Oak Street Health Agrees to Pay $60M to Resolve Alleged False Claims Act Liability for Paying Kickbacks to Insurance Agents in Medicare Advantage Patient Recruitment Scheme

 

Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health’s primary care clinics.

The Anti-Kickback Statute prohibits anyone from offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce referrals of patients or to provide recommendations of items or services covered by Medicare, Medicaid and other federally funded programs. Under the Medicare Advantage (MA) Program, also known as Part C, Medicare beneficiaries have the option to obtain their health care through privately-operated insurance plans known as MA plans. Some MA Plans contract with health care providers, including Oak Street Health, to provide their plan members with primary care services.

The United States alleged that, in 2020, Oak Street Health developed a program to increase patient membership called the Client Awareness Program. Under the Program, third-party insurance agents contacted seniors eligible for or enrolled in Medicare Advantage and delivered marketing messages designed to generate interest in Oak Street Health. Agents then referred interested seniors to an Oak Street Health employee via a three-way phone call, otherwise known as a “warm transfer,” and/or an electronic submission. In exchange, Oak Street Health paid agents typically $200 per beneficiary referred or recommended. These payments incentivized agents to base their referrals and recommendations on the financial motivations of Oak Street Health rather than the best interests of seniors. The settlement resolves allegations that, from September 2020 through December 2022, Oak Street Health knowingly submitted, and caused the submission of, false claims to Medicare arising from kickbacks to agents that violated the Anti-Kickback Statute.

“Health care providers that attempt to profit from kickbacks will be held accountable,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department's Civil Division. “We are committed to rooting out illegal practices committed by Medicare Advantage providers, insurance agents and brokers that undermine the interests of federal health care programs and the patients they serve.”

“Kickbacks, in any form, have no place in our federal healthcare system” said Acting U.S. Attorney Morris Pasqual for the Northern District of Illinois. “My office is alert for kickbacks that can subvert patient choice and defraud federal health care programs. This investigation and settlement help to ensure that patient choice is prioritized above a provider’s bottom line.”

“Kickbacks impose hidden costs on the federal health care system and compromise medical choice and decision-making,” said Special Agent in Charge Mario Pinto of the Department of Health and Human Services Office of the Inspector General (HHS-OIG). “Working determinedly with our law enforcement partners, HHS-OIG will continue to protect the integrity of federal health care programs, and we encourage the public to come forward with information about violative conduct.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Joseph Stinson. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned U.S. ex rel. Stinson v. Oak Street Health, et al., No. 20-cv-7381 (N.D. Ill.). As part of today’s resolution, Mr. Stinson will receive $9.9 million.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Northern District of Illinois, with assistance from HHS-OIG and the FBI.

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).

Trial Attorney David G. Miller of the Justice Department's Civil Division and Assistant U.S. Attorney Jonathan C. Haile for the Northern District of Illinois handled the matter.

The claims resolved by the settlement are allegations only. There has been no determination of liability.

Bronx Former Attorney Pleads Guilty To Large-Scale Immigration Fraud

Damian Williams, the United States Attorney for the Southern District of New York, announced  that KOFI AMANKWAA, a Bronx-based former immigration attorney, pled guilty to immigration fraud in connection with his supervision of a multi-year scheme to file fraudulent immigration documents under the Violence Against Women Act (“VAWA”).  AMANKWAA pled guilty today before U.S. District Judge Katherine Polk Failla.

 

U.S. Attorney Damian Williams said: “For years, Kofi Amankwaa oversaw a massive immigration fraud scheme, filing thousands of immigration documents falsely alleging that his clients were victims of abuse by their children or other family members. Amankwaa’s actions undermined our U.S. immigration system, exploited VAWA — a law that allows noncitizen victims of domestic abuse a path to lawful permanent residence status — and victimized vulnerable clients in the process. This guilty plea highlights this Office’s dedication to holding accountable those who abuse the trust placed in them as attorneys and fraudulently use our immigration system as a tool for their own financial gain.” 

According to the allegations in the Information, public filings, and statements made in public court proceedings:

From September 2016 through November 2023, AMANKWAA and others at his direction met with clients and instructed them to sign fraudulent Form I-360 VAWA Petitions falsely stating that the clients were abused by their U.S. citizen children.  AMANKWAA also signed the petitions, under penalty of perjury, as the attorney preparer. 

AMANKWAA used the filing of the fraudulent Form I-360 VAWA Petitions, among other filings, as a basis to request for his clients’ advance parole travel documents — documents that enable individuals without legal status in the U.S. to travel abroad temporarily and return.  AMANKWAA then directed his clients, upon obtaining the advance parole travel documents, to travel abroad and return to the U.S.  Last, AMANKWAA used the fraudulently procured advance parole as a basis for his clients to apply for lawful permanent resident status. 

AMANKWAA carried out this illegal scheme knowing that his clients had not, in fact, been abused by their children or without ever asking whether any such abuse occurred.  Moreover, AMANKWAA was often unsuccessful in obtaining lawful permanent resident status for his clients because the clients’ immigration applications were denied on the basis of fraud, among other reasons.  AMANKWAA typically charged his clients between $3,000 and $6,000 for his services, plus administrative fees.

In November 2023, following numerous complaints by clients regarding the fraudulent abuse allegations, AMANKWAA’s license to practice law in the State of New York was suspended, and in August 2024, AMANKWAA was disbarred.

As part of today’s plea, AMANKWAA has agreed to forfeit $13,389,000 and pay $16,503,425 in restitution to his victims. 

If you believe you or your family member is a victim of VAWA fraud perpetrated by AMANKWAA, please contact USANYS.VAWAFraud@usdoj.gov.

AMANKWAA, 70, of South River, New Jersey, pled guilty to one count of immigration fraud, which carries a maximum sentence of 10 years in prison.  

The maximum potential sentence is prescribed by Congress and is provided here for informational purposes only, as any sentencing of the defendant will be determined by a judge. 

Mr. Williams praised the outstanding investigative work of the Newark Field Office of Homeland Security Investigations.  Mr. Williams also thanked the U.S. Citizenship and Immigration Services’ Office of Fraud Detection and National Security for their support in this investigation.

Attorney General James’ Office of Special Investigation Releases Report on Death of Jarrel Garris

 

New York Attorney General Letitia James’ Office of Special Investigation (OSI) released its report on the death of Jarrel Garris, who died on July 10, 2023 after an encounter with members of the New Rochelle Police Department (NRPD) that occurred on July 3, 2023 in New Rochelle. Following a thorough investigation, which included review of body-worn camera footage and security camera video, interviews with involved officers, and comprehensive legal analysis, OSI concluded that a prosecutor would not be able to disprove beyond a reasonable doubt at trial that the officer’s use of force against Mr. Garris was justified under New York law. In its report, OSI recommends that NRPD update its training and policies for responding to petty nonviolent offenses to provide officers with objective criteria for assessing whether or not a situation warrants the use of physical force.

On the afternoon of July 3, NRPD officers responded to a complaint of a man who was eating items he had not paid for at a grocery store on Lincoln Avenue in New Rochelle. When the first officer arrived, she encountered Mr. Garris walking slowly outside of the store. The officer attempted to verbally engage Mr. Garris, asking him what he was doing and whether he was eating food in the grocery store. A second officer arrived and both officers attempted to verbally engage with Mr. Garris. Mr. Garris was not responding to the officers' questions when the third officer got to the scene. 

The third officer placed one handcuff on Mr. Garris and a physical struggle ensued. The third officer directed the first officer to use her taser on Mr. Garris, but she could not get a clear shot and did not deploy it. At one point in the struggle, Mr. Garris had his hands on the second officer’s gun. The third officer noticed and yelled “gun!” before he discharged his service weapon, striking Mr. Garris. The officers began performing life-saving measures on Mr. Garris until an ambulance arrived. Mr. Garris was taken to a local hospital, where he died from his injuries on July 10, 2023.

Under New York’s justification law, a police officer may use deadly physical force when the officer reasonably believes it to be necessary to defend against the use of deadly physical force by another. In this case, Mr. Garris had his hands on one officer’s gun while they were attempting to arrest him. Another officer deployed his service weapon because he believed he needed to protect himself, the other officers, and any bystanders. Given the circumstances and based on the law and the evidence, a prosecutor would not be able to disprove beyond a reasonable doubt at trial that the officer’s use of deadly force was justified.

Currently, the NRPD’s training and policies direct officers to use their own discretion when determining whether or not to use physical force to make an arrest when responding to petty nonviolent offenses like the one in this case. Although it is not possible to know if a different approach would have changed the outcome in this specific matter, OSI recommends that NRPD update its training and policies for these matters to provide officers with objective criteria for assessing if using physical force to make an arrest is warranted. These trainings should involve real-world scenarios so that officers can become accustomed to the sorts of situations they may encounter in the field and the appropriate effective responses without relying on physical force in every case. The OSI recommends NRPD implement criteria including determinations such as whether:

• The individual is physically combative or passively noncompliant;
• There are ways to achieve compliance without physical force;
• Law enforcement personnel at the scene have been trained in de-escalation tactics or interacting with people experiencing mental health crises; and
• All methods of nonviolent de-escalation were exhausted.

Governor Hochul Signs Legislation to Expand Health Care Access for New Yorkers

Legislation S.8486-C/A.9102-C Relates to Medicaid Reimbursement for Treatment in Place and Transportation to Alternative Health Care Settings by Ground Ambulance Services

Legislation S.6226-A/A.5789-A Provides For Availability of Ambulance Services and Advanced Life Support First Response Services to Store and Distribute Blood and Initiate and Administer Blood Transfusions

Governor Kathy Hochul signed a legislative package to ensure equitable access to essential health care and reaffirm New York’s commitment to safeguarding public health and improving patient outcomes across communities.

“My Administration is committed to addressing health care disparities in our State and ensuring all New Yorkers can access the care that they need and deserve,” Governor Hochul said. “This legislation ensures essential treatment and transportation, and allows New Yorkers to focus on their well-being during an emergency rather than worrying about the financial cost or availability of critical health care when they need it most.”

Legislation S.8486-C/A.9102-C requires Medicaid reimbursement for ambulance services when treatment in place is administered and/or when transportation is provided to alternative health care settings instead of a general hospital

Legislation S.6226-A/A.5789-A authorizes ground ambulance and advanced life support first response services to store and distribute blood and initiate and administer blood transfusions, mirroring authorizations provided to air ambulance services.

Bronx Borough President Vanessa L. Gibson - Community Resources & Updates

 

Dear Neighbor,

 

Thank you for joining us for another week in review.

We are pleased to recognize National Healthy Aging Month, a time dedicated to celebrating and enhancing the well-being of our seniors. This month reminds us of the importance of ensuring that our older adults have access to the resources and support they need to live safe, healthy, and fulfilling lives.

 

Healthy aging encompasses not just physical health but also mental and emotional well-being, social connections, and access to essential services. Our seniors have made invaluable contributions to our community, and it is our responsibility to ensure they receive the care and support they deserve.

 

We are excited to announce that, throughout September, we are partnering with Grow NYC and the New York City Department for the Aging to host special pop-ups at farmers markets across the borough. These events will provide seniors with valuable information about health resources, wellness tips, and community services in a welcoming and accessible environment.

 

I encourage everyone to visit these pop-ups, check in on the older adults in their lives, and explore how we can all contribute to their well-being. Whether it’s by sharing information, encouraging regular health check-ups, or simply offering companionship, every effort counts.

 

Let’s come together to support our seniors and celebrate their vital role in our community.

 

If you have any questions or concerns, please do not hesitate to contact our office at 718-590-3500 or email us at webmail@bronxbp.nyc.gov.

In partnership,

Bronx Borough President Vanessa L. Gibson

IN THE COMMUNITY

Grateful for the incredible turnout at this Sunday’s African American Day Parade! It was an honor to celebrate our culture and community with all of you.

A special thank you to my colleagues in government, and to the community for coming together to make it a memorable day. What a great way to close out the summer!

UPCOMING EVENTS

COMMUNITY EVENTS

GENERAL INFORMATION

NYS Office of the Comptroller State Comptroller DiNapoli Statement on MTA's Release of Its 2025-2029 Capital Program

 

New York State Comptroller Thomas P. DiNapoli released the following statement regarding the Metropolitan Transportation Authority’s (MTA’s) release of its 2025-2029 Capital Program.

“The MTA’s proposed $68.4 billion 2025-2029 Capital Program is the largest in the MTA’s history, but it will still leave many needs unaddressed. As the MTA moves forward with the program it must be fully transparent on how the projects it has chosen to prioritize are the right ones to improve safety, frequency and reliability of service. This will help underscore the importance of the work to the MTA’s funding partners as they examine the proposal.

“The proposal also assumes the large $15 billion hole in the MTA’s 2020-2024 capital program will be funded, creating uncertainty over which projects risk delays or cancellation if that money is not found, and how those choices would affect the new proposal. In sum, the MTA has over $48 billion in planned spending over both capital programs that do not yet have an identified funding source. Like the MTA, the public is also waiting for more information about what steps the authority’s funding partners might take to help bridge that funding gap.”

Recent Report

MTA 2025-2029 Capital Program Scenarios

MAYOR ADAMS, COMPTROLLER LANDER ANNOUNCE NEW YORK CITY’S THIRD ISSUANCE OF SOCIAL BONDS, INVESTMENTS THAT SUPPORT AFFORDABLE HOUSING

 

Proceeds Will Help Finance Development of Over 4,300 Affordable Housing Units

Upcoming Sale Follows Another Record-Breaking Year for Producing and Connecting New Yorkers to New, Affordable Homes

New York City Mayor Eric Adams and New York City Comptroller Brad Lander today announced New York City’s plans to issue approximately $820 million of taxable, fixed rate “General Obligation Social Bonds” in October 2024. Selling bonds to investors generates funds that the city uses to build and maintain its world-class infrastructure. Proceeds from the sale of these social bonds will support the construction and development of over 4,300 more affordable housing units in New York City and continue to build on the administration’s efforts to build more homes across the five boroughs, through efforts such as, the ‘City of Yes for Housing Opportunity’ proposal.

“Our administration is committed to making New York City a safer, more affordable city,” said Mayor Adams. “With a historically low vacancy rate and more people feeling the squeeze of market pressures, we must say ‘yes’ to using every tool in our toolbox to build more affordable housing across New York City. Social bonds are a smart and effective way to achieve our housing goals and give investors a critical opportunity to partner with the city so that we can become a more affordable city.”

“Social bonds have been an important tool to support the reimbursement of crucial affordable housing projects throughout the five boroughs and are a creative way for New York City to tap into the growing investor demand for socially sustainable investments,” said Comptroller Lander. “I am thrilled that we are able to continue this successful initiative now for the third year and remain focused on implementing strategies that preserve one of our greatest assets — genuinely affordable housing.”

This will be the city’s historic third issuance of social bonds — all of which occurred since 2022,  when Mayor Adams and Comptroller Lander took office. Issuing social bonds is a creative strategy that enables the city to take advantage of the demand for investment opportunities while addressing policy objectives, such as making the city more affordable. The first two social bond issuances totaled $1.1 billion and helped to finance nearly 7,800 affordable housing units. S&P Global Ratings provided an independent opinion for each of the three transactions, affirming that the bonds are aligned with the International Capital Markets Association’s Social Bond Principles, which support the financing of projects — like affordable housing — that seek to achieve positive social outcomes.

This bond offering comes after another record-breaking year for the production of affordable housing in New York City, and follows passage of the Fiscal Year 2025 Adopted Budget wherein Mayor Adams and the City Council agreed to invest an additional $2 billion in the capital budgets of the New York City Department of Housing Preservation and Development (HPD) and the New York City Housing Authority — bringing the city’s investment in affordable housing to a record level of $26 billion over the current 10-year plan. The Adams administration has pledged to use every possible tool to deliver more affordable housing for New Yorkers, with a bold “moonshot” goal of building 500,000 new homes by 2032.

Net proceeds from the upcoming sale of social bonds will be used to reimburse prior spending by the city under HPD’s Extremely Low-and Low-Income Affordability (ELLA) program, Senior Affordable Rental Apartments (SARA) program, and Supportive Housing Loan Program (SHLP). The projects being financed are expected to provide an estimated 2,008 units under the ELLA program, 744 units under the SARA program, and 1,597 units under the SHLP program. Over 80 percent of newly constructed units being financed are for households earning 60 percent of area median income (equal to $93,180 for a family of four) or below. Additionally, 1,713 of the total units — nearly 40 percent — will provide housing for individuals and families formerly experiencing homelessness.

In addition to the social bonds, the city also intends to sell approximately $680 million of non-labeled taxable fixed-rate bonds to finance capital projects.

Subject to market conditions, pricing for both the social bonds and non-labeled bonds will take place on Wednesday, October 9, 2024, via negotiated sale through an underwriting syndicate led by joint senior managers BofA Securities and Blaylock Van, with J.P. Morgan, Jefferies, Loop Capital Markets, Ramirez & Co., Inc., RBC Capital Markets, Siebert Williams Shank, and Wells Fargo Securities serving as co-senior managers.

Permits Filed for 269 Van Cortlandt Avenue East in Norwood, The Bronx

Permits have been filed for an eight-story residential building at 269 Van Cortlandt Avenue East in Norwood, The Bronx. Located between Bainbridge Avenue and Rochambeau Avenue, the lot is near the Norwood subway station, serviced by the D train. Shimshon Grunstein of AFS Systems Inc. is listed as the owner behind the applications.

The proposed 75-foot-tall development will yield 17,982 square feet designated for residential space. The building will have 30 residences, most likely rentals based on the average unit scope of 599 square feet. The masonry-based structure will also have nine enclosed parking spaces.

Nikolai Katz Architect is listed as the architect of record.

Demolition permits will likely not be needed as the lot is vacant. An estimated completion date has not been announced.