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Common Types of
Fraud:



|
Fast
Facts
about
the
FCA
|
|
The Government Counts on Whistleblowers:
More than
80 percent of the False Claims Act cases that are now
pursued by the U.S. Department of Justice are initiated by
whistleblowers. |
|
Cheaters Pay Whistleblower Awards: Companies cheating the U.S. Government pay whistleblower
rewards – not one dime comes from U.S. taxpayers.
The reason for this is that the False Claims Act calls for
triple damages so that the Government can be made whole, not only
by recouping the cost of whistleblower awards, but also by
recovering the cost of investigations, prosecutions, and
lost interest. |
|
Big
Cases Require Big Investments: Big fraud cases prosecuted under the False Claims Act
often require many years of litigation and investigation.
For example, the whistleblower in the first Columbia-HCA
fraud case spent 13 years pursuing his False Claims Act
lawsuit. The law firm that spearheaded this case invested
more than 85,000 hours in
the case. In the end, the various frauds perpetrated by
Columbia-HCA returned over $1.5 billion to the U.S.
Treasury.
|
|
Frivolous Lawsuits are Discouraged:
Because most False Claims Act lawyers work on a contingency
basis, they only get paid if they win. This means that they
are unlikely to invest time, money and energy building a
case that they themselves do not feel will be productive.
In addition, under the False Claims Act, a complainant can
be required to pay the defendants attorney’s fees if the
court finds that the claim was frivolous or brought
primarily for purposes of harassment.
|
|
The
False Claims Act Provides Some Employment Protections:
If an employee is fired, demoted, harassed, or otherwise
discriminated against for filing a False Claims Act suit,
the law provides for reinstatement, double back pay, and
compensation for special damages, including litigation costs
and reasonable attorneys’ fees.
|
|
Drug Company Frauds are Pervasive and Large:
Over 180 pharmaceutical fraud cases, covering more than
500 drugs, are now under
investigation by the U.S. Department of Justice under the
False Claims Act.
Settlement of just 16 drug
manufacturing cases
returned over $4 billion
to the U.S. Government and the 50 states.
|
|
Routine Mistakes and Errors
are Not Prosecuted Under the False Claims Act:
The False Claims Act is not used to correct minor billing
mistakes or errors, as these frauds are not systematic and
rarely amount to truly large sums of money.
|
|
Major
Cases Under Watch:
|
|
Nominal Pricing Fraud:
FCA cases involving
violations of the nominal pricing exception have been
filed. Possible cases involve statins, proton pump
inhibitors, non-steroidal anti-inflammatory drugs, and
others.
Iraq War Fraud:
Numerous large cases
dealing with contractor fraud in Iraq are reported to be
under investigation, but remain under seal.
Anti-Psychotic Drugs:
Investigations
about the off-label marketing of Zyprexa, Risperdal and
Seroquel are under way. These three drugs
represented combined sales of $12 billion in
2006.
Average Wholesale Price Fraud:
The U.S. Government
has joined three cases likely to go to trial this summer:
Abbott, Dey and Roxane Pharmaceuticals. More than 50
other companies face similar charges in Boston.
Outlier
Fraud: Several large outlier fraud investigations against hospitals
are under investigation.
|
|
Newsletters |
August
20,
2010
n
WellCare to
Settle for $137 Million?
n
Nelnet to Pay $55
Million
n
Grand
Canyon Education Pays $5.2 Million
n
States Strengthen
False Claims Acts
n
The Pharma Fraud
Show
n
Indiana A.G. Calls for More Whistleblowers to
Come Forward
August 5,
2010
n
HP to Pay $50
Million
n
At Tenet, It's Déjà Vu All
Over Again
n
Privatizing the Profit
n
For Profit Colleges Encouraging Fraud
July 26,
2010
n
Teva
Pharmaceuticals Pays $169 Million
n
Whistleblower
Incentives Key to Financial Reform
n
Sodexo School
Lunch Fraud
n
A Missing
$8.7 Billion in Iraq
July 20, 2010
n
Elan Says It Will Settle for Over
$203 Million
n
The Payola Room
n
HHS Wants to Exclude Executives
n
National Cardio Labs Pays $3.6
Million
n
Planned Parenthood Case Reinstate
June 28,
2010
n
Wellcare
Health Plans
FCA Case Is Unsealed
n
Northrop
Pays $12.5 Million
n
Indiana
to Join FCA Lawsuit
n
Dry
Milk Diversion FCA Lawsuit
June 22,
2010
n
HHS Wants to Exclude Executives
n
Colorado Passes FCA
n
Supreme Court Rejects Cert
n
U.S. Joins Suit Against Oracle
n
IRS Whistleblower Web Site
June 7,
2010
n
Tuomey Must Pay $45 Million
n
St. Jude's Kickbacks
n
University of Texas Under
Investigation
n
SBA Lender to Pay $26 Millio
May 14,
2010
n
Eric
Holder Brags on Success
n
Whistleblowing
Isn't Easy or Fun
n
Novartis to
Pay $72 Million
n
SBA
Lender to Pay $26 Million
n
Novartis to
Pay $72 Million
n
U.S.
and 33 States Join FCA
Case Against Wyeth
April
30, 2010
n
AstraZeneca to Pay
$520 Million
n
Ortho-McNeil to
Pay $81 Million
n
Schwarz to Pay $22
Million
n
Grassley Cautions
OIG, States
April 19, 2010
n
Maryland False
Claims Act Signed Into Law
n
Guidant to Pay
$296 Million
n
Abbott Must
Produce Emails
n
Learning Tree to
Pay $4.5 Million
n
An American Scheme
April 6, 2010
n
ExxonMobil to Pay
$32 Million for Fraud... and No Taxes in FY 2009
n
DoJ Joins Against
KBR in Iraq
n
SD
of NY
Forming Civil Fraud Unit
n
Whistle-blowers
Find More Fraud than Regulators
n
NJ Hospital to
Pay $6.35 Million
March 23, 2010
n
Health
Care Bill Strengthens False Claims Act:
Bill Sharpens Teeth of Primary Federal
Fraud-fighting Tool
March
18, 2010
n
Alpharma to Pay
$42.5 Million
n
Mass. Joins Suit
Against J&J
n
Stimulus Under
Investigation
n
DoJ Needs More
Resources
n
Davis Bacon Triggers an FCA
March
8, 2010
n
EMC to Pay $87.5 Million
n
Two Nursing Homes Settle
n
Healthcare is Over
50 Percent Waste and Fraud?
n
Swedish Rubber Co.
to Settle
n
Staffing Firm
Prepares for Possible Settlement
n
Christiana
Care Health
Systems
Settles for $3.3
Million
n
Brookhaven
Memorial
Hospital Medical Center
to Pay $2.92
Million
n
New True Crime
Thriller on the Bernie Madoff Fraud
February
23, 2010
n
Teva Pharmaceuticals to Pay $315
Million
n
Massive PVC Pipe Fraud Leads to Federal, State & Local Cases
n
Eon Labs Pays U.S. $3.5 Million
n
Hospital to Pay $2.79 Million
n
Lincoln Law Collects in Lincoln Fabric Fraud Case
February 3, 2010
n
Novartis To
Plead Guilty
n
Major Drug Cases
in the Wings
n
Will Stimulus
Money See Repeat Players in the Game of Fraud?
n
Atricure to Pay
U.S. $3.76 Million
n
A Smoking Gun
PowerPoint
January 25, 2010
n
DoJ Joins
Case Against Johnson & Johnson
n
Bile Stents Marketed
Off-label
n
Boston
Scientific To Pay $22 Million
n
New Jersey FCA
Used to Go After Fraud at Methadone Clinics
n
Dental Company
Nailed for $24 Million Medicaid Fraud
n
Iraq Fraud
Settlement on Horizon?
January 13, 2010
n
Chevron to
Pay $45 Million
n
First IRS
Whistleblower Payment
n
Physicians to Pay
$9.5 Million
n
St. John to Pay
$13 Million
n
Lamborghinis and
Yachts
December
22, 2009
n
University of Phoenix to Pay $78.5
Million
n
Schering-Plough Pays $69 Million
n
NY Home Health Fraudsters to Pay $24
Million
n
Our Lady of Lourdes
Health Care Services to Pay $8 Million
December
4, 2009
n
Four Companies pay $39 Million
to Settle California Whistleblower Case
n
NJ Hospital Pays $3 Million
n
Sports Clinic Pays $3 Million
n
Three FCA Cases In Orbit
November
24, 2009
n
DoJ
Recovers Over $5.6 Billion But Announces Just $2.4 Billion
n
S upreme
Court Takes Up FCA Case
n
Merck Wins Summary Judgment
n
DoJ Joins Katrina-related Suit
n
NJ Hospital to Pay $3 Million
November
17, 2009
n
Massive
Food Fraud in
Iraq
n
$47 Billion in Medicare
Bad Billing?
n
Tenet's Sulzbach vs. the U.S.
n
Lilly
to Pay Utah $24 Million
n
Whistleblower
Given No Credit
November
10, 2009
n
Guidant Agrees to Pay $296
million
n
Omnicare and Ivax Pay $112 Million for
Kickbacks
n
Defective
Bunker Buster Fuses
n
Abbott Faces Depakote Probe
n
An SEC Whistleblower Bill on the
Horizon?
November 2, 2009
n
Astra Zeneca Reserves $520 Million for
Seroquel Settlement
n
Fifteen
States Join Amgen FCA
n
Enforcement Resources Needed
n
Texas
Hospital Group to Pay $27 Million
n
Senators Introduce
Anti-Fraud Bill
n
Stryker
Biotech Indicted Over Product Promotion
n
Energy Saving Fraud?
n
Apollo
Reserves $80.5 Million
October 20, 2009
n
Massive California Pension
Fraud Alleged
n
Mylan
to Pay $121 Million
n
MPC Products to Pay $25 Million
n
AstraZeneca Hit With $14.7
Million Verdict in Kentucky
n
Alabama Supreme Court Overturns Three Jury
Verdicts Against Pharma
n
E-Rate Fraud Settlement
n
Over 1,000 Qui Tams in Backlog
n
IRS Whistleblower Stats
October 15, 2009
Taxpayers Against Fraud
2009 Award Winners
n
Lawyer of the Year:
Frederick
M. Morgan, Jennifer M. Verkamp,
Scott A. Powell, and Don McKenna
n
Whistleblower of the Year:
Thomas Cantor
n
Honest Abe Integrity in
Government Award to Senator Patrick Leahy (D-VT) and Congressman James
Sensenbrenner
September
30, 2009
n
Lilly settles with Eight States
n
More Kyphon Settlements
n
Alan Grayson on Bigger Fish
n
Payola Politics and the FDA?
n
Nelnet Whistleblower
n
Fruit
Company Settles FCA
n
CRS on
the FCA
September 22, 2009
n
Arizona
Settles AWP Drug Cases
n
SAIC Faces Potential $230 Million
Liability n
Massachusetts Sues
Housing Developer n
Pinkerton to
pay $1 million in FCA case
September 15, 2009
n
Biovail to Pay $25 Million
n
An
FCA for Wall Street?
n
Top 15 Drugs Sales in 2008
September 2, 2009
n
Pfizer Settles Largest False Claims Act
Case Ever
August
25, 2009
n
Quest Diagnostics Pays Another
$12.5 Million
n
Covenant Pays $4.5 Million
n
Jim Sheehan Seeks Dead People
n
Convicted Murderer Pleads
Guilty to Medicare False Claims
n
GPOs
Under the Glass
August 14, 2009
n
Westchester Must Build
Housing to Help End Discrimination
n
Boeing
to Pay in Two Cases
n
Dynamics to Pay $15 Million
n
Katrina Case Moves Forward
n
Profile In Integrity
August 6, 2009
n
State Zyprexa Deal in the
Wings
n
Baxter Pays
$6.8 Million to
IL
n
Computer Assets to Pay $350,000
n
Tulare Healthcare Settlement
n
Allegran's Botox Problem
July 21, 2009
n
NY State and NY City Pay Record Medicaid
Settlement n
Excluded Doc Bills Millions
n
Lockheed Faces Suit Over F-35
n
Spinal Fraud on National Scale
n
Florida Doctor Pays $1.7 Million
n
Foreign Banks Kick Out U.S. Tax Cheats
n
Six-fold FCA Dam
July 14, 2009
n
The F-22's Defective Skin
n
Burn Bags Mean Smoke and Fire
n
An SEC Whistleblower Program?
n
Michigan Medicaid Inspector General?
n
Did DoJ Settlement With Beazer Send the
Wong Message? n
Robbing Medicare and Medicaid Is Better
Than Robbing Banks
July 7, 2009
n
DoJ Joins Suit Against
SAIC
n
Massive DME Fraud Scheme
n
Yale Hospital Pays $3
Million
n
Beazer to Pay Many
Millions
n
LSU Pay $700,000
n
An SEC Whistleblower
Program?
June 30, 2009
n
Major
Settlements Ahead
n
Major
Cases in the Backlog
n
Major Cases
Settled So Far This Year
June 16, 2009
n
Bone Growth Fraud?
n
DoJ Files on Mortgage Fraud
n
WV Seeks $2 Billion from Lilly
n
New Jersey University Pays $2
Million for Double Billing
n
Oklahoma Ortho Center to Pay $3.5
Million n
Hawaiian Hospital Settles FCA
June 3, 2009
n
Aventis Settles for $95.5 Million
n
Pogue Case Against Healthways
Settles for $40 Million
n
Crooks Worry About Tougher FCA
n
Senator Charles Grassley on
Bipartisan Support for Amendments to the False Claims Act
n
Documents Show AstraZeneca Off-label
Marketed Seroquel n
URS Unit Pays $1.7 Million
n
Alabama Hits Hard
May
22, 2009 n
President Signs False Claims Act
Amendments Into Law n
AstraZeneca Faces Heat
n
DoJ's Tony West Says FCA Enforcement
a High Priority n
Regency Pays $4 Million
n
HealthEast to Pay $2.3 Million
n
Minnesota Gets a State FCA
May
12, 2009
n
President
Signs False
Claims Act Amendments Into Law
May
12, 2009
n
House Strengthens FCA
n
DoJ Joins Lawsuit Against Wyeth
over Protonix
n
More For Your Money With the FCA
n
DoJ Budget Increase
n
The High Cost of Low Morals
May
6, 2009
n
House Passes
Fraud Enforcement and Recovery Act:
367 to 59
u
The Complete Newsletter Index
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|
WellCare
to Settle for $137 Million?
WellCare Health Plans
says it has reached a $200 million settlement in a
class-action lawsuit and
a
$137.5 million preliminary deal with the U.S.
Department of Justice Department on False Claims Act
charges. The company paid $80 million last
year to settle a Florida Medicaid fraud case.
The current FCA case was brought by
former WellCare
analyst Sean Hellein who wore a wire for 18 months
as part of an undercover investigation which
produced more than 1,000 hours of audio and video
surveillance. Hellein's FCA complaint claimed
WellCare stole $400 million to $600 million, and
notes the company held a celebratory dinner to
honor those who successfully disenrolled 425 infants.
>>
To read more
|
Aug. 20, 2010
|
|
Nelnet
to Pay $55 Million
Nelnet has agreed to pay $55 million to settle a
False Claims Act case alleged the company had
defrauded the government as part of a student loan
subsidy program.
The lawsuit was brought by former
U.S. Education Department specialist Jon Oberg.
>>
To read more
|
Aug. 20, 2010
|
States
Strengthen False Claims Acts
New York and
Illinois have strengthened their state False Claims Acts
to comply with the federal government's Fraud
Enforcement and Recovery Act (FERA). The New York
Act,
spearheaded by
Senator Eric. T.
Schneiderman,
now also allows qui tam plaintiffs to bring
actions for tax fraud when the net income or sales of
the defendant total $1 million or more and the damages
pleaded in the action exceed $350,000.
|
Aug. 20, 2010 |
The
Pharma Fraud Show
The Bureau of
Investigative Journalism has put together a 25-minutes
video which notes that "the United States healthcare
industry is the world’s biggest –
with $300 billion a year spent on prescription drugs
alone, and rising. But recent months have seen health
scandal after health scandal, with some of the world’s
biggest pharmaceutical companies fined billions of
dollars These cases are beginning to reveal vast
corruption in the drug industry, with revelations of
fraud, of cover-ups of fatal side effects and huge
kickbacks paid to doctors." >>
To see the video
|
Aug. 20, 2010 |
At Tenet, It's Déjà Vu All
Over Again
Tenet may be in deep trouble again. The company,
which has repeatedly had the largest False Claims Act cases ever
settled, is now under investigation for
billing Medicare for heart
defibrillator implant surgeries. The case (or cases) appear to
be related to DoJ investigations of
Medtronic
and St Jude Medical for matters surrounding implantable cardiac
defibrillators.
Tenet said it anticipates that more
of its hospitals may receive similar information requests,
suggesting a wide-spread pattern of kickbacks.
>>
To read more
|
Aug. 5, 2010 |
HP
to Pay $50 Million
Hewlett Packard Co.
says it has reached a settlement agreement in principle with the
U.S. Department of Justice to resolve an investigation into alleged
kickbacks paid between HP, Sun Microsystems, and Accenture. HP
will pay about $50 million to settle two lawsuits alleging HP
submitted false claims to the U.S. government. >>
To read more
|
Aug. 5, 2010 |
Whistleblower
Incentives Key
to Financial Reform
The new financial reform bill signed into law by
President Obama, provides for a
whistleblower awards of 10 to
30 percent of what the government recoups in fines and
settlements in financial fraud cases, provided the whistleblower
comes forward with original information to the SEC.
>>
To read more
|
July 26, 2010
|
Sodexo
School Lunch Fraud
Sodexo has agreed to pay
$20 million to settle a False Claims Act case
involving pocketed food service rebates
involving 21 New York school districts and the
State University of New York system. NY
Attorney General Andrew Cuomo is investigating
the rebating practices of other corporate food
service providers. >>
To read more
|
July 26, 2010
|
Teva
Pharmaceuticals Pays $169 Million
Teva Pharmaceuticals has agreed to pay $169 million to
the Federal government,
Texas,
Florida and California in order to settle a False
Claims Act case filed by Ven-a-Care of the Florida Keys
charging the company with violating Medicaid best-price
rules. |
July 26, 2010 |
|
Elan Says It Will
Settle for Over $203 Million
The Elan Corporation says
it has
reached an agreement in principle with the U.S. Department of
Justice to settle a False Claims Act case dealing with the sales
and marketing of Zonegran, an antiepileptic prescription
medicine.
Elan has
set aside $206.3 million in a
litigation reserve.
>>To
read more
| July 20, 2010
|
HHS
Wants to Exclude Executives
The Office of the
Inspector General of
Health and Human Services says it
is finding support for legislation that would allow it
to exclude any worker — past or present — found
responsible for Medicare fraud.
Lew
Morris, chief counsel for the
Office of Inspector General (OIG),
says it's time to exclude executives
who greenlight massive fraud schemes under their watch.
>>
To read more
|
July 20, 2010 |
Whistleblowing
Isn't Easy or Fun
An article by Aaron S. Kesselheim
and co-authors, in the May 13 issue of the
New England Journal of Medicine,
notes that False Claims Act whistleblowing isn't easy, with most relators
losing their jobs, and other experience extreme economic, marital,
and psychological stress. >>
To read the report
| May 28, 2010 |
Eric
Holder Brags on Success
At a recent
health care fraud press conference held with HHS Secretary
Kathleen Sebelius, Attorney General Eric Holder
noted that DoJ was prosecuting record numbers of health care
fraud cases and that the Civil Division
"opened nearly 900 new civil
health care fraud investigations and had more than 1,100 pending
cases." >>
To
read more
| May 28, 2010
|
Novartis to
Pay More Than $72 Million
Novartis Vaccines &
Diagnostics, and Novartis Pharmaceuticals, have agreed
to pay over $72 million to
settle a False Claims Act case charging a predecessor
company, Chiron,
with off-label
marketing of the cystic fibrosis drug TOBI. The
federal share of the
settlement is
$43.5 million, with
$29 million go to the
states. >>
To read more
| May 28, 2010 |
Ortho-McNeil
to Pay $81 Million
Ortho-McNeil-Janssen has agreed to pay $81 million to
settle False Claims Act charges that the company was
engaged in off-label marketing of Topamax, a drug approved
to treat seizures. The FCA complaints allege
Ortho-McNeil paid doctors kickbacks to prescribe the
drug for such off-label uses as eating disorders, weight
loss, alcohol dependence, and anxiety disorders.
Whistleblowers
Angela Maher and
Anastasia Savka-Klovski
and
Dr. Gary R. Spivack will share in the relator
awards.
>>
To read more >>
Complaint
and
settlement.
| April 28, 2010 |
Schwarz
Pharma to Pay $22 Million
Schwarz Pharma Inc.
will pay $22 million to settle a False Claims Act case
charging the company with marketing two unapproved
drugs, Deponit and Hyoscyamine Sulfate Extended Release
(Hyoscyamine Sulfate ER). The
federal
share of the settlement is $12.24 million, and the state
Medicaid share of the settlement is $9.76 million. Under
the settlement, the two whistleblowers,
Constance Conrad and James Conrad will receive a
total of $1,836,575 from the federal share and
additional amounts from the state share.
| April 28, 2010 |
|
AstraZeneca
to Pay $520 Million for Seroquel
AstraZeneca has agreed to pay $520 million to settle a
False Claims Act case charging the company with
off-label marketing of the atypical anti-psychotic drug
Seroquel. Three previous off-label atypical
anti-psychotic drug cases have already settled (Lilly's
Zyprexa, Johnson & Johnson's Risperdal, and
Bristol-Myers Squibb's Abilify). In this
settlement,
the
federal government will
receive $302 million and the states will receive $218
million. The two relators in the case were
Dr. Stefan Kruszewski
and
James Wetta. This is
the largest purely civil off-label marketing settlement.
>>
To read more.
>> To read the
complaint or
settlement
| April 27, 2010 |
Maryland
False Claims Act Signed Into Law
On April 13,
Maryland
Governor Martin O'Malley
signed into law the Maryland False Claims Act which
lawmakers expect will save the state millions of
dollars. Twenty-six states and the District of
Columbia now have
state False Claims Acts.
Lt. Gov. Anthony Brown,
who led the O’Malley Administration’s efforts to pass
the Maryland FCA, said the new law will put Maryland “in
a better position than most states to implement national
health reform.”
>>
To read more
| April 19, 2010 |
Abbott
Must Produce Emails
Abbott Laboratories must produce emails written over the
course of a 12-year period by its CEO and two others in
a Depakote probe involving off-label marketing and
kickbacks. >>
To read more
| April 19, 2010 |
Guidant
to Pay $296 Million
Guidant had
pled guilty to criminal
violations of the Federal Food, Drug and Cosmetic Act
for failing to report "catastrophic failures" in three
models of its surgically implantable heart
defibrillators. >>
To read more
| April 19, 2010 |
Alpharma
to Pay $42.5 Million
Alpharma Inc. has
agreed to pay
$42.5
million to settle a
False Claims Act case charging the company
with kickbacks in connection with the sale of
morphine-based drug, Kadian. The drug company also
misrepresented the safety and efficacy of the drug.
Though a settlement has been reached,
HHS has
expressly
reserved the right
"to institute, direct, or to maintain any administrative
action seeking exclusion against Alpharma and/or King,
and/or their officers, directors, and employees, from
Medicare, Medicaid, and all other Federal health care
programs." >>
To read more
| March 18, 2010 |
|
Novartis
To Plead Guilty With
$397 Million
in Litigation Reserves
Swiss drug maker Novartis has said it will plead guilty
to criminal fraud charges related to the company's
off-label promotion of the epilepsy drug Tripletail, and
will pay a $185 million fine. Novartis' Trileptal
problems are only part of the equation, however;
Novartis is also being investigated for kickbacks and
off-label marketing related to Diovan, Exforge,
Sandostatin, Tekturna and Zelnorm. In a sign that
a global settlement may be at hand, Novartis has said
that it has increased its litigation reserve from $318
million to $397 million.>>
To read more
| Jan 25, 2010 |
|
DoJ
Joins Case Against J & J
DoJ has joined two False Claims Act cases against drug
manufacturer Johnson & Johnson and its subsidiaries,
alleging the companies paid millions in kickbacks to
Omnicare in order to get Omnicare to operate as an
"extension of [Johnson & Johnson] sales force" in
dispensing the anti-psychotic drug Risperdal to nursing
home patients. >>
To read
more
| Jan 25, 2010 |
|
Chevron
to Pay $45 Million
Chevron has
said it will pay $45.5 million to settle a False Claims
Act case charging the company with underpaying royalties
for natural gas pumped from wells on federal and Indian
land.
The lawsuit was originally filed in 1996 by
Harrold
Wright, who is now deceased. Mr. Wright's $12.3 million
relator's share will go to his heirs.
>>
To read more
| Jan 13, 2010 |
|
First
IRS Whistleblower Payment
The law offices
of Kenney & McCafferty report the first major IRS
Whistleblower Office payment of $5.5 million to one of
their clients for his work
in reporting a major tax fraud seven years ago. This is
a partial payment; even more money is to be recovered
ahead! >>
To read more
| Jan 13, 2010 |
|
Dental
Company Nailed for
$24 Million Medicaid Fraud
National Dental Management Company has agreed to
pay $24 million to resolve three FCA cases charging the
company with billing for medically unnecessary dental
services performed on children insured by Medicaid.
Three relators will split $2.4 million from the federal
share of the settlement. >>
To read more
| Jan 25, 2010 |
|
Big
Iraq Settlement on Horizon?
A $600 million Iraq war fraud settlement may be on the
horizon. Kuwait's Public Warehousing Company (also known
as Agility) appears to have told Kuwaiti newspaper
Al-Qabas that the company expects to pay between
$500 million and $600 million to settle a food-fraud
case, provided the U.S. Government agrees to the terms.
>>
To read
more
| Jan 25, 2010 |
|
Boston
Scientific To Pay $22 Million
Boston
Scientific has agreed to pay $22 million to resolve
a False Claims Act case in which its Guidant
subsidiary was charged with paying kickbacks of
$1,000 to $1,500 to doctors in order to get them to
use their heart pacemakers. >>
To read more
| Jan 25, 2010
|
University
of Phoenix to Pay $78.5 Million
The
University of Phoenix has agreed to pay
$67.5 million
to the U.S. Government, plus $11
million in private attorneys’ fees, to settle a case
filed by two whistleblower who accused the school
of violating Dept. of Education rules prohibiting
schools from accepting federal student financial aid
while paying admissions counselors cash incentives based
on the number of students recruited. This is the
second-largest FCA settlement in a non-intervened case.
>>
To read more
| Dec 22, 2009 |
|
Schering-Plough
Pays $69 Million
Schering-Plough has
agreed to pay $69 million to
settle FCA lawsuits in which the company is charged with
inflating the price of Albuterol and other drugs in order to
collect millions of dollars in overpayments from California and
Florida's Medicaid programs. The lawsuits were filed by
Ven-A-Care of the Florida Keys on behalf of California, Florida,
and the federal government, and were 11 years coming to
resolution. >>
To read more
| Dec 22, 2009 |
|
New
York City Home Health Care
Companiesto Pay $24 Million
Three New York City home
health agencies have
agreed to pay $24
million to settle False
Claims Act cases
charging the companies
with overcharging
Medicaid for services
provided by hundreds of
home health aides who
had little or no
required training.
>>
To
read more
| Dec 22, 2009
|
Our
Lady of Lourdes Health Care
Services to Pay $8 Million
Our Lady of Lourdes Health Care Services Inc., the
parent company of two New Jersey hospitals, has agreed
to pay $8 million to resolve allegations the hospitals
defrauded Medicare by unnecessarily inflating charges to
obtain “outlier payments.” >>
To read
more
| Dec 22, 2009 |
|
DoJ
Recovers Over $5 billion But Announces Just $2.4
Billion in "Official" FCA Recoveries
Fiscal Year 2009 has been a record year in False Claims
Act recoveries, with
well over $5.6
billion in overall recoveries announced.
So why do "official"
DoJ numbers
show only $2.4 billion in False
Claims Act recoveries?
Simple: The U.S. Department of Justice
does not count criminal recoveries (in the
Pfizer matter alone, this was $1 billion), nor do they
count money disbursed to the states in settlements
(about 45% of all money collected in Medicaid cases),
nor do they count money not actually collected this
Fiscal Year. Bottom
line: Total "official" False Claims Act
recoveries in 2009 were $2.4 billion, though more than
$5 billion in False Claims Act case recoveries were
announced by Uncle Sam and the States. |
Nov 19, 2009
|
|
Omnicare
and Ivax Pay $112 Million;
DoJ Proceeds Against Nursing Home
Chains
DoJ has announced a $112 million settlement with
Omnicare, to resolve
multiple whistleblower lawsuits related to kickbacks.
The FCA lawsuits allege
Johnson & Johnson
paid Omnicare and
two nursing home
chains so doctors would prescribe Risperdal,
an antipsychotic drug, to nursing home patients
for which it was an improper medication. In
addition,
IVAX
Pharmaceuticals paid $8 million in kickbacks
to Omnicare
to facilitate a drug-switching scheme. Finally,
Omnicare, and two nursing
home chains conspired to have Omnicare pay $50 million in
exchange for Omnicare getting the contract to deliver
pharmacy services to the nursing homes. >>
To read the DoJ
Press Release
| Nov 3, 2009 |
|
Fifteen
States Join Amgen CA
No longer content to always let
Uncle Sam lead in the war against fraud, 15 state Attorneys
General have come out swinging, joining a massive False Claims
Act lawsuit against Amgen, charging the company with a
systematic program of kickbacks designed to increase Medicaid
costs through the illegal promotion of anti-anemia drug Aranesp.
>>
To read more
| Nov 2, 2009 |
|
Texas
Hospitals to Pay $27 Million
South Texas Health Systems has
agreed to pay $27.5 million to settle claims it paid kickbacks
to doctors who referred patients to hospitals within the group.
Whistleblower
Bruce Moilan will receive $5.5
million for his help in prosecuting the case.
>>
To read more
| Nov 2, 2009 |
|
Senators
Introduce
Anti-Fraud Bill
Senators
Patrick Leahy (D-VT), Senators Arlen Specter (D-PA), Ted Kaufman
(D-DE),
Herb Kohl (D-WI), Chuck Schumer (D-NY) and Amy Klobuchar (D-MN),
have introduced the
Health Care Fraud Enforcement Act of 2009 which would increase
sentencing guidelines for health care fraud, clarify that health
care crimes are considered fraud no matter where they are
codified in the law, clarify that health care kickbacks are
false claims under the False Claims Act, and restore the
original intent as to scienter, while increasing antifraud
enforcement funding by $20 million per year
through 2016. >>
To read more
| Nov 2, 2009 |
|
Stryker
Faces Promotion
Investigation
A federal grand jury has
indicted
Stryker Biotech in a case involving two devices made for
spinal and long bone surgeries which were promoted
for applications that were not approved by the FDA.
>>
To read more
| Nov 2, 2009
|
|
Apollo
Reserves $80.5 Million
The University of Phoenix
(Apollo Systems) has taken a pre-tax charge of $80.5 million in
expectation of settling an FCA case dealing with
illegal incentive
recruitment.
In FY
the University of
Phoenix derived 86 percent
of $3.77 billion in revenue from federal grants and loans,
up from 48 percent in 2001.
>>
To read more
| Nov 2, 2009
|
|
Massive
California Pension Fraud Alleged
California
Attorney General Jerry Brown has joined a False Claims Act suit
against
State Street
Bank
alleging almost $200 million in illegal overcharges and
penalties charged to
CALPERS, the largest U.S. defined-benefit public
pension fund, and the California State Teachers’ Retirement
System. >>
To read more
| Oct 20, 2009 |
|
Mylan to Pay $121
Million
Mylan, a generic drug maker, has
agreed to pay $121 million to settle a long-standing False
Claims Act case brought by Ven-a-Care of the Florida Keys.
>>
To read more
| Oct 20, 2009 |
|
MPC Products Corp. Pays $25 Million
MPC Products, a Skokie,
Illinois defense contractor which supplies the military with parts used
in fighter jets and helicopters, has agreed to pay a fine and
damages totaling $25 million to resolve allegations it overcharged the
government for more than a decade. The whistleblower in
this case, Joe Caputo, will receive $4.5 million as his share of
the award. >>
To read more
| Oct 20, 2009 |
|
$14.7 Million
AstraZeneca Verdict in KY
AstraZeneca has been hit with a $14.7 million
jury verdict in Kentucky for inflating the cost of prescription
drugs sold to the state's Medicaid program. This was not a False Claims Act case, as Kentucky still has
no state False Claims Act. >>
To read more
| Oct 20, 2009 |
|
Alabama Supreme
Overturns
Three Jury
Verdicts Against Pharma
Without benefit of hearing oral argument, the
Alabama Supreme Court has overturned
three jury verdicts against AstraZeneca
($215 million reduced post-trial to $160 million), GlaxoSmithKline
($81 million), and Novartis ($33 million). In
a 44-page opinion the
Court held there was no basis for the state's fraud claims as the
State knew that Average Wholesale Price was, in fact, not a true wholesale price
average. The court ruling does not affect the $138 million in
settlements the state has reached with other pharmaceutical
companies in the AWP litigation.
>>
To read more
| Oct 20, 2009 |
|
Over 1,000 Qui Tam
Cases in Backlog
Senator Charles Grassley (R-Iowa) notes that over 1,000
qui tam cases remain backlogged, and that of this
number, 985 are health care qui tam cases, including 200
that have to do with pharmaceutical pricing and
marketing. Another 205 qui tam cases allege
procurement fraud against the
Department of Defense. >>
To read more
| Oct 20, 2009
|
|
Pfizer
Settles Largest FCA Case Ever
Pfizer and its subsidiary,
Pharmacia & Upjohn Company have agreed to pay the U.S.
Government over $2.3 billion
to settle a series of False Claims
Act cases involving the illegal
promotion of several drugs. This is
the largest health care fraud
settlement in the history of the
U.S. Department of Justice.
Of
the $2.3 billion settlement,
$1.3 billion is a criminal fine and
forfeiture related to the fraudulent
off-label marketing of Bextra.
This $1.3 billion criminal fine is
the largest ever imposed in the U.S.
A total of $1 billion will be paid to settle civil False Claims
Act liabilities involving the
following drugs:
-
Bextra (an anti-inflammatory
drug)
-
Geodon (an anti-psychotic drug)
-
Lipitor (a cholesterol drug)
-
Norvasc (anti-hypertensive drug)
-
Viagra (erectile dysfunction)
-
Zithromax (antibiotic)
-
Zyrtec (antihistamine)
-
Zyvox (an antibiotic)
-
Lyrica (an anti-epileptic drug)
-
Relpax (anti-migraine drug)
-
Celebrex (anti-inflammatory
drug)
-
Depo-provera (birth control)
Of the $1 billion
paid to settle False Claims Act
claims, $668,514,830 will go to the
Federal Government, and $331,485,170
will go to the states.
Of the $1 billion
paid under the FCA, the sums
work out as follows:
A total of six
whistleblowers and their
attorneys will receive payments
totaling more than $102 million from
the federal share of the civil
recovery, with additional money to
flow as a result of parallel False
Claims Act cases filed at the state
level. The
six relators and their share are:
-
John Kopchinski: $51,500,999
-
Stefan Kruszewski:
$29,013,420
-
Ronald Rainero: $9,321,369
-
Glenn DeMott: $7,431,505
-
Dana Spencer: $2,743,637
-
Blair Collins: $2,354,582
Whistleblower John Kopchinski
brought off-label marketing
allegations regarding Bextra, and
his case represents $1.8 billion of
the total. Mr. Kopchinski was
represented by Washington Attorney
Erika Kelton of the law firm of
Phillips and
Cohen,
and
his relator's
share under the federal FCA is $51.5
million.
Whistleblower Dr. Stefan Kruszewsi
brought
allegations regarding the
off-label
marketing of Geodon. Dr.
Kruszewski was represented by
Pennsylvania attorneys Brian Kenney
and Tavy Deming of the law
firm of
Kenney, Egan McCafferty & Young
and
W.
Scott Simmer and Thomas J. Poulin of
Blank Rome.
Whistleblower
Glenn DeMott
brought off-label allegations
regarding Geodon,
Lyrica, Relpax, Celebrex, Bextra,
and Depo-provera. Mr.
DeMott was represented by
Grant & Eisenhofer
attorneys
Reuben Guttman,
John Kairis, and
Traci Buschner, as well as
Ann Lugbill,
Michael Anderson and
Mark Hanna of
Murphy Anderson.
Whistleblower
Blair Collins brought kickback
allegations regarding Lipitor,
Norvasc, Viagra, Zithromax, and
Zyrtec to the U.S. Government's
attention.
Mr. Collins was
represented by Boston attorneys
Suzanne E. Durrell, Robert M.
Thomas, Jr. and Rory Delaney.
Whistleblower
Ronald Rainero, represented by
Philadelphia attorneys
Stephen A. Sheller,
James J. Pepper, and Brian J.
McCormick of
Sheller P.C.,
brought
off-label
allegations regarding Zyvox.
Pfizer is not yet
out of the woods as far as the
False Claims Act is concerned.
Earlier this year, the U.S.
Government joined a case against
Wyeth involving kickbacks and
pricing violations in the sale of
Protonix, an acid reflux drug.
Pfizer acquired Wyeth in
August, and now owns that potential
liability. "
| Sept 2, 2009
|
|
NY
State and NY City Pay Record Medicaid Settlement
New York State and City have
agreed to pay
$540 million to settle
a false claims case in which the state and city were accused of
improperly billing Medicaid for student speech,
physical and occupational therapy, psychological counseling and
transportation costs. This is the largest Medicaid False Claims
Act case in history. >>
To read more (PDF)
| July 21, 2009 |
|
Forest Reserves $170 Million
Forest Laboratories has
set aside $170 million to settle a False Claims Act case related
to the kickbacks paid to doctors for off-label prescription of
the antidepressants Celexa
and Lexapro to children as well
as the off-label marketing of Levothroid. Forest
notes that "there can be no assurance that the amount
reserved by the Company will be sufficient and that a larger
material amount will not be required."
>>
To read more
|
May 5, 2009 |
|
DoJ
Joins HSUS Bad Meat Lawsuit
The U.S. Department of Justice has joined a False Claims Act
lawsuit filed by the U.S. Humane Society against a Southern California slaughterhouse whose workers were videotaped
pushing "downer" cows down a
chute to be processed for meat. Westland-Hallmark
Meat Co. was, at one time, the second largest supplier of
hamburger meat to the National School Lunch Program, and
fraudulently certified that no meat from "downer" cows
entered the food supply.
>>
To read more
|
May 5, 2009 |
|
Northrop to Pay
$325 Million in Satellite Case
Northrop Grumman
has agreed to pay $325 million to settle
a False Claims Act lawsuit
that alleged TRW (now owned by Northrop) made
defective parts for spy satellites that resulted
in serious malfunctions and expensive fixes, all
charged to U.S. taxpayers. The Northrop
settlement is the
largest
military-procurement fraud whistleblower case
to date, and was brought by Robert Ferro, an
Aerospace Corp. official who first discovered
the problem in 1995 and brought it to
TRW's attention. The problem went
uncorrected and satellites failed. When TRW engaged
in a cover up, Mr. Ferro
decided to blow the whistle, and he will be awarded
$48.7 million for his work, and the work of his
attorneys, in bringing the case. >>
To read more
|
April 10, 2009 |
|
TAF
Testifies in Support of FCA Amendments
TAF President
Jeb White
testified before the House Judiciary Committee in
support of H.R. 1788, the False Claims Act Corrections Act of
2009, noting that the bill would
"significantly enhance the
Government’s ability to identify, prosecute and deter fraud on
U.S. Government programs" by closing and correcting a number of
loopholes that fraud-feasors have used and abused to drain
billions of dollars from the U.S. Treasury. The FCA Corrections
Act would also modernize the law to address new types of
fraudulent schemes, and clarify procedural questions, while
strengthening the Government’s Civil Investigative Demand
authority. >>
To read the testimony
(PDF)
|
April 2, 2009 |
|
California
Sues Seven Labs California is suing seven private medical labs,
alleging they cost the state hundreds of millions of dollars by
overcharging Medi-Cal by as much as 400 percent. The
whistleblower in this case is Chris Riedel, CEO of Hunter
Laboratories, who refused to join in the price-gouging
practices. The seven defendants are:
Quest Diagnostics; Health Line
Clinical Labs; Westcliff
Medical Labs; Physicians Immunodiagnostic Laboratory; Whitefield
Medical Laboratory; Seacliff Diagnostics Medical Group, and;
Laboratory Corporation of America. >>
To read the complaint
(PDF) | April 2, 2009 |
|
Risperdal Marketed Off-label Three former salespeople have filed suit against Pharmaceutica
alleging the company engaged in off-label marketing of antipsychotic drug Risperdal.
According to the lawsuit, company salespeople were encouraged to
push the drug to doctors as a treatment for bipolar
disorder and depression. Risperdal
generated $3.4 billion in sales
in 2008.
>>
To read more
|
March
17, 2009 |
|
FCA
Recoveries Over $25 Billion
Total False Claims Act
recoveries (Federal and State) since the 1986 amendments now
total over $25 billion.
To put this
into perspective, the $25 billion
recovered from fraud-feasors to date represents a stack of
$100 bills more than 25 miles high.
In the health care arena, the U.S. Government is recovering
$15 back for every $1
invested in False Claims Act
health care investigations and prosecutions.
|
Oct.
1,
2009 |
|
Massive Amgen Fraud Case
An unidentified
whistleblower has filed a
False Claims Act case
against Amgen, the
biotechnology company which
makes arthritis and
psoriasis drug Enbrel, and
anti-anemia drug Aranesp.
Amerisource-Bergen
and online
health-information provider
WebMD Health Corp are also
named. The case came out
from under seal at a judge's
directive, and DoJ is still
deciding if it will join.
The case involves off-label
marketing, kickbacks and
Medicaid best price
violations. >>
To read more
|
March 10, 2009 |
|
US
Joins Against NM Hospitals
DoJ has joined a False
Claims Act case against Community Health Systems Inc., and three
of its hospitals in New Mexico. CHS is charged with violating
the FCA by knowingly causing to be presented false claims for
federal matching Medicaid funds. CHS paid New Mexico counties
knowing that the money would then be used to illegally obtain
triple that amount in federal funding, which would then be paid
back to CHS under New Mexico's
Medicaid
program.
>>
To read more
|
March 10, 2009 |
|
Pharma
Lawyers Now Driving Billion Dollar Settlements Would $1,000-an-hour lawyers for big pharmaceutical companies
continue to litigate if they were paid only if they won? That's
a question pharmacy company executives might want to start
asking in the wake of the fifth straight loss in an Average
Wholesale Price case at the state level. Here's how the cases
line up by state, company, and
jury verdict, with the last number
a "national number" when the state verdict is weighted by
population:
4Alabama
- AstraZeneca - $215 million - $14.06 billion 4Alabama
- GlaxoSmithKline - $81 million - $5.29 billion 4Alabama
- Novartis -- $33 million - $2.15 billion 4Missouri
- Schering-Plough - $107 million - $5.55 billion
4Wisconsin
- Pfizer - $153 million - $8.7 billion
The Wisconsin verdict is the
latest blow to the pharmaceutical industry, but it will not be
the last as Sandoz is about to go to trial in Alabama and dozens
of other companies are lined up behind that.
|
Feb. 24, 2009 |
|
DoJ
Joins FCA Suit Against Scios and Johnson & Johnson
The U.S. Justice Department has joined two
whistleblower lawsuits alleging that Johnson
& Johnson
and Scios engaged in off-label marketing of the cardiac drug
Natrecor. >>To
read more
|
Feb. 24, 2009 |
|
IRS
Whistleblower Case Settled for $780 Million
UBS
AG, Switzerland’s largest bank, will pay $780 million to settle
charges it helped thousands of wealthy Americans evade taxes.
UBS settled after
Heinrich Kieber,
a former employee of a Liechtenstein bank, brought documents to
the IRS detailing massive tax cheating by U.S. citizens. >>
To read more
|
Feb. 24, 2009 |
|
Katrina Case
Reinstated
The U.S. Fifth
Circuit Court of Appeals has reinstated a
New Orleans whistleblower lawsuit against
insurers that allegedly overbilled the
National Flood Insurance Program after
Hurricane Katrina. The lawsuit, by Branch
Consultants, was dismissed in October of
2007 on the grounds that its core
allegations were already covered by a rival
whistleblower suit in Mississippi. >>
To read more
|
Feb. 24, 2009
|
|
Glaxo's $400 Million
Reserve
GlaxoSmithKline has reserved $400
million to settle off-label and kick back charges related
to "several products” sold from
1997 to 2004, including the antidepressant Wellbutrin. Glaxo said
the reserve “reflects the current status of the
[DoJ] investigation." >>
To read
more
|
Feb. 10, 2009 |
|
Lilly
Pays Record $1.4 Billion for Zyprexa Fraud In the largest single settlement with a False Claims
Act component, Eli Lilly has
agreed to pay $1.4 billion
to settle charges it
defrauded Medicare and Medicaid by off-label marketing of Zyprexa.
The drug was promoted to nursing homes to
treat dementia, which it does
not do.
Of the $1.4
billion settlement, $800 million was paid under the FCA, and
$615
million was a criminal penalty (a $515 million fine and asset
forfeiture of $100 million).
|
Jan. 10, 2009 >>
Press Release |
Information
|
Guilty Plea Agreement
|
Government's Memorandum For Entry Of Plea
and Sentencing
|
|
Updated
Advising the Qui Tam
Whistleblower The second edition of the bestselling
Advising the Qui
Tam Whistleblower by Robin Page West is now available from
the American Bar Association, with a portion of the proceeds to
come back to TAF. This publication provides complete and
concise information to assist an attorney in evaluating a
client's potential claim, and to determine whether pursuit of a
qui tam action is warranted. The handy guide provides an
overview of the statute, highlights common and controversial
topics, and contains updated statistics as well as a discussion
of the recent Supreme Court Allison Engine case, as well
as updated case law on the defenses of:
-
Government knowledge/lack of intent
-
Constitutionality
-
Lack of
Rule 9(b) specificity
-
Lack of
presentment
-
Public
disclosure/not original source
-
Limitations
-
Lack of
falsity
-
Materiality
-
Counterclaims
-
Improper
relator: pro se, government employee or deceased
-
Relator-released
claims
Advising
the Qui Tam Whistleblower: From Identifying a Case to Filing
Under the False Claims Act, also present information on:
-
Submitting false cost and pricing data
-
Providing an inferior product
-
Falsely
certified medical procedures
-
Tax law
-
Parasitic suits
Use this
volume as a starting point for further thinking. Nine companion
forms are included. >>
To order |
|
FY
2009 FCA Statistics The U.S. Department of Justice reports they
secured $1.34 billion in settlements and judgments in the fiscal
year ending Sept. 30, 2008, but the actual number is actually
much higher than that. Why the lower number? Simple: for
statistical purposes, the DoJ does not count the money won in
settlements that is subsequently handed over to the states, nor
does it count criminal penalties. These can quickly add up.
For example, in the DoJ's recent release, they count the Merck
FCA recovery at $361.5 million even though the
DoJ's own press release says the total was $650 million.
In the
Cephalon case,
DoJ reports a $375
million recovery even though the
DoJ's own press release says the total was $425 million.
In the Staten Island University
Hospital case, DoJ reports $74 million
while the press reports the full figure of over $88 million
which includes the recovery to the state.
The DoJ's most recent press
release list the CVS False Claims Act case as a $21 million
recovery, even though their earlier press release
put the figure at $37 million.
So how much money did the False Claims Act actually return last
year according to our records?
A little over $2 billion.
| Nov. 12, 2008 |
|
Vytorin
in 35-state
Off-Label Investigation DoJ and 35 state Attorney Generals offices are
investigating whether Merck and Schering-Plough improperly
promoted the cholesterol drug Vytorin. Merck says it has
received five “civil investigative demands” from a multistate
group so far.
>>
To read more
|
Nov. 12, 2008 |
|
 |
|
Ranbaxy
Under Investigation Ranbaxy, one of the largest drug
companies in the world, is under investigation for
making weak or adulterated
HIV drugs given to
thousands
of AIDS patients in Africa and billed to the
U.S. Government under the President's
Emergency Plan for AIDS Relief program
(PEPFAR). Ranbaxy is also being investigated for lying about its Zocor
formulation sold in the U.S. >>
To read more
|July 16, 2008 |
|
Join
Taxpayers Against Fraud
Taxpayers Against Fraud
Education Fund is a 400-member
strong
organization of False Claims Act
plaintiffs lawyers. If you are a qui tam lawyer, and are
not a member of TAF, you are missing out on the latest legal
opinions, settlements, and practitioner strategies. >>
Join today |
|
Faulty Flares Ignite Lawsuit
The Dept. of
Justice has joined a whistleblower lawsuit alleging that ATK
Thiokol Inc. made defective battlefield flares that can
ignite if dropped from a
height of as low as 3 feet. The defective flares cost from $700
to $1,000 each, and the U.S. Army and Air Force paid ATK
more than $100 million for the product. >>
To read more
|
June 26, 2007 |
|
Drug
Companies May Have
To Return More of America's Stolen Billions
The U.S. Department of Justice
has joined a False Claims Act case filed by Ven-a-Care of
the Florida Keys against Roxane Laboratories Inc. and
Boehringer Ingelheim Pharmaceuticals for Medicaid and
Medicare drug pricing violations. This federal action comes
more than a year after Roxane and Boehringer paid $10
million to settle a Texas False Claims Act case alleging
similar misconduct involving misrepresentations about the
"Average Wholesale Price" of prescription drugs sold to
Medicaid. In
announcing their
intervention in the case, the U.S. Department of
Justice noted that "The
United States alleges that Medicare and Medicaid have
reimbursed Roxane's customers in excess of $500 million for
the drugs which are the subject of the complaint." The Roxane Labs case joins a similar case
against Abbott
Laboratories by Ven-a-Care
that the U.S. Department of Justice joined in May of 2006,
and another against
Dey Pharmaceuticals
that the DoJ joined in September of 2006. Complaints against
more than 40
additional companies engaged in Average Wholesale Price
violations have been filed in Federal and
State courts.
Along with Abbott,
Roxane, Dey and Boehringer Ingelheim, defendants in
intervened cases include (but are not limited to): Amgen,
Armour Pharmaceutical; Aventis Pharmaceuticals, Baxter
Healthcare, Bedford Laboratories; Ben Venue Laboratories,
Braun of America, C.H. Boehringer Sohn, Centocorps Inc.,
Forest Pharmaceuticals, Grundstucksverwaltung GMBH & Co.,
EMD, Geneva Pharmaceuticals, GlaxoSmithKline, Glaxo Wellcome,
Burroughs Wellcome, Hoechst Marion Roussell, Hoffman-LaRoche,
Hospira Inc., Immunex, Ivax Pharmaceuticals, Janssen
Pharmaceutical Products, Johnson & Johnson, Lipha, McGaw,
Merck, Mylan Laboratories, Mylan Pharmaceuticals, Novartis,
Ortho Biotech Products, Pfizer, Pharmacia, Pharma
Investment, PurePac Pharmaceutical, Roche Laboratories,
Roxane Laboratories, Sandoz, Sicor, Gensia Pharmaceuticals,
Schering-Plough Corp., SmithKline Beecham Corp.,
GlaxoSmithKline, Teva Pharmaceuticals, Warrick
Pharmaceuticals, Z.L.B. Behring. While "the rock" of the U.S. Department of Justice
squeezes pharmaceutical companies from one side, a potential
"hard spot" can be found in the courtroom of U.S. District
Judge Patti Saris who
ruled in November
that "Average Wholesale Price" means exactly what the
dictionary says it does, and is not a "term of art" that the
drug companies can unilaterally define. Judge Saris'
November ruling suggests that the pharmaceutical industry
may face real difficulties in her courtroom. Back in November, we predicted that more Average
Wholesale Price cases would come to resolution in 2007, in
part to avoid the high cost of courtroom failure (mandatory
triple damages, plus mandatory statutory fines and
exclusion). In late December, Bristol-Myers Squibb was the
first company to
work out a settlement
of both its AWP cases and an off-label marketing case
for a combined total of $499 million. More cases are sure
to follow. Stay tuned.
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Fighting
Healthcare Fraud:
Whistleblower Statute Returns
$15 for Every $1 Invested
A
TAF report by economist Jack Meyer, concludes that every
dollar invested by the U.S. Government in investigation and
prosecution of federal health care fraud returns $15 back to the
American people -- a phenomenal rate of direct return that does
not factor in the benefits of fraud deterrence.
>>
To read more
| August 2, 2006 |
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One
Click Statistics Sheet
A simple one-click presentation (6
PDF pages) of
official Department of Justice False Claims Act Statistics for
FY 1987-2008 can be found >>
here
(note that this
table does not include recoveries to the states in Medicaid
cases, nor does it include criminal fines collected as an
outgrowth of FCA cases). |
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Pharma
Lies for Pharma
Profits How lucrative are the
lies told by prescription drug manufacturers? Very!
The table below, assembled from the recent
State of Florida's False Claims Act complaint against Mylan,
Teva, and Watson pharmaceuticals, shows how drug companies
capture market share at the expense of U.S. taxpayers. >>
To learn more about "marketing the spread" frauds.
|
Drug and Company |
Reported Wholesale
Acquisition Cost (WAC) |
Florida Medicaid cost
based on WAC |
Actual pharmacy cost
of buying drugs |
Difference in $ |
Spread as percent of
actual |
|
Rantidine, 150mg tablet (Mylan) |
$14.00 |
$14.98 |
$2.88 |
$12.10 |
420% |
|
Clonazepam, .5mg tablet
per 100 (Teva) |
$9.31 |
$9.96 |
$4.49 |
$5.47 |
122% |
|
Carisoprodol,350mg tablet
(Watson) |
$363.40 |
$388.84 |
$113.10 |
$275.74 |
244% |
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