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May 31, 2019

Generic drug maker Heritage Pharmaceuticals, Inc. has entered into a deferred prosecution agreement for criminal antitrust charges, admitting that it conspired to fix prices, rig bids, and allocate customers for the diabetes drug glyburide.  Heritage will pay a $225,000 criminal penalty and has agreed to cooperate in ongoing antitrust investigations.  In addition, Heritage will pay $7.1 million to resolve allegations under the False Claims Act that the company paid and received unlawful remuneration under the Anti-Kickback Statute through its arrangements with other generic drug makers regarding prices, supply, and allocation of customers for drugs including glyburide, hydralazine, and theophylline.  DOJ; USAO ED Pa

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud,

May 29, 2019

Houston-based patient recruiter and home health clinic owner Egondu “Kate” Koko has been sentenced to over 15 years in prison and ordered to pay $14 million for participating in a $20 million kickback scheme involving Medicare beneficiaries.  Koko had plead guilty in October to paying bribes to both physicians and patients in order to earn between $9.5 and $25 million in ill-gotten gains, as well as to laundering money under another person’s identity and using proceeds from the fraud to buy a home.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

May 29, 2019

Almirall, LLC, f/k/a Aqua Pharmaceuticals, LLC , will pay $3.5 million to settle kickback allegations exposed by a former Aqua sales representative.  According to the whistleblower, the pharmaceutical company paid kickbacks in the form of free meals, trips, gift cards, and gifts, to dermatology providers in exchange for prescriptions of their drugs to Medicare and TRICARE patients.  It also paid kickbacks by compensating healthcare providers for speaking engagements and consulting services. For coming forward with details of the fraud, the unnamed whistleblower will receive a $735,000 share of the recovery.  USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

May 29, 2019

A doctor in South Carolina has agreed to pay $92,506.30 to settle allegations of accepting illegal payments from OK Compounding, LLC, in exchange for prescribing their pain creams to TRICARE patients.  The False Claims Act violations allegedly occurred between February and May 2013, and involved “medical director fees” paid to Dr. Jerry Back that were in reality, kickbacks.  This was the eighth kickback settlement in the Northern District of Oklahoma since the beginning of the year.  USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud, Provider Fraud,

May 8, 2019

A South Florida woman who received kickbacks in exchange for patient referrals has been sentenced to over 7 years in prison. In exchange for at least $710,000, Yamilet Diaz allegedly referred Medicare beneficiaries to five home health agencies, aiding the agencies in unlawfully receiving over $1.6 million in reimbursements from Medicare that were tainted by the kickbacks. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

May 2, 2019

Insys Therapeutics executives were convicted for their part in a racketeering conspiracy where they defrauded Medicare and private insurance carriers. From May 2012 to December 2015, the defendants bribed medical practitioners to prescribe Subsys, an extremely addictive sublingual fentayl spray intended for use by cancer patients. In furtherance of these efforts, the defendants provided kickbacks to practitioners who increased their Subsys prescriptions. The defendants also defrauded health insurance providers who were hesitant to approve payment for the drug when it was prescribed for non-cancer patients. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare, Off-Label and Unapproved Use, Pharma Fraud,

April 30, 2019

Pharma company US WorldMeds LLC has agreed to pay $17.5 million and enter into a corporate integrity agreement to resolve allegations that it improperly induced the use of its drugs Apokyn, used to treat Parkinson's, and Myobloc.  The company was alleged to have improperly used a foundation to pay Apokyn copayments for Medicare beneficiaries, knowing that it was the only donor to the foundation’s Parkinson’s Disease fund and that virtually all of the fund’s donations were spent on Medicare Apokyn patients.  In addition, the company was alleged to have paid kickbacks to physicians, including excessive speaking and consulting fees, to induce them to prescribe Apokyn and Myobloc. The litigation was initiated under the False Claims Act by whistleblowers, who will receive $3.15 million of the settlement.  DOJ; USAO Conn

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

April 30, 2019

The former CEO of hospital chain Health Management Associates LLC, Gary D. Newsome, has agreed to pay $3.46 million to resolve claims in a whistleblower lawsuit that he personally caused HMA to submit false claims to federal healthcare programs in violation of the False Claims Act.  Newsome was alleged to have caused HMA to pressure emergency department physicians to increase inpatient admissions without regard to medical necessity, so that the hospital chain could bill for more costly inpatient services.  In addition, Newsome was alleged to have caused HMA to make bonus payments to emergency department physicians, and contract concessions to the company, EmCare, that provided emergency department physician staffing, to increase inpatient admissions.  Newsome was the CEO from 2008 through 2013, prior to HMA's acquisition by Community Health Systems Inc.  HMA settled related claims in September 2018, and EmCare settled related claims in December 2017.  Two whistleblowers, Jacqueline Meyer, a former employee of EmCare, and J. Michael Cowling, a former employee of HMA, will receive approximately $725,000 from this settlement.  DOJ

Tagged in: Anti-Kickback and Stark, Defendants, FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

April 25, 2019

Two pain management clinics in Northern Virginia, National Spine and Pain Centers and Physical Medicine Associates, will pay $3.3 million to resolve a False Claims Act case first filed by a whistleblower who was a former physician assistant at one of the clinics.  The clinics were alleged to have billed services provided by physician assistants and nurse practitioners as if they were provided by a physician, to have ordered medically-unnecessary urine drug tests, and to have submitted claims for urine drug testing that did not comply with the Stark Law and/or Anti-Kickback Statute.  USAO EDVA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 25, 2019

Pharma company Amgen Inc. has agreed to pay $24.75 million and enter into a corporate integrity agreement to resolve allegations that its use of purportedly independent foundations to pay copayments on its drugs Sensipar and Kyprolis for Medicare beneficiaries violated the False Claims Act.  Amgen's "donations" were not bona fide, but were, by design, intended to benefit only patients of its own drugs, thereby constituting an unlawful kickback designed to generate revenue for Amgen.  With respect to Kyprolis, Amgen's donation to the fund was expressly tied to the anticipated amount required to fund Kyprolis copayments.    DOJ; USAO Mass

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud,

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