Here is our look-back at the top-10 Department of Justice False Claims Act recoveries in 2015 for violations of the Anti-Kickback Statute and/or the Stark Law. Click here for a full chronological listing of all the DOJ False Claims Act recoveries in 2015.
10. AA ADVANCED CARE — Felix Gonzalez, owner of Miami home health care company AA Advanced Care, was ordered to pay $21.4 million in restitution (and sentenced to 113 months in prison) for billing Medicare for expensive physical therapy and home health care services that were not medically necessary or provided at all, and for paying kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care and certifications for medically unnecessary therapy and home health services. Click here for more.
9. CITIZENS MEDICAL — Texas-based Citizens Medical Center agreed to pay $21.8 million to settle charges of engaging in improper financial relationships with referring physicians. Specifically, the hospital allegedly provided compensation to several cardiologists that exceeded the fair market value of their services and paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals. Click here for more.
8. DAIICHI SANKYO — The global pharmaceutical company agreed to pay $39 million to resolve charges of paying kickbacks to induce physicians to prescribe Daiichi drugs, including Azor, Benicar, Tribenzor and Welchol. The kickbacks allegedly took the form of speaker fees as part of Daiichi’s Physician Organization and Discussion programs which were often just lavish dinners with the speaking physicians’ own medical group or staff. Click here for more.
7. HEALTH DIAGNOSTICS — Virginia-based cardiovascular testing disease laboratory Health Diagnostics Laboratory Inc. agreed to pay $47 million to resolve charges of paying kickbacks to physicians in exchange for patient referrals and billing federal health care programs for medically unnecessary testing. Click here for more.
6. EXPRESS SCRIPTS — Accredo Health Group, a unit of Express Scripts Holding Co., agreed to pay $60 million to settle charges that the company participated in a kickback scheme with Novartis Pharmaceuticals Corp. involving the prescription drug Exjade. According to the government, Novartis provided kickbacks, in the form of patient referrals and related benefits, to Accredo in exchange for Accredo recommending refills to Exjade patients. Click here for more.
5. TUOMEY HEALTHCARE — The South Carolina-based hospital system agreed to pay $72.4 million to settle charges of billing Medicare for services referred by physicians with whom the hospital had improper financial relationships. Click here for more.
4. ADVENTIST HEALTH SYSTEM — The non-profit healthcare organization agreed to pay $115 million to settle allegations it maintained improper compensation arrangements with referring physicians. Click here for more.
3. WARNER CHILCOTT — Warner Chilcott US Sales agreed to pay $125 million to resolve its criminal and civil liability arising from illegally marketing the drugs Actonel, Asacol, Atelvia, Doryx, Enablex, Estrace and Loestrin by paying physicians to induce them to prescribe Warner Chilcott drugs. Click here for more.
2. MILLENNIUM HEALTH — Millennium Health (formerly Millennium Laboratories) agreed to pay $256 million to resolve charges it billed Medicare for medically unnecessary urine drug and genetic testing and provided free point of care urine drug test cups to physicians expressly conditioned on the physicians’ agreement to return the urine specimens to Millennium for hundreds of dollars’ worth of additional testing. Click here for more.
1. NOVARTIS — The pharmaceutical giant agreed to pay $390 million to resolve charges it gave kickbacks to specialty pharmacies in return for recommending two of its drugs, Exjade and Myfortic. Click here for more.
* * *If you would like more information or would like to speak to a member of Constantine Cannon’s whistleblower lawyer team, please click here.