Ninth Circuit Finds Materiality in the Face of Continued Government Payment
Posted 07/14/17
By Rosie Dawn Griffin
Earlier this month, the U.S. Court of Appeals for the Ninth Circuit revived United States ex rel. Campie v. Gilead Scis., a False Claims Act (FCA) suit against pharmaceutical giant Gilead Sciences and, in doing so, provided the qui tam bar with additional guidance on how the lower courts will interpret the Supreme Court’s emphasis on materiality in Universal Health Services, Inc. v....
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Hundreds of people nationwide, including dozens of doctors, have been charged in health care fraud prosecutions, accused of collectively defrauding the government of $1.3 billion. Nearly one-third of the 412 charged were accused of opioid-related crimes. The health care providers, about 50 of them doctors, billed Medicare and Medicaid for drugs that were never purchased;...
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Last week, federal authorities announced that Dr. Rassan M. Tarabein, a neurologist who operates the Eastern Shore Neurology and Pain Center in Daphne, Alabama, had been arrested on myriad federal and state charges relating to health care fraud. A federal grand jury recently returned a 22-count superseding indictment against Tarabein, charging him with health care fraud,...
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A hospice company in Bensalem, Pennsylvania, has agreed to pay to the United States $2 million to resolve allegations that it provided unnecessary hospice services.
Compassionate Care of Gwynedd Inc. is a hospice provider based in Bensalem and a subsidiary of Compassionate Care Hospice Group Inc., a Florida corporation with its principal place of business in Parsippany, New...
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As of 2017, a third (approximately 19 million) of all Medicare beneficiaries are now in the Medicare Advantage (MA) program, which is run by private insurers. The insurers receive payments from the federal government based on the sickliness of the population the plan insures, populations with more incidents of severe or chronic diseases lead to higher reimbursements. Insurers...
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Pharmaceutical maker Allergan, Inc. has agreed to pay $13 million to settle claims it illegally promoted eye drugs through a kickback scheme to induce doctors to prescribe its products.
According to the complaint, Allergan improperly provided services such as business consulting and continuing medical education to boost its sales by encouraging doctors to recommend...
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On Wednesday, opening statements were delivered in the trial of Martin Shkreli, the “pharma bro” who is best known for his fiftyfold price increase of the lifesaving HIV/AIDS drug Daraprim while CEO of Turing Pharmaceuticals. Shkreli is being tried, however, on several counts of securities and wire fraud dating from his time running the hedge funds MSMB Capital and MSMB...
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Pacific Alliance Medical Center, a hospital in Los Angeles’ Chinatown neighborhood, 
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The owner and director of compliance of an Indiana compounding pharmacy were charged criminally in connection with their distribution of over- and under-potent drugs, and defrauding the United States by interfering with and obstructing the lawful functions of the FDA.
Paul J. Elmer, 64, of Fishers, Indiana, and Caprice R. Bearden, 62, of Carmel, Indiana, were charged in a...
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A mother and daughter who secretly co-owned and operated seven home health care agencies in the Miami, Florida area were each sentenced to over 10 years in prison for their roles in a $20 million Medicare fraud conspiracy that involved paying illegal health care kickbacks to patient recruiters and medical professionals.
Mildrey Gonzalez, 61, and her daughter, Milka Alfaro,...