Category

Business Fraud

U.S. Justice Department Files Civil Complaint To Stop Tennessee Pharmacies’ Unlawful Dispensing Of Opioids

By | Business Fraud, False Claims Act Litigation

On February 8, 2019, the U.S. Department of Justice unsealed a civil complaint filed in the Middle District of Tennessee against two pharmacies, their owner, and three pharmacists, to stop them from dispensing controlled substance medications, including powerful opioids that have been linked to abuse and diversion.

The civil complaint alleges that the defendants were dispensing and billing Medicare for prescriptions in violation of the Controlled Substances Act and the False Claims Act. According to the United States’ complaint, the defendants’ unlawful dispensing of opioids has been tied to the deaths of at least two people and numerous others have been treated at hospitals for serious overdoses within a short time of obtaining controlled substances from the pharmacies.

The complaint alleges that the pharmacies and pharmacists filled numerous prescriptions for controlled substances outside the usual course of professional practice and in violation of the pharmacists’ corresponding responsibility to ensure that prescriptions were written for a legitimate medical purpose. Specifically, the complaint alleges that the defendants routinely dispensed controlled substances while ignoring numerous “red flags” or warning signs of diversion and abuse, such as unusually high dosages of oxycodone and other opioids, prescriptions for opioids and other controlled substances in dangerous combinations, and patients travelling extremely long distances to get and fill prescriptions. The complaint further asserts that the pharmacies falsely billed Medicare for illegally dispensed prescriptions.

A federal judge has already issued a temporary restraining order in the case, and the United States seeks civil monetary penalties and treble damages.

In announcing the unsealing of the complaint, one of the U.S. Attorneys assigned to the case stated, “The civil complaint unsealed today contains disturbing allegations of high-risk dispensing practices by the defendants. Given the national public health emergency resulting from the opioid crisis in our nation, the U.S. Attorney’s Office will use every resource at our disposal, including seeking injunctive relief and civil monetary penalties as we have here, to stop pharmacies and pharmacists from continuing to abuse their dispensing authority to fuel this epidemic.”

The Special Agent in Charge of DEA’s local Field Division stated, “The action supported today by the Drug Enforcement Administration should serve as a warning to those in the pharmacy industry who choose to put profit over customer safety. Pharmacists serve on the front lines of America’s opioid epidemic and they share responsibility with physicians to protect those whom they serve from the dangers associated with prescription medications. We will be vigilant in holding them accountable.”

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find qui tam lawyers who may handle your False Claims Act matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Pathology Lab Settles False Claims Act Allegations For $63.5M

By | Business Fraud, False Claims Act Litigation, Qui Tam Lawsuits, Qui Tam Litigation, whistleblower lawyers

The U.S. Department of Justice announced on January 30, 2019 that pathology laboratory company Inform Diagnostics has agreed to pay $63.5 million to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with referring physicians. Inform Diagnostics, formerly known as Miraca Life Sciences Inc., is headquartered in Irving, Texas, and was a subsidiary of Miraca Holdings Inc., a Japanese company, during the relevant period. In 2017, majority ownership of the company changed and the company was renamed.

The settlement resolves allegations that Inform Diagnostics violated the Anti-Kickback Statute and the Stark Law by providing to referring physicians subsidies for electronic health records (EHR) systems and free or discounted technology consulting services. The Anti-Kickback Statute and the Stark Law restrict the financial relationships that health care providers, including laboratories, may have with doctors who refer patients to them. Although regulations adopted by the Department of Health and Human Services (HHS) in 2006 included provisions that allowed laboratories to provide EHR donations to physicians under certain conditions, the United States alleged that Inform Diagnostics violated those conditions. HHS withdrew those exemptions for laboratories in 2013.

The allegations stem from three lawsuits that were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens to bring suit on behalf of the United States for false claims and share in any recovery. The whistleblowers’ share of the settlement has not yet been determined.

In announcing the settlement, an Assistant Attorney General of the U.S. Department of Justice’s Civil Division stated, “The Department of Justice has longstanding concerns about improper financial relationships between health care providers and their referral sources because those relationships can alter a physician’s judgment about the patient’s true health care needs and drive up health care costs for everybody. In addition to yielding a substantial recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

The case was investigated by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Middle District of Tennessee, the U.S. Attorney’s Office for the Middle District of Florida, the Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation. The cases are captioned United States ex rel. Dorsa v. Miraca Life Sciences, Inc., Case No. 13-cv-1025 (M.D. Tenn.); United States ex rel. LPF, LLC v. Miraca Life Sciences, Inc., et al., 3:16-cv-1355 (M.D. Tenn.); and United States ex rel. Heaphy, et al. v. Miraca Life Sciences, Inc., 3:18-cv-1027 (M.D. Tenn.).

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find qui tam lawyers who may handle your False Claims Act matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Facebook Alleged To Have Promoted “Friendly Fraud” Through Children’s Games

By | Business Fraud, Business Litigation, Class Action Lawsuits

The Center for Investigative Reporting (“Reveal”) announced on January 24, 2019 in an article entitled, “Facebook knowingly duped game-playing kids and their parents out of money” that “Facebook orchestrated a multiyear effort that duped children and their parents out of money, in some cases hundreds or even thousands of dollars, and then often refused to give the money back, according to court documents unsealed” that span from 2010 to 2014.

Reveal analyzed more than 135 pages of documents that were recently unsealed as part of a class-action lawsuit focused on how Facebook allegedly targeted children in an effort to expand revenue for online games, such as Angry Birds, PetVille and Ninja Saga. The unsealed documents include internal Facebook memos, secret strategies, and employee emails that Reveal describes as painting a troubling picture of how the social media giant conducted business.

Reveal describes how Facebook encouraged game developers to let children spend money without their parents’ permission – something the social media giant called “friendly fraud” – in an effort to maximize revenues (“friendly fraud” is the term Facebook used when children spent money on games without their parents’ permission). Sometimes the children did not even know they were spending money but Facebook employees knew it: their own reports allegedly showed underage users did not realize their parents’ credit cards were connected to their Facebook accounts and they were spending real money in the games.

Reveal claims that Facebook denied requests for refunds when parents found out how much their children had spent (a child could spend hundreds of dollars a day on in-game features such as arming their character with a flaming sword or a new magic spell to defeat an enemy, even if they did not realize it until their parents received their credit card bills) and that Facebook employees referred to these children as “whales” – a term borrowed from the casino industry to describe profligate spenders.

Facebook reportedly had analyzed data on game revenue from children for the time period from October 12, 2010 through January 12, 2011 and found that children had “spent a whopping $3.6 million” during the three-month period. Facebook also found that more than 9 percent of the money it made from children was being clawed back by the credit card companies (the average chargeback rate for businesses is 0.5 percent, according to the Merchant Risk Council; the Federal Trade Commission said in an unrelated fraud case in 2016 that a 2 percent chargeback rate was a “red flag” of a “deceptive” business).

Facebook reportedly found that with regard to the Angry Birds game, about 93 percent of the time the refunds were a result of credit card holders not realizing the game was charging their account (Facebook found that the average age of those playing Angry Birds was 5). Reveal stated that rather than trying to stop children from making costly mistakes, a Facebook internal memo entitled “Friendly Fraud – what it is, why it’s challenging, and why you shouldn’t try to block it” stated that developers should just give free virtual items to users who complain, things such as flaming swords, extra lives and other in-game enhancements – this was better than refunding money to kids because, as the Facebook employee said in her message, “Virtual goods bear no cost.”

Facebook released the following statement in response to Reveal’s request for an interview:

“We were contacted by the Center for Investigative Reporting last year, and we voluntarily unsealed documents related to a 2012 case about our refund policies for in-app purchases that parents believe were made in error by their minor children. We intend to release additional documents as instructed by the court. Facebook works with parents and experts to offer tools for families navigating Facebook and the web. As part of that work, we routinely examine our own practices, and in 2016 agreed to update our terms and provide dedicated resources for refund requests related to purchased made by minors on Facebook.”

Source

If your business is presently or may soon be involved in litigation in the United States, email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find business litigation contingency lawyers who may handle your business litigation matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

U.S. Announces $269.2 Million Settlement With Walgreens In Two Civil Healthcare Fraud Lawsuits

By | Business Fraud, False Claims Act Litigation, Qui Tam Lawsuits, Qui Tam Litigation, whistleblower lawyers

The Department of Justice U.S. Attorney’s Office Southern District of New York (Manhattan U.S. Attorney) announced on January 22, 2019 that the United States filed and settled two healthcare fraud lawsuits against national pharmacy chain Walgreens Boots Alliance, Inc. (“Walgreens”) in which Walgreens must pay the United States and state governments a total of $269.2 million.

First Settlement – Insulin Pens

The U.S. alleged that Walgreens routinely submitted false days-of-supply data to federal healthcare programs when it sought federal reimbursement for insulin pens it dispensed to federal beneficiaries who did not need them. The U.S. alleged that Walgreens engaged in two practices that resulted in the fraudulent submissions: Walgreens configured its electronic pharmacy management system to prevent its pharmacists from dispensing less than a full box of five insulin pens, even when patients did not need that much insulin; and when a full box of insulin pens exceeded the federal healthcare program’s limit on the total days of supply (i.e., the total number of daily doses) that could be dispensed and reimbursed at that time, Walgreens allegedly evaded this restriction by falsely stating in its reimbursement claims that the total days of supply did not go over the limit. The U.S. contended that as a result, federal healthcare programs paid Walgreens millions of dollars for insulin that many beneficiaries did not actually need, and substantial quantities of valuable medication were wasted. The U.S. alleged that this conduct also opened the door to potential healthcare risks and abuse, such as the improper resale of insulin pens on the Internet.

The settlement requires Walgreens to pay approximately $168 million to the U.S., and Walgreens agreed separately to pay approximately $41.2 million to state governments. The settlement was approved on January 16, 2019 by a federal judge and was unsealed on January 22, 2019.

Second Settlement – Discount Drug Pricing

The U.S. alleged that Walgreens operated a program called the Prescription Savings Club (“PSC”) under which customers received discounts when they ordered drugs from Walgreens. Medicaid regulations required Walgreens to seek Medicaid reimbursement only at the lowest of certain drug price points, including the “usual and customary price” (“U&C price”). Medicaid rules of many states defined the U&C price as the price offered through discount programs like the PSC. Contrary to these requirements, Walgreens allegedly did not disclose to Medicaid the discount drug prices it offered customers through the PSC when it sought reimbursement from Medicaid. As a result, Medicaid programs paid Walgreens more in reimbursements than it would have paid had Walgreens disclosed the lower PSC prices.

The settlement requires Walgreens to pay a total of $60 million, of which approximately $32 million is to the United States and approximately $28 million will go to state governments. The second settlement was approved on January 15, 2019 by a federal judge and was also unsealed on January 22, 2019.

In both settlements, Walgreens admitted and accepted responsibility for conduct the U.S. alleged in its complaints under the False Claims Act. Both cases arose from lawsuits filed by whistleblowers under the False Claims Act.

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find qui tam lawyers who may handle your False Claims Act matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Over $2.8 Billion Recovered From False Claims Act Cases In Fiscal Year 2018

By | Business Fraud, False Claims Act Litigation, Qui Tam Lawsuits, Qui Tam Litigation, whistleblower lawyers

The U.S. Department of Justice announced on December 21, 2018 that the Department obtained more than $2.8 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending September 30, 2018.  Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $59 billion.

Of the $2.8 billion in settlements and judgments recovered by the Department of Justice this past fiscal year, $2.5 billion involved the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.  This is the ninth consecutive year that the Department’s civil health care fraud settlements and judgments have exceeded $2 billion.  The recoveries included in the $2.5 billion reflect only federal losses but, in many of these cases, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.

In addition to combating health care fraud, the False Claims Act serves as the government’s primary civil remedy to redress false claims for federal funds and property involving a multitude of government operations and contracts.  These areas range from defense and national security to import tariffs and small business programs.

In 1986, Congress strengthened the Act by increasing incentives for whistleblowers to file lawsuits alleging false claims on behalf of the government.  These whistleblower, or qui tam, actions comprise a significant percentage of the False Claims Act cases that are filed.  If the government prevails in a qui tam action, the whistleblower, also known as the relator, receives up to 30 percent of the recovery.  Whistleblowers filed 645 qui tam suits in fiscal year 2018.

Of the $2.8 billion in settlements and judgments reported by the government in fiscal year 2018, over $2.1 billion arose from lawsuits filed under the qui tam provisions of the False Claims Act.  During the same period, the government paid out $301 million to the individuals who exposed fraud and false claims by filing these actions.

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find qui tam lawyers who may handle your False Claims Act matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

U.S. Intervenes In West Virginia Hospital False Claims Act Lawsuit

By | Business Fraud, False Claims Act Litigation, Qui Tam Lawsuits, whistleblower lawyers

The U.S. Department of Justice announced on December 21, 2018 that the United States has partially intervened in a lawsuit under the False Claims Act against Wheeling Hospital Inc. (Wheeling), R & V Associates Ltd. (R & V), and Ronald Violi in the U.S. District Court for the Western District of Pennsylvania. The government intervened with respect to allegations that Wheeling, which is located in Wheeling, WV, violated the Stark Law and Anti-Kickback Statute, and that those violations were caused by R & V, Wheeling’s contracted management consultant, and Violi, Wheeling’s CEO.

The Stark Law prohibits a hospital from billing Medicare for services referred by physicians that have an improper financial relationship with the hospital. The Anti‑Kickback Statute, in relevant part, prohibits offering or paying anything of value to encourage the referral of items or services covered by federal healthcare programs. The United States alleges that Wheeling’s compensation to a number of employed and contracted physicians violated these statutory prohibitions because that compensation was based on the volume or value of the physicians’ referrals or was above fair market value.

The lawsuit was initially filed in December 2017 by Louis Longo, who was previously employed as Wheeling’s Executive Vice President, under the whistleblower provisions of the False Claims Act. Those provisions authorize private parties to sue on behalf of the United States for false claims and share in any recovery. The Act permits the United States to intervene and take over the lawsuit. Those who violate the Act are subject to treble damages and applicable penalties.

The case is captioned United States of America ex rel. Louis Longo v. Wheeling Hospital, Inc. et al., No. 17-cv-1654 (W.D. Pa.).

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as <em>qui tam</em> attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to find qui tam lawyers who may handle your False Claims Act matter on a contingency basis.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Target Agrees To Pay $3 Million To Resolve Allegations Of Operating An Unauthorized Automatic Refill Program In Massachusetts

By | Business Fraud, Business Litigation, Qui Tam Litigation

The Massachusetts Attorney General announced on December 11, 2018 that Target Corp. has agreed to pay $3 million to resolve allegations that it violated federal and state law by improperly billing and receiving payments from the Massachusetts’ Medicaid program (MassHealth).

Under the terms of the settlement, Target Corp. will pay $3 million to resolve allegations that from August 2009 through July 2015, the company operated an unauthorized automatic refill program at their Massachusetts locations.

Current regulations prohibit pharmacies in Massachusetts from automatically refilling prescriptions that were not explicitly requested by a MassHealth patient or caregiver at the time of each filling event. The AG’s Office alleges that Target automatically refilled prescriptions and billed MassHealth inappropriately for them: “Target did not follow state and federal regulations put place to prevent waste in our MassHealth system. This settlement will bring money back to our state and will help ensure that our health care resources reach those who need them the most.”

The AG’s Office has previously taken action against pharmacies for using improper automatic refill programs for MassHealth members. In August, PharmaHealth agreed to pay $360,000 to settle allegations of operating an unauthorized automatic refill program. In 2015, Neighborhood Diabetes paid $1.5 million to resolve allegations of improper billing and in 2013, AllCare Pharmacy paid $1.6 million to settle with the AG’s Office to resolve similar allegations.

The investigation stemmed from a qui tam action brought by a whistleblower in the United States District Court for the District of Minnesota. The qui tam action alleged claims under the federal False Claims Act and the Massachusetts False Claims Act.

If you have information regarding false claims having been submitted to the federal government and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Defense Contractor Pleads Guilty To Major Fraud In Provision Of Supplies To U.S. Troops In Afghanistan

By | Business Fraud, Business Litigation, Qui Tam Litigation

The U.S. Department of Justice announced on December 8, 2014 that Supreme Foodservice GmbH, a privately held Swiss company, and Supreme Foodservice FZE, a privately-held United Arab Emirates (UAE) company, pleaded guilty to major fraud against the United States and agreed to resolve civil violations of the False Claims Act, in connection with a contract to provide food and water to the U.S. troops serving in Afghanistan. The companies pleaded guilty in the Eastern District of Pennsylvania (EDPA) and paid $288.36 million in the criminal case, a sum that includes the maximum criminal fine allowed.

In addition, Supreme Group B.V. and several of its subsidiaries agreed to pay an additional $146 million to resolve a related civil lawsuit, as well as two separate civil matters, alleging false billings to the Department of Defense (DoD) for fuel and transporting cargo to American soldiers in Afghanistan.  The lawsuit was filed in the EDPA, and the fuel and transportation allegations were investigated by the Southern District of Illinois and the Eastern District of Virginia, respectively, along with the Department’s Civil Division.

According to court documents, between July 2005 and April 2009, Supreme Foodservice AG, together with Supreme Foodservice KG, now called Supreme Foodservice FZE, devised and implemented a scheme to overcharge the United States in order to make profits over and above those provided in the $8.8 billion subsistence prime vendor (SPV) contract.  The companies fraudulently inflated the price charged for local market ready goods (LMR) and bottled water sold to the United States under the SPV contract.  The Supreme companies did this by using a UAE company it controlled, Jamal Ahli Foods Co. LLC (JAFCO), as a middleman to mark up prices for fresh fruits and vegetables and other locally-produced products sold to the U.S. government, and to obscure the inflated price the Supreme companies were charging for bottled water.  The fraud resulted in a loss to the government of $48 million.

The government alleged that Supreme AG, Supreme FZE and Supreme’s owners made concentrated efforts to conceal Supreme’s true relationship with JAFCO, and to make JAFCO appear to be an independent company.  They also took steps to make JAFCO’s mark-up on LMR look legitimate, and persisted in the fraudulent mark-ups even in the face of questions from DSCP about the pricing of LMR.

Defendant Supreme GmbH pleaded guilty to major fraud against the United States, conspiracy to commit major fraud and wire fraud.  Supreme FZE, which owns JAFCO, pleaded guilty to major fraud against the United States.  The Supreme companies agreed to jointly pay $48 million in restitution and $10 million in criminal forfeiture.  Each company also agreed to pay $96 million in criminal fines.  In addition, as a result of the criminal investigation, the Supreme companies paid $38.3 million directly to the DSCP as a refund for separate overpayments on bottled water.

In a related civil settlement, Supreme Group agreed to pay another $101 million to settle a whistleblower lawsuit, filed in the U.S. District Court for the EDPA by a former executive, which alleged that Supreme Group, and its food subsidiaries, violated the False Claims Act by knowingly overcharging for supplying food and water under the SPV contract.  The payment also resolves claims that, from June 2005 to December 2010, the Supreme food companies failed to disclose and pass through to the government rebates and discounts it obtained from its suppliers, as required by its SPV contract with the United States.

Separately, Supreme Site Services GmbH, a Supreme Group subsidiary, agreed to pay $20 million to settle allegations that they overbilled for fuel purchased by the Defense Logistics Agency (DLA) for Kandahar Air Field (KAF) in Afghanistan under a NATO Basic Ordering Agreement.  The government alleged that Supreme Site Services’ drivers were stealing fuel destined for KAF generators while en route for which the company falsely billed DLA.

Supreme Group’s subsidiary Supreme Logistics FZE also has agreed to pay $25 million to resolve alleged false billings by Supreme Logistics in connection with shipping contracts between the U.S. Transportation Command (USTRANSCOM), located at Scott Air Force Base in Illinois, and various shipping carriers to transport food to U.S. troops in Afghanistan during Operation Enduring Freedom.  The shipping carriers transported cargo destined for U.S. troops from the United States to Latvia or other intermediate ports, and then arranged with logistics vendors, including Supreme Logistics, to carry the cargo the rest of the way to Afghanistan.  The United States alleged that Supreme Logistics falsely billed USTRANSCOM for higher-priced refrigerated trucks when it actually used lower-priced non-refrigerated trucks to transport the cargo.

The EDPA lawsuit was initially filed under the qui tam or whistleblower provisions of the False Claims Act, by Michael Epp, Supreme GmbH’s former Director, Commercial Division and Supply Chain.  The False Claims Act prohibits the submission of false claims for government money or property and allows the United States to recover treble damages and penalties for a violation.  Under the Act’s whistleblower provisions, a private party may file suit on behalf of the United States and share in any recovery.  The case remained under seal to permit the United States to investigate the allegations and decide whether to intervene and take over the case.  Epp will receive $16.16 million as his share of the government’s settlement of the lawsuit.

Source

If you have information regarding false claims having been submitted to the federal government and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Actelion Pharmaceuticals Agrees To Pay $360 Million To Resolve False Claims Act Liability For Paying Kickbacks

By | Business Fraud, Business Litigation, Qui Tam Litigation

The U.S. Department of Justice announced on December 6, 2018 that Actelion Pharmaceuticals US, Inc. (“Actelion”) has agreed to pay $360 million to resolve claims that it illegally used a nonprofit foundation as a conduit to pay the copays of thousands of Medicare patients taking Actelion’s pulmonary arterial hypertension drugs, in violation of the False Claims Act.

Under the Anti-Kickback Statute, a pharmaceutical company is prohibited from offering or paying, directly or indirectly, any remuneration (which includes money or any other thing of value) to induce Medicare patients to purchase its drugs. This prohibition includes the payment of patients’ copay obligations.

When a Medicare beneficiary obtains a prescription drug covered by Medicare, the beneficiary may be required to make a partial payment, which may take the form of a copayment, coinsurance, or a deductible (“copays”). The U.S. Congress included copay requirements in the Medicare program, in part, to serve as a check on health care costs, including the prices that pharmaceutical manufacturers can demand for their drugs. The copay obligations can be substantial for expensive medications.

It was alleged by the federal government that Actelion used the foundation as an illegal conduit to pay the copay obligations of thousands of Medicare patients taking Actelion’s pulmonary arterial hypertension drugs, as an inducement for those patients to purchase its drugs because Actelion knew that the prices it set for those drugs could otherwise pose a barrier to those purchases.

The federal government claimed that from 2014 to 2015, Actelion made donations to the foundation, which, in turn, used those donations to pay copays of patients prescribed Actelion’s pulmonary arterial hypertension drugs. The federal government alleged that Actelion routinely obtained data from the foundation detailing how much the foundation had spent for patients on each such drug and then used this information to decide how much to donate to the foundation and to confirm that its contributions were sufficient to cover the copays of only patients taking its pulmonary arterial hypertension drugs. The foundation reportedly warned Actelion against receiving such data.

The federal government further alleged that Actelion had a policy of not permitting Medicare patients to participate in its free drug program, which was open to other financially needy patients, even if those Medicare patients could not afford their copays for its pulmonary arterial hypertension drugs. The federal government claimed that Actelion referred such Medicare patients to the foundation, which allowed the patients copays to be paid and resulted in claims to Medicare for the remaining cost, in order to generate revenue from Medicare and induce purchases of its pulmonary arterial hypertension drugs.

Actelion was acquired by Johnson & Johnson on June 16, 2017.

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation

Federal Government Intervenes In Health Care Qui Tam Lawsuit

By | Business Fraud, Business Litigation, Qui Tam Litigation

The U.S. Department of Justice announced on December 11, 2018 that the United States has intervened in a complaint against Sutter Health LLC, a California-based healthcare services provider, and an affiliated entity, Palo Alto Medical Foundation, that alleges that Sutter violated the False Claims Act by submitting inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans.

Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed healthcare insurance plans called Medicare Advantage Plans (MA Plans) that are owned and operated by private Medicare Advantage Organizations (MAOs).  MA Plans are paid a capitated, or per-person, amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans.

The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the health status of each plan beneficiary.  The adjustments are commonly referred to as “risk scores.”  In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.

Sutter Health, a non-profit public benefit corporation that provides healthcare services through affiliated entities, including hospitals and medical foundations, contracted with certain MAOs to provide healthcare services to California beneficiaries enrolled in the MAOs’ MA Plans.  In exchange, Sutter received a share of the payments that the MAOs received from CMS for the beneficiaries under Sutter’s care.

Sutter submitted diagnoses to the MAOs for the MA Plan enrollees that they treated.  The MAOs, in turn, submitted the diagnosis codes to CMS from the beneficiaries’ medical encounters, such as office visits and hospital stays, and these diagnosis codes were used by CMS to calculate a risk score for each beneficiary.

The False Claims Act lawsuit alleges that Sutter Health and Palo Alto Medical Foundation knowingly submitted unsupported diagnosis codes for certain patient encounters for beneficiaries under their care.  These unsupported diagnosis scores allegedly inflated the risk scores of these beneficiaries, resulting in inflated payments to Sutter.   The lawsuit further alleges that once the Sutter entities became aware of these unsupported diagnosis codes, they failed to take sufficient corrective action to identify and delete additional potentially unsupported diagnosis codes.

The lawsuit was filed under the qui tam, or whistleblowerprovisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery.  The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case.  The whistleblower was a former employee of Palo Alto Medical Foundation.

The case is captioned United States ex rel. Ormsby v. Sutter Health, et al., Case No. 15-CV-01062-JD (N.D. Cal.).

Source

If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

Email us at info@businesslitigationcontingencylawyers.com or telephone us toll-free in the United States at 800-756-2143 to to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.

BusinessLitigationContingencyLawyers.com – The Practical Solution For Business Litigation