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FILED
IN CLERK'S OFFICE
US DISTRICT COURT E.O.N.Y.
* NOV 2~ 201lt *
SLR.:RKH:LDM
F# 2004VOI161
BROOKLYN OFFICE
X
VNITBD STAlES OF AMERICA ex reL
ELIZABETII M. RYAN,
Plaintiff,
STIPULATION AND
ORDER OF SETTLEMENT
Civil Action No. 04-2483
-against-
(Gleeson, J.)
(Pollak, M.J.)
Defendants.
X
I.
PARTIES
Human Services ("HHS") (collectively the ''United States"), Elizabeth M Ryan ("Ryan
or the "Relator''), and Dr. Gilbert Lederman and Gilbert Lederman M.D., PC (together
"Lederman") (hereinafter referred to collectively as the "Parties"), through their
authorized representatives.
II.
A.
PRMMQLE
The United States has alleged that, at ail relevant times, Lederman
was a health care provider who provided cancer treatment services, including stereotactic
body radiosurgery ("BRS''), to, among others, Medicare beneficiaries.
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B.
..........
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-- - -
16, 2004, Relator commenced an action by filing a Complaint (the "Qui Tam
Complaint") pursuant to the qui tam provisions of the False Claims Act, 31 U.S. C.
3730 (b)-(b), in the United States District Court for the Eastern District ofNcw York,
captioned United Stales ex rei. Ryan v. Staten Island University Hospital, et al.,
No. CV-04-2483 (E.D.N.Y.) (the "Civil Action'1
C.
Action on February 19,2008. On Jul:r 31,2008, the United States filed a complaint (the
"Complaint-in-Intervention'') in which it aasertcd claims under the False Claims Act and
common law claims arising out of Lederman's billing of BRS to Medicare.
D.
be submitted claims for payment to the Medicare Program (Medicare), Title XVIII of the
Social Security Act, 42 U.S.C. l395-l39Skkk-1.
E.
the following conduct: during the period 1996 through December 2003, Lederman
knowingly presented or caused to be presented false claims to Medicare seeking
reimbursement for BRS that Lederman provided to approximately 300 patients
(hereinafter referred to aa the "Covered Conduct'').
F,
nor a conceasion by the United States that its claims are not well founded.
G.
H.
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protracted litigation ofthe above claims, Lederman, tho Relator, and the United States
have reached a full and final settlemont of the claims in the Civil Action pursuant to the .
Terms and Conditions herein.
Ill.
1.
Lederman shall pay to the United Ststes two million one hundred
seventy f'tve thousand dollars ($2,17S,OOO) (tho "Settlement Amount") no later than ten
(I 0) daya after the Effective Date of this Agreement, as defined in paragraph 28, below.
Payment of the Settlement Amount shall be made by electronic funds transfer pursuant to
written instructions to be provided by the Office of the United States Attorney for the
Eastern District ofNew Yorlc.
2.
Amount from Lederman and as scon as feasible after receipt, the United States shall pay
three hundred twenty six thousand two hundred fifty dollars ($326,250) to Relator. Such
payment shall be mode by electronic funds transfer to the client trnst account of
Liffiander & Reich LLP for the benefit of Elizabeth M. Ryan.
3.
and costs, pursuant to 31 U.S.C. 3730(d)(l) of the False Claims Act ("Relator's
Attorney's Fees''}, in the amount of one hundred seventy five thousand dollars
($175,000). Full payment of the Relator's Attorney's Fees is due within ten (10) days
after the Effective Date of this Agreement, as defined in paragraph 28, below. Such
payment ohall be made by electronic funds transfer pursuant to written instructions to be
provided by Relator's counsel.
4.
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claims) below, and conditioned upon Ledennan's full payment of the Settlement
Amount, and subject to Paragraph 15 below (concerning bankruptcy proceedings
commenced within 91 days of the Effective Date of this Agraement or any payment made
under this Agreement), 1he United States releases Lederman from any civil or
administrative monetary claim the United States has for the Covered Conduct under the
False Claims Act, 31 U.S.C. 3729-3733; the Civil Monetary Penslties Law, 42 U.S.C.
1320a-7a; the Program Fraud Civil Remedies Act, 31 U.S.C. 3801-3812; or the
Lederman's full payment of the Settlement Amount and Relator's Attorney's Fees, and
subject to Paragraph 15 below (concerning banl<l'Uptcy proceedings commenced within
91 days of the Effective Date of this Agreement or any payment made under this
Agreement), Relator, for herself and for her heirs, successors, attorneys, agents, and
assigns, releases Lederman from any civil monetary claim Relator has on behalf of the
United States for the Covered Conduct under the False Claims Act, 31 U.S.C. 37293733.
6.
Agreement, or any other term of this Agreement, the following claims of the United
a.
b.
Revenue Code);
c.
Any liability to the United States (or its agencies) for any
f.
Agreement;
othc:r claims for defective or deficient products or sc:rvices, including quality of goods
and services;
g.
h.
herein.
7,
shall not object to this Agreement but agree and confirm that this Agreement is fair,
adequate, and reasonable under all the circumstances, pursuant to 31 U.S.C.
3730(c)(2)(B). Conditioned upon Relator's receipt of the payment described in
Paragraph 2, Relator and her heirs, successors, attorneys, agents, and assigns fully and
finally release, waive, and forever discharge the United States, its agencies, officers,
agents, employees, and servants, from any claims arising from the filing of the Clvil
Action or under 31 U.S.C. 3730, and from any claims to a share oftheproceedsofthis
Agreement and/or the Civil Action.
8.
Relator, for herself, and for her heirs, successors, ~ttorneys, agents,
and assigns, releases Ledennan, and its officers, agents, and employees, :from any
liability to Relator arising :from the filing of the Civil Action, or under 31 U.S.C.
3730(d) fur exponses or attorney's fees and costs.
9.
Lederman waives and shaH not assert any defenses Lederman may
have to any criminal prosecution or administrative action relating to the Covered Conduct
that may be baaed in whole or in part on a contention that, under the Double Jeopardy
Clause in the Fifth Amendment of the Constitution, or under the Excessive Fines Clause
in the Eighth Amendment of the Constitution, this Agreement bers a remedy sought in
such criminal prosecution or admlnistrative action. Nothing in this peragraph or any
other provision of this Agreement constitutes an agreement by the United States
concerning the characterization of the Settlement Amount or any of the payments
required under paragrsphs 1 through 3, herein, for purposes of the Internal Revenue laws,
Title 26 of the United States Code.
10.
Lederman fulJy and finally releases the United States, its agencies,
officers, agents, employees, and servants, from any claims (including attorney's fees,
costs, and expenses of every kind and however denominated) that Lederman has asaerted,
could have asserted, or may assert in the future against the United States, Its agencies,
officers, agents, etttployecs, and servants, related to the Covered Conduct and the United
States' investigation and prosecution thereof.
11.
attorneys, agents and assigns from any claims (including attorney's fees, costs, and
expenses of every kind and however denominated) that Lederman has asserted, could
have asserted, or may assert in the future against Relator and her heirs, attorneys, agents
and assigns, related to the Covered Conduct and the Relator's investigation and
prosecution thereof.
12.
denial of claims for payment now being withheld from payment by any Medicano
contractor (e.g., Medicare Administrative Contractor, fiscal intermediary, carrier), or any
state payer, related to
Medicare contractor or any state payer any previously denied claims related to the
Covered Conduct, and agrees not to appeal any such denials of claims.
13.
Federal Acquisition Regulation, 48 C.F.R. 31.205-47; and in Titles XVIII and XIX of
the Social Security Act, 42 U.S.C. l39S-1395kkk-1 and 1396-1396w-S; and the
regulations and official program directives promulgated thereunder) incurred by or on
behalf of Lederman; its present or former offioers, directors, employees, shareholders,
and agents in connection with:
(1)
(2)
(3)
actions undertaken in response to the United States' audit(s) and civil investigation(a) in
connection with the matters covered by this Agreement (including attorney's fees);
(4)
(5)
and
pnrsuant to this Agreement and any psyments that Lederman may make to Relator,
including costs and attorneys fees.
are unallowable costs for government contracting purposes and under the Medicare
Program, Medicaid Program, TRICARE Program, and Federal Employees Health
Benefits Program (FEHBP) (hereinafter referred to as "Unallowable Costs").
b.
Costs shall be separately determined and accounted for by Lederman, and Lederman shall
not charge such Unallowable Costs directly or indirectly to any contracts with the United
States or any State Medicaid program, or seek psyment for such Unallowable Costs
through any cost report, cost statement, informstion statement, or payment request
Pavment: Lederman further agrees that within 90 days of the Effective Date of this
Agreement it shall identify to applicable Medicare fiscal intermediaries, carriers, and/or
contractors, and Medicaid and FEHBP fiscal agents, any Unallowable Costs (as defmed
in this Paragraph) included in payments previously sought from the United States, or any
State Medicaid program, including, but not limited to, payments sought in any cost
reports, cost statements, information reports, or payment requests already submitted by
Lederman or any of its subsidiaries or affiliates, and shall request, and agree, that such
cost reports, cost statements, information reports, or payment requests, even if already
settled, be adjuated to account for the effect of the inclusion of tho Unallowable Costs.
Lederman agrees that the United States, at a minimum, shall be eJ!titled to recoup from
Lederman any overpayment pins applicable interest and penalties as a result of the
rights of the United States to audit; examine, or re-examine Lederman's books and
records to determine that no Unallowable Costs have been claimed in accordsnce with
the provisions of this Paragraph.
14.
the Settlement Amount. Further, the Parties warrant that, in evaluating whether to
execute this Agreement, they (a) have intended thst the mutual promises, covenants, and
obligatlons set forth herein constitute a contemporaneous exchange for new value given
to Lederman, within the meaning of 11 U.S.C. 54 7(c)(!), and (b) conclude that these
mutual promises, covenants, and obligations do, in fact, constitute such a
oontemporanemis exchange. Further, the Parties warrant thet the mutual promises,
covenants, and obligations set forth herein are intended to and do, in fact, represent a
reasonably equivalent exchange of value which is not intended to hinder, delay, or
defraud any entity to which Lederman was or became indebted to on or after the_ date of
this transfer, within the meaning of 11 U.S.C. 548(a)(l).
IS.
payment made under this Agreement, Lederman commences, or a third party commences,
any case, proceeding, or other action under any law relating to banlauptcy, insolvency,
reorganization, or relief of debtors, (a) seeking to have any order fur l'eliefofLederman's
debts, or seeking to adjudicate Lederman as bankrupt or insolvent; or (b) seeking
appointment of a receiver, trustee, custodian, or other similar official for Lederman or fur
all or any substantial part ofLederman's assets, Lederman agrees as follows:
a.
avoided pursuant to 11 U.S.C. 547, aod Lederman shall not argue or otherwise take the
position in any such case, proceeding, or action that: (i) Lederman's obligations under
this Agreement may be avoided under II U.S.C. 547; (ii) Lederman was insolvent at
the thne this Agreement was entered Into, or became insolvent as a result of the payment
made to the United States; or (iii) the mutual promises, covenants, and obligations set
10
forth in this Agreement do not constitute a contemporaneous exchsnge for new value
given to Lederman.
b.
avoided for any reason, including, but not limited to, through the exercise of a trustee's
avoidance powers under the Bankruptcy Code, the United Stetes, at its sole option, may
rescind the releases in this Agreement and bring any civil and/or administrative claim,
action, or proceeding against Ledennan for the claims that would otherwise be covered
by the releases provided in Paragraphs 4 and S, herein. Lederman agrees that (i) any such
claims, ections, or proceedings brought by the United States (including any proceedings
to exclude Lederman from participation in Medicare, Medicaid, or other Federal health
care programs) are not subject to an "aotomatic stay" pursuant to 11 U.S.C. 362(a) as a
result of the action, case, or proceedings described in the first clause of this Paragraph,
and that Ledennan shall not argue or otherwise contend that the United States' claima,
actions, or proceedings are subject to an automatic stay; (ii) Lederman shall not plead,
argue, or otherwise raise any defenses under the theories of statute of limitations, laches,
estoppel, or similar theories, to any such civil or administrative claims, actions, or
proceeding that are brought by the United Stetes within sixty (60) calendar days of
written notification to Lederman that the releases have been rescinded pursuant to this
Paragraph, except to the extent such defenses were available on the Effective Date of the
Agreement; and (iii) the United States has a valid claim against Lederman in an amount
no less the $2,175,000, and the United States may pursue its claim in the case, action, or
proceeding referenced in the first clause of this Paragraph, as well as in any other case,
action, or proceeding.
11
c.
Agreement.
16.
only. The Parties do not release any claims against any otber person or entity, except to
tbe extent provided for in Paragraph 17 (waiver for beneficiaries paragraph), below.
17.
Lederman agrees that it waives and shall not seek payment for any
oftbe health care billings covered by this Agreement from any health care beneficiaries
or their parents, sponsors, legally responsible individuals, or third party payors based
upon the claims defined as Covered Conduct.
18.
described in Paragraph 1, herein, tbc Parties shall promptly sign and ffie in the Civil
Action a Joint Stipulation of Dismissal oftbe Civil Action pursuantto Rule 4l(a)(l).
19.
own legal and other costs incurred in connection witb this mstter, including the
preparation and performance of tbis Agreement.
20.
and voluntarily enters In to this Agreement witbout any degree of duress or compulsion.
21.
exclusive jurisdiction and venue for any dispute relating to tbis Agreement is tbc United
States District Court for the Eastern District of New York. For purposes of construing
tbis Agreement, this Agreement shall be deemed to have been drafted by all Parties to
12
this Agreement and shall not, therefore, be construed against any Party for that reason in
any subsequent dispute.
22.
Parties. This Agreement may not be amended eJWept by written consent of the Parties.
23.
The undersigned counsel represent and warrant that they are fully
authorized to oxeoutc this Agreement on behalf of the persons and entities indicated
below.
24.
constitutes an original and all of which constitute one and the same Agreement
25.
form, or any other electronic means intended to preserve the original graphic or pictorial
appearance of signatures shall constitute acceptable, binding signatures for purposes of
this Agreement.
13
1\Jov' 1; 1~1Lt
LORE'ITA E. LYNCH
United States Attorney
Eastern Dis1rict ofNew York
271 Cadman PlazaEast
Brooklyn, NY 1120 I
BY:
~J-&:(
LAURA D. MANTELL
RICHARD K. HAYES
Assistant U.S. Attorney
DATED: _ __
ROBERTK. DECONTI
Assistantlnspector General for Legal Affairs
Office of Counsel to the
Inspector General
Office of Inspector General
United States Department of
Health and Human Services
BY:
14
WRETIAE. LYNCH
United States Attorney
Eastern District ofN ew York
271 Cadman Plaza East
Brooklyn, NY 11201
DATED:----
BY:
LAURA D. MANTELL
14
DATIID:
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DATED: (
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BY:
BY:
[. bM!'t L ~rAw!\ M
DATIID:~:
BY:
DATED:,~--
ELIZABETHM.RYAN
DATED:.~-~-
15
DATED: _ __
BY:
GILBERT LEDERMAN
DATED: _ _ __
BY:
DATED:#~
~~/!~
DATED:#
BY:
~7/Jd
RICHARD I. REICH, BSQ
Counsel for Relator
15
\_
SO ORDEREJL
On this ~day of November, 2014
s/John Gleeson
HONO
United
GLEESON
Judge
16
Encl.
cc:
. , .
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Laura D. Mantell
Assistant U.S. Attorney
(718) 254-6253