WLC has been very active in the Medicare Advantage space. In one instance, we worked with two clients to file a qui tam lawsuit under the False Claims Act. The case, filed in 2020, is captioned United States ex rel. Butler, et al., v. Shikara, et al., No. 20-cv-80483 (S.D. Fl.) and included several Medicare Advantage insurers, as well as an insurance brokerage, provider group, and a physician, as defendants.
Our clients both worked at the defendant insurance brokerage, Well-Life Group, LLC. Though ostensibly owned by his wife, our clients alleged that the brokerage was controlled by Dr. Mazin Shikara, who himself owned and controlled a large primary care practice and management services organization. Based on their experience at the brokerage, Butler and Philipp alleged that several Medicare Advantage insurers knowingly paid Dr. Shikara and his organizations to enroll patients in their Medicare Advantage plans. Our clients asserted that such conduct violated the Anti-Kickback Statute and led to the submission of tainted (and thus, false) claims to Medicare for enrollees.
As WLC partner Erica Blachman Hitchings notes:
It was a true privilege to work with two clients who were willing to alert the government to misconduct that targets the ever-growing number of seniors opting for Medicare Advantage plans.
This is particularly true because these clients came forward in 2020, well before the U.S. Department of Health and Human Services issued a Special Fraud Alert warning about the dangers of kickbacks to brokers in exchange for referrals in the Medicare Advantage marketplace. The allegations in this case fall squarely within the concerns that HHS-OIG identified in its 2024 Special Fraud Alert.
A Medicare beneficiary often relies on — and trusts — their insurance agent to direct them to insurance plans and providers that best fit their needs. When, as alleged here, an agent’s recommendation is “skewed” by an illegal kickback, Medicare enrollees can face “significant and detrimental consequences.”
We take great pride in not only turning out great legal work product, but in helping our clients understand and level-set through each step of a long journey. Reflecting on the experience, client Brian Butler noted:
Erica demonstrated exceptional expertise—particularly regarding Medicare Advantage Plans (‘Part C’)—and a depth of knowledge in this area that stood apart from most other attorneys I consulted. She was consistently accessible throughout the process and took the time to walk us through each step of the case, explaining complex issues in a clear and reassuring way. Her initial filing of the complaint laid critical groundwork that ultimately contributed to a successful outcome.
While WLC is proud to have represented Butler and Philipp from “Day 1,” the entire process has been a team effort. In addition to an early collaboration with McCabe Rabin, WLC was grateful to work hand-in-hand with Amy Easton and Jeffrey Dickstein of Phillips & Cohen LLP, as well as Scott Terry and Chris Gray of Florin Gray.
Notably, Florin Gray handled the litigation following the government’s decision to not intervene in the case. This included an intensive period of discovery, as well as successfully fending off several motions to dismiss and a motion for summary judgment.
WLC attorney Erica Blachman Hitchings notes:
The Florin Gray team dove right into the case, working tirelessly for the next two years to achieve this resolution. It was a true privilege to collaborate with Scott and Chris. Their litigation prowess, endless work ethic, and deep commitment to the clients was evident day in and day out.
In addition, we appreciate the continued engagement of the Department of Justice, which monitored the litigation, filed two statements of interest, and reviewed the settlement before consenting to dismissal of the claims.
The matter resolved before trial, with no determination of liability.