Caldwell Cassady & Curry’s John Summers, a former Assistant U.S. Attorney, recently represented a whistleblower client in connection with a multimillion-dollar False Claims Act settlement arising from false or invalid diagnostic information provided to the Medicare Advantage program.
Mr. Summers and Houston attorney Rachel V. Rose successfully represented Dr. Robert Oristaglio Jr. in claims against Tennessee-based Community Care Health Network LLC (Matrix Medical Network), its subsidiary DPN USA (HealthFair), and DPN USA founder Shahriah Ekbatani.
Dr. Oristaglio was the chief medical officer for HealthFair, which provided mobile medical services across the U.S. His lawsuit in the U.S. District Court for the Eastern District of Texas detailed how the defendants submitted unsupported medical diagnoses from Medicare Advantage assessments to insurance companies that provided related coverage, resulting in higher payments to the settling defendants from the Medicare Advantage program.
Dr. Oristaglio’s lawsuit was one of two False Claims Act cases that collectively resulted in settlements of $56.5 million. The False Claims Act grants whistleblowers like Dr. Oristaglio certain rights to share in the Government’s recoveries from the whistleblower’s case. Under those provisions, the Government awarded Dr. Oristaglio $3.6 million.
The case is United States, ex rel. Oristaglio v. Community Care Health Network, Inc., d/b/a Matrix Medical Network, et al., No. 4:22-CV-00133.