa False Claims Act 36 5 170. The allegations contaned in the above paragraphs are hereby re-alleged as set forth fully above. 17 I. This is an action for treble damages and civil penalties for violations of The Iowa False Claims Act Iowa Code § 685.1 et seq. 172. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. i 73. As a result Defendants knowingly presented or caused to be presented false claims to the Iowa Medicaid program. i 74. Defendants knowingly accomplished these unawful acts by making, using or causing the use of false records or statements. i 75. The Iowa Medicaid Program was unaware of the falsity or fraudulent natue of the claims, and paid the claims. Such claims otherwise would not have been allowed. i 76. By reason of these payments the State of Iowa has been damaged and continues to be damaged in a substantial amount to be determined at triaL. XIII COUNT Violations of La. Rev. Stat. Ann. §§ 6:438.1 et seq. The Louisiana Medical Assistance Program Integrity Law 177. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 178. This is an action for treble damages and civil penalties for violations of the Louisiana Medical Assistance Program Integrity Law, La. Rev. Stat. Ann. §§ 6:438.1 et seq. 37 5 179. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. i 80. As a result Defendants knowingly presented or caused to be presented false claims to the Louisiana Medicaid program. i 81. Defendants knowingly accomplished these unawful acts by making, using, or causing the use of false records or statements. i 82. The Louisiana Medicaid Program, unaware of the falsity or fraudulent nature of the claims paid for claims. Such claims would otherwise not have been allowed. i 83. By reason of these payments the State of Louisiana has been damaged and continues to be damaged in a substantial amount to be determned at triaL. COUNT xiv Violations of Md. Code Ann. Health-Gen. §§ 2-601 et seq. The Maryland False Health Claims Act of2010 and Md. Code Ann. Gen. Provo §§ 8-101 et seq. The Maryland False Claims Act 184. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 185. This is an action for treble damages and civil penalties for violations of the Maryland False Health Claims Act, Md. Code An. Health-Gen. §§ 2-601 et seq., and the Maryland False claims Act Md. Code An. Gen. Provo §§ 8-101 et seq. i 86. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 38 5 187. As a result Defendants knowingly presented or caused to be presented false claims to Marland state health plans or programs, the State of Marland and Counties of the State of Marland. 188. Defendants knowingly accomplished these unlawfl acts by makng, using, or causing the use of false records or statements. 189. Maryland state health plan or programs, the State and Counties, unaware of the falsity or fraudulent nature of the claims, paid these ESRD related claims. Such claims otherwise would not have been allowed. 190. By reason of these payments the State of Marland and Counties have been damaged and continue to be damaged in a substantial amount to be determined at triaL. COUNT XV Violations of Mass. Ann. Laws ch.12, §§ 5 et seq. The Massachusetts False Claims Act 19 i. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 192. This is an action for treble damages and civil penalties for violations of the Massachusetts False Claims Act, Mass. Ann. Laws ch. 12, §§ 5 et seq. 193. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. I 94. As a result Defendant knowingly presented or caused to be presented false claims to the Massachusetts Medicaid program, as well as other programs funded by Massachusetts and its subdivisions. 39 5 195. Defendants knowingly accomplished these unawful acts by making, using, or causing the use of false records or statements. 196. The Massachusetts Medicaid Program and any additional program fuded by Massachusetts and its subdivisions were unaware of the falsity or fraudulent natue of the claims. Those programs paid for claims that otherwise would not have been allowed. i 97. By reason of these payments the Commonwealth of Massachusetts and its political subdivisions have been damaged and continue to be damaged in a substantial amount to be determined at triaL. COUNTXVI Violations of Mich. Compo Laws. Servo §§ 400.601 et seq. The Michigan Medicaid False Claims Act i 98. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 199. This is an action for treble damages and civil penalties for violations of the Michigan Medicaid False Claims Act, Mich. Compo Laws. Servo §§ 400.601 et seq. 200. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 201. As a result Defendants knowingly presented or caused to be presented false claims to the Michigan Medicaid program and or the Michigan Deparment of Community Health. 202. Defendants knowingly accomplished these unlawful acts by making, using, or causing the use of false records or statements. 40 5 203. The Michigan Medicaid Program and Deparment of Community Health, were unaware of the falsity or fraudulent natue of the claims, and paid for claims. Such claims otherwise would not have been allowed. 204. By reason of these payments the State of Michigan has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNT XVII Violations of Minn. Stat. §§ ISC.OI et seq. The Minnesota False Claims Act 205. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 206. This is an action for treble damages and civil penalties for violations of the Minnesota False Claims Act, Minn. Stat. §§ 15C.01 et seq. 207. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 208. As a result Defendants knowingly presented or caused to be presented false claims to the state of Minnesota, political subdivisions of the State of Minnesota and programs fuded by Minnesota and its subdivisions. 209. Defendants knowingly accomplished these unlawful acts by making, using, or causing to be used a false record or statement. 210. The State of Minnesota and any program funded by Minnesota or its subdivisions were unaware of the falsity or fraudulent nature of the claims. These programs therefore paid for claims that otherwise would not have been allowed. 41 5 211. By reason of these payments the State of Minnesota and its political subdivisions have been damaged and continue to be damaged in a substatial amount to be determined at triaL. COUNT XVII Violations of Mont. Code Ann. §§ 17-8-401 et seq. The Montana False Claims Act 212. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 213. This is an Action for treble damages and civil penalties for violations of the Montana False Claims Act, Mont. Code An. §§ 17-8-401 et seq. 214. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 215. As a result Defendants knowingly presented or caused to be presented false claims to Montana, and "Governent entities" of the State of Montana as defined in the Montana False Claims Act. 2 I 6. Defendants knowingly accomplished these unawful acts by making, using, or causing the use of false records or statements. 217. The State of Montana and Montana Governent entities were unaware of the falsity or fraudulent nature of the claims. Such claims otherwise would not have been allowed. 21.8. By reason of these payments the State of Montana and its Government entities have been damaged and continue to be damaged in a substantial amount to be determined at triaL. COUNT xix Violations of Nev. Rev. Stat. Ann. §§357.010 et seq. The Nevada Submission of False Claims to State or Local Government Act 42 5 219. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 220. This is an action for treble damages and civil fines for violations of the Nevada Submission of False Claims to State or Local Governent Act, Nev. Rev. Stat. An. §§ 357.010 et seq. 221. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 222. As a result Defendants knowingly presented or caused to be presented false claims to the state of Nevada, as well as programs funded by Nevada and its Political Subdivisions as defined under the Nevada False Claims to State and Local Governent Act. 223. Defendants knowingly accomplished these unlawfl acts by making, using, or causing the use of false records or statements. 224. The state of Nevada and its political subdivisions were unaware of the falsity or fraudulent nature of the claims. Such claims otherwise would not have been allowed. 225. By reason of these payments the State of Nevada and its political subdivisions have been damaged and continue to be damaged in a substatial amount to be determined at triaL. COUNT XX Violations of N.J. Stat. Ann. § 2A:32C-I et seq. The New Jersey False Claims Act 226. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 227. This is an action for treble damages and civil fines under the Section 2A:32C-3 of the New Jersey False Claims Act, N.J. Stat. Ann. §§ 2A:32C-1 et seq. 43 5 228. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 229. As a result Defendants knowingly presented or caused to be presented false claims to the State of New Jersey and programs funded by the State of New Jersey as "State" is defined under the New Jersey False Claims Act. 230. Defendants knowingly accomplished these unlawful acts by making, using, or causing the use of false records or statements. 231. The State of New Jersey and programs funded by the State of New Jersey were unaware of the falsity or fraudulent natue of the claims. Such claims otherwise would not have been allowed. 232. By reason of these payments the State of New Jersey has been damaged and continues to be damaged in a substatial amount to be determined at triaL. XXI COUNT Violations ofN.M. Stat. Ann. §§ 27-14-1 et seq. The New Mexico Medicaid False Claims Act and N.M. Stat. Ann. §§ 44-9-1 et seq. The New Mexico Fraud Against Taxpayers Act 233. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 234. This is an action for treble damages and civil fines under The New Mexico Medicaid False Claims Act and New Mexico Fraud Against Taxpayers Act N.M. Stat. Ann. §§ 27- 14-1 et seq. 44 5 235. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 236. As a result Defendants knowingly presented or caused to be presented false claims to the New Mexico Medicaid program, as well as programs fuded by The State of New Mexico as defined under the New Mexico Fraud Against Taxpayers Act. 237. Defendants knowingly accomplished these unlawful acts by making, using or causing the use of false records or statements. 238. The New Mexico Medicaid Program and other programs fuded by the State of New Mexico were unaware of the falsity or fraudulent natue of the claims. They therefore paid for claims that otherwise would not have been allowed. 239. By reason of these payments the State of New Mexico has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNT XXI Violations of N.Y. State Fin. Law §§ 188 et seq. The New York False Claims Act 240. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 241. This is an action for treble damages and civil fines under the New York False Claims Act. N.Y. State Fin. Law §§ 188 et seq. 242. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 45 5 243. As a result Defendants knowingly presented or caused to be presented false claims to the New York Medicaid program, as well as programs funded by the State of New York and programs fuded by Local Governents of the State as defined under the New York False Claims Act. 244. Defendants knowingly accomplished these unlawful acts by making, using, or causing the use of false records or statements. 245. The New York Medicaid Program and other programs fuded by New York State and New York Local Governents were unaware of the falsity or fraudulent nature of the claims. They therefore paid for claims that otherwise would not have been allowed. 246. By reason of these payments the State of New York and Local Governents have been damaged and continue to be damaged in a substatial amount to be determined at triaL. COUNT XXII Violations of N.C. Gen. Stat. §§ 1-605 et seq. The North Carolina False Claims Act 247. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 248. This is an action for treble damages and civil fines against the Defendants under The North Carolina False Claims Act, N.C. Gen. Stat. §§ 1-605 et seq. 249. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 250. As a result Defendants knowingly presented or caused to be presented false claims to North Carolina and programs funded by the State of North Carolina. 46 5 25 I. Defendants knowingly accomplished these unlawfl acts by makg, using, or causing the use of false records or statements. 252. The State of North Carolina and programs fuded by the State of North Carolina were unaware of the falsity or fraudulent nature of the claims. They therefore paid for claims that otherwise would not have been allowed. 253. By reason of these payments the State of North Carolina has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNT xxv Violations of Okla. Stat. tit. 63, §§ 5053 et seq. The Oklahoma Medicaid False Claims Act 254. The allegations contained in the above paragraphs are hereby re-alleged as set fort fully above. 255. This is an action for treble damages and civil fines against the Defendants under the Oklahoma Medicaid False Claims Act, Okla. Stat. tit. 63, §§ 5053 et seq. 256. Defendants engaged in a kickback scheme to direct payments of Insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 257. As a result Defendants knowingly presented or caused to be presented false claims to Oklahoma and programs funded by the State of Oklahoma. 258. Defendants knowingly accomplished these unlawful acts by making, using, or causing the use of false records or statements. 259. The State of Oklahoma and programs funded by the State of Oklahoma were unaware of the falsity or fraudulent nature of the claims. They therefore paid for claims that otherwise would not have been allowed. 47 5 260. By reason of these payments the State of Oklahoma has been damaged and continues to be damaged in a substatial amount to be determined at triaL. COUNT XXV Violations of R.I. Gen. Laws §§ 9-1.1-1 et seq. The Rhode Island False Claims Act 261. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 262. This is an action for treble damages and civil fines against Defendants under The Rhode Island False Claims Act, R.I. Gen. Laws §§ 9-1.-1 et seq. 263. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 264. As a result Defendants knowingly presented or caused to be presented false claims to the State of Rhode, as well as programs fuded by the State of Rhode I sland as defined under the Rhode Island False Claims Act to include all Rhode Island agencies, government entities, cities, towns. 265. Defendants also knowingly accomplished these unlawfl acts by making, using, or causing the use of false records or statements. 266. The State of Rhode Island and programs funded by the State of Rhode Island were unaware of the falsity or fraudulent nature of the claims. They therefore paid for claims that otherwise would not have been allowed. 267. By reason of these payments the State of Rhode Island has been damaged and continues to be damaged in a substantial amount to be determined at triaL. 48 5 COUNT XXVI Violations ofT.C.A. §§ 4-18-101 et seq. The Tennessee False Claims Act and T.C.A. §§ 71-5- 181 et seq. and Tennessee Medicaid False Claims Act 268. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 269. This is an action for treble damages and civil fines against the Defendants under T.C.A §§ 4-18-101 et seq., the Tennessee False Claims Act and T.C.A §§ 71-5-181 et seq. the Tennessee Medicaid False Claims Act. 270. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 2 71. As a result Defendants knowingly presented or caused to be presented false claims to the Tennessee Medicaid program, as well as programs fuded by Tennessee and its political subdivisions as defined under the Tennessee False Claims Act and the Tennessee Medicaid False Claims Act. 272. Defendants knowingly accomplished these unlawful acts by making, using. or causing the use of false records or statements. 273. The Tennessee Medicaid Program and other programs funded by Tennessee and its political subdivisions were unaware of the falsity or fraudulent nature of the claims. They therefore paid for claims that otherwise would not have been allowed. 274. By reason of these payments the State of Tennessee and its political subdivisions have been damaged and continue to be damaged in a substantial amount to be determined at triaL. 49 5 COUNT XXVII Violations of Tex. Hum. Res. Code Ann. §§ 36.001 et seq. The Texas Medicaid Fraud Prevention Act 275. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 276. This is an action for treble damages and civil fines against the Defendants under the Texas Medicaid Fraud Prevention Act, Tex. Hum. Res. Code Ann. §§ 36.001 et seq. 277. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 278. As a result Defendants knowingly presented or caused to be presented false claims to the Texas Medicaid program, and or knowingly accomplished these unlawfl acts by making using or causing to be used a false record or statement. 279. The Texas Medicaid Program was unaware of the falsity or fraudulent nature of the claims. Texas therefore paid for claims that otherwise would not have been allowed. 280. By reason of these payments the State of Texas has been damaged and continues to be damaged in a substantial amount to be determined at triaL. COUNT XXVII Violations of 32 VSA §§ 630 et seq. The Vermont False Claims Act 281. The allegations contained in the above paragraphs are hereby rc-alleged as set forth fully above. 282. Plaintiff-Relator seeks relief against Defendants under the Vermont False Claims Act, 32 VSA §§ 630 et seq. 50 5 283. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 284. As a result Defendants knowingly presented or caused to be presented false claims to the Vermont Medicaid program, as well as programs fuded by the State of Vermont as defined under the Vermont False Claims Act to include, any agency of state governent, and any political subdivision. 285. Defendants knowingly accomplished these unlawful acts by making, using, or causing the use of false records or statements. 286. The Vermont Medicaid Program and other Vermont programs were unaware of the falsity or fraudulent natue of the claims. They therefore paid for claims that otherwise would not have been allowed. 287. By reason of these payments the State of Vermont and its political subdivisions have been damaged and continue to be damaged in a substantial amount to be determined at triaL. COUNT xxx Violations of Va. Code Ann. §§ 8.01-216.1 et seq. The Virginia Fraud Against Taxpayers Act 288. The allegations contained in the above paragraphs are hereby re-alleged as set fort fully above. 289. Plaintiff-Relator seeks relief against Defendants under the Virginia Fraud Against Taxpayers Act, Va. Code An. §§ 8.01-216.1 et seq. 5i 5 290. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 291. As a result Defendants knowingly presented or caused to be presented false claims to the Virginia Medicaid program, as well as programs funded by the Commonwealth of Virginia as defined under the Virginia Fraud Against Taxpayers Act to include, any agency of state government, and any political subdivision. 292. Defendants knowingly accomplished these unlawful acts by making, using, or causing to the use of false records or statements. 293. The Virginia Medicaid Program and other Commonwealth of Virginia programs were unaware of the falsity or fraudulent natue of the claims. They therefore paid for claims that otherwise would not have been allowed. 294. By reason of these payments the Commonwealth of Virginia has been damaged and continues to be damaged in a substantial amount to be determned at triaL. COUNT XX Violations of RCW 74.66.005 et seq. The Washington Medicaid Fraud Act 295. The allegations contained in the above paragraphs are hereby re-alleged as set forth fully above. 296. This is an action for treble damages and civil fines against the Defendants under The Washington Medicaid Fraud Act RCW 74.66.005 et seq. 297. Defendants engaged in a kickback scheme to direct payments of insurance and copayments for End Stage Renal Dialysis ("ESRD") services thereby creating false claims. 52 5 298. As a result Defendants knowingly presented or caused to be presented false claims to the Washington Medicaid program. 299. Defendants knowingly accomplished these unlawfl acts by making, using, or causing the use of false records or statements. 300. The State of Washington was unaware of the falsity or fraudulent nature of the claims. The State therefore paid for claims that otherwise would not have been allowed. 301. By reason of these payments the State of Washington has been damaged and continues to be damaged in a substatial amount to be determined at triaL. PRAYER FOR RELIEF WHEREFORE, Plaintiff-Relator, on behalf of himself, the United States, and all States listed herein request that judgment be entered in his favor and against Defendants as follows: (a) That Defendants cease and desist from violating 31 U.S.c. § 3729, et seq., and the counterpart provisions of the State False Claims Acts set fort above; (b) Plaintiff-Relator be awarded the maximum amount allowed pursuant to §3730(d) of the False Claims Act and the maximum amount allowed pursuant to the State False Claims Act statutes; (c) That in the event the United States Governent continues to proceed with this action, the Plaintiff-Relator be awarded an amount for bringing this action of at least i 5% but not more than 25% of the proceeds of any award or the settlement of the claims; (d) That in the event the United States Government does not proceed with this action, the Plaintiff-Relator be awarded an amount that the Court decides is reasonable for collecting the civil penalty and damages, which shall be not less than 25% nor more than 30% of the proceeds of any award or settlement; 53 5 (e) That ths Cour enter judgment against all Defendants in an amount equal to thee times the amount of damages the United States has sustained because of Defendants' actions, plus a civil penalty of not less than $5,000 and not more than $11,000 of between $5,500-$11,000, for each violation of 31 U.S.c. § 3729 occurrng prior to November 2, 2015, and a civil fine of between $10,781 and $21,563, for such conduct occurring after November 2, 2015. See 81 Fed. Reg. 42491 (June 30, 2016). In addition Defendants are liable for any increase in civil fines as specified by the Federal Civil Penalties Infation Adjustment Act of 1990, plus the appropriate amount to the States for damages and civil fines as determined under the above listed State False Claims Acts; (f) That Plaintiff-Relator be awarded an amount that the Cour decides is reasonable, which shall not be less than i 5% of the proceeds or settlement of any related administrative, criminal, or civil actions, including the monetary value of any equitable relief, fines, restitution, or disgorgement to the United States and/or third paries; (g) That Plaintiff-Relator be granted a trial by jur; (h) That Plaintiff-Relator, the United States, and the States listed herein be awarded pre- judgment interest; (i) That the Plaintiff-Relator, be awarded all costs of this action, including attorneys' fees and costs pursuant to 31 U.S.C. §§ 3730(d) and similar provisions of the Sate False Claims Acts listed herein. (j The United States, the States, sub-divisions or municipalities and the Plaintiff-Relator recover such other relief as the Court deems just and proper 54 5 JURY TRIAL DEMADED Respectfully submitted, KOHN, KOHN & COLAPINTO, LLP ~David. Colapinto BBO # 551835 3233 P Street, N.W. Washington, D.C. 20007-2756 Email: dc(1kkc.com Phone: 202-342-6980 Fax: 202-342-6984 and- ~.I? PRICE BENOWITZ, LLP Anthony C. Munter BBO #600016 409 7th Street, N.W. Washington, DC 20004 Email: tony(ipricebenowitz.com Phone: 202-417-6000 Fax: 202-664-1331 Attorneys for Plaintiff-Relator September 7, 2016 55