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December 6, 2018

Actelion Pharmaceuticals US, Inc., will pay $360 million to settle claims that it violated the False Claims Act by means of illegally using a foundation as a channel through which it paid the copays of thousands of Medicare patients who were taking Actelion’s pulmonary arterial hypertension drugs to induce patients to purchase the medications. Actelion collected data from the foundation on its spending for patients and used this information to calculate its donations to the foundation, ensuring that its contributions were adequate to cover the copays of patients taking the subject drugs. The company continued these practices despite allegedly receiving warnings from the foundation.   DOJ  

December 4, 2018

In connection with fraud involving two medical devices, Covidien and ev3 Inc. have agreed to pay a total of $31 million to resolve allegations of violating the False Claims Act. According to whistleblower and former employee of Covidien, Jeffrey Faatz, sister company ev3 Inc.'s Onyx Liquid Embolic System was only FDA approved for use within the brain, but was allegedly being marketed to surgeons for use outside the brain. Furthermore, ev3 reportedly incentivized its sales representatives to sell the device for unapproved purposes by setting up sales quotas and bonuses, and did so even as FDA officials expressed safety concerns to the company's executives. Separately, Covidien was accused of paying kickbacks to hospitals to induce use of its Solitaire mechanical thrombectomy device, causing false claims to be submitted to Medicare and Medicaid. For blowing the whistle on this case, Faatz will receive a relator's share of $2 million. DOJ; USAO CDCA; USAO SDFL; USAO MA

December 4, 2018

Medical device-maker LivaNova USA, Inc. has agreed to pay $1.87 million to resolve claims that it paid improper kickbacks to physicians who were among the largest referrers of patients for LivaNova's implanted epilepsy device.  The payments took the form of "speaking fees" for the doctors, although the doctors who received them were primarily speaking to their own staffs.  Ashley Case, a former employee of LivaNova, initiated the investigation by filing a case under the False Claims Act; she will receive an unspecified share of the settlement.  USAO NDGA

November 28, 2018

Dr. Thomas Baker, Dr. Carolyn Kochert, Dr. Larry L. Zhou, and Dr. Julie Y. Chao, have agreed to settle with the United States Government for violation of the Federal False Claims Act, the Physician Self-Referral law (“Stark”), and the Anti-Kickback Statute due to their involvement in a kickback scheme with Southwest Laboratories and Medscan Laboratory, thus causing false claims to be submitted to Medicare. The four physicians will pay a total amount of over $1.5 million. The individual amounts paid are as follows: Dr. Baker, of Tennessee - $484,481.80; Dr. Kochert, of Indiana - $129,682.84; Dr. Zhou, of Kentucky - $277,758.18; Dr. Chao, of Indiana - $650,000. DOJ

November 20, 2018

Gray Wesley Barrow, a doctor and co-owner of Louisiana Spine & Sports LLC, a pain management clinic in Baton Rouge, has pleaded guilty to receiving approximately $336,000 in unlawful kickbacks.  According to the plea, between 2014 and 2016 Barrow sent urine specimens collected from his patients to a drug testing laboratory that agreed to pay him a percentage of the reimbursements paid to the laboratory by health care benefit programs including Medicare. DOJ; USAO M.D. La.

November 14, 2018

After pleading guilty last year, the owner of two health clinics in Detroit has been sentenced to 160 months in prison and ordered to pay over $6 million for defrauding Medicare. Along with multiple co-defendants, Jacklyn Price allegedly took part in a scheme to bill Medicare for services that were obtained through kickbacks, not medically necessary, not actually provided, or provided by an unlicensed practitioner. Her co-defendants, Millicent Traylor, Muhammad Qazi, and Christina Kimbrough, were all sentenced in September. DOJ

November 5, 2018

A Michigan-based patient recruiter for home health care agencies was convicted, following trial, for her role in a scheme to bill Medicare for claims arising from illegal kickbacks. Together with co-conspiring home healthcare agencies, Sophia Eggleston defrauded Medicare of $1.1 million. The scheme, which was active for at least three years, involved Eggleston soliciting and receiving kickbacks in exchange for patient referrals to co-conspirator home health agency contacts, who then submitted Medicare claims for services purportedly provided to the referred patients. Eggleston faces sentencing in February. DOJ

October 26, 2018

Abbott Laboratories and AbbVie, Inc. have agreed to pay $25 million to settle a case initiated by a whistleblower alleging that the pharma companies paid unlawful kickbacks and engaged in unlawful off-label marketing for the drug TriCor.  The kickbacks took the form of gifts and payments for consulting and speaking engagements that were meant to induce or reward physicians for prescribing TriCor.  The off-label marketing consisted of Abbott's advertising the drug for conditions for which it was not FDA-approved.  The whistleblower, Amy Bergman, a former Abbott sales representative, will receive $6.5 million of the settlement.  USAO E.D.Pa.

October 18, 2018

Four individuals have pleaded guilty to conspiring to violate the Anti-Kickback Statute for a scheme that made payments to patient recruiters and a medical office assistant to find TRICARE beneficiaries to get prescriptions for compounded prescription pain cream, scar cream, and supplements from a doctor who had never seen the patients.  In less than one year, the scheme generated over $10 million in compound prescriptions for over 100 TRICARE beneficiaries.  E.D. Ark.

October 9, 2018

The former CFO and COO of Houston-area Atrium Medical Center and Pristine Healthcare, Starsky Bomer, has been convicted for his role in a $16 million Medicare kickback scheme.  Bomer and others paid illegal kickbacks to group home owners and patient recruiters in exchange for the referral of Medicare patients for outpatient mental health treatment through the hospitals' partial hospitalization program (PHP).  While the hospitals billed Medicare $16 million for these patients, the evidence at trial demonstrated that Bomer knew that PHP services were not necessary for most of the patients, and that the patients were not, in fact, provided with such services.   DOJ
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