United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente
In a sign that the government’s enforcement efforts against fraud in the Medicare managed care system have reached a tipping point, the U.S. Department of Justice announced today that it is joining a portion of a whistleblower lawsuit brought by a Constantine Cannon client under the False Claims Act against Kaiser Permanente and affiliated entities, one of the nation’s largest managed-care organizations. ...
FDA’s Approval of Alzheimer’s Drug Highlights Need for Whistleblowers
The Food and Drug Administration (FDA) is supposed to protect American consumers from unscrupulous private actors—charlatans, snake-oil salesmen, and the like—seeking to profit by selling unproven medical “cures,” treatments, and devices to the public. Emerging during the era of the robber barons as part of Theodore Roosevelt’s efforts to “civilize capitalism,” the FDA has prevented untold harm to...
Catch of the Week: Medical Device Companies to Pay $38.75M Over Defective Coagulation Monitor Allegations Linked to Patient Deaths, Injuries
Medical device manufacturers Alere Inc. and Alere San Diego Inc. will pay nearly $40 million to resolve allegations that they knowingly sold defective blood coagulation monitors used by Medicare beneficiaries and falsely billed Medicare for the devices. The monitors are supposed to ensure that patients taking anticoagulant drugs receive a safe dosage to avoid life-threatening consequences from too much or too little...
Catch of the Week: Dental Clinics to Pay $2.7M for Using Unsterilized Tools on Medicaid Patients
For over five years, Upper Allegheny Health Systems, a health care system operating several dental clinics in New York and Pennsylvania, allegedly performed dental services without sterilizing equipment between patients and falsely billed Medicaid for those services. After a former employee blew the whistle, the United States and the State of New York stepped in to investigate, and the defendant agreed to a $2.7...
Catch of the Week: Virginia OB/GYN Sentenced to 59 Years in Prison for Performing Medically Unnecessary Procedures for More Than Ten Years
Healthcare fraudsters are typically motivated by greed. But in satisfying that greed, some fraudsters perform reprehensible acts that permanently affect the victims of the fraud, making even the penalty they receive pale in comparison.
This week we focus on the conviction of Javaid Perwaiz, an OB/GYN in Hampton Roads, Virginia, who was sentenced to 59 years in prison for performing medically unnecessary surgeries...
Catch of the Week: Another Pharma Company, Incyte, Settles FCA Claims For Kickbacks to a Charitable Foundation
The Department of Justice announced this week that Incyte Corporation, a Delaware pharmaceutical company, has agreed to pay $12.6 million to resolve allegations that it violated the False Claims Act by paying kickbacks to a charitable foundation to increase prescriptions for the drug Jakafi, which is used to treat myelofibrosis, a form of leukemia that causes extensive scarring in bone marrow and leads to severe...
Catch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme
Ivan Andre Scott, a 36-year-old Florida man, just landed a 10-year prison sentence for organizing a $3.3 million Medicare fraud scheme involving two of the hottest healthcare trends – telemedicine and genetic testing to assess the likelihood of future cancer. The conspiracy targeted vulnerable Medicare beneficiaries for pricey cancer screening genetic tests, prosecutors said. Claims for these tests were falsely...
Bristol-Myers Squibb Settlement Highlights a Common-Sense Law: The Medicaid Drug Rebate Program
Drug prices are out of control. They now account for roughly 10% of our healthcare spending and America’s per capita outlay has nearly doubled over the past two decades. For the least fortunate among us, many of these medications have become out of reach altogether. While new proposals are regularly made, one approach that often gets overlooked is simply enforcing the laws already on the books.
That is just...
The False Claims Act: It Benefits More than Just the Government
The False Claims Act, a Civil War-era law, encourages private individuals, such as whistleblowers, to come forward and file suit against unscrupulous government contractors, and share in the government's recovery. The passage of the law was inspired by contractors selling the Union Army bags of sand as flour, lame mules as cavalry horses, and glued-together rags as uniforms.
The main purpose of the law is, of...