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New York Introduces Bills to Expand Whistleblower Protections

Posted 06/21/19

Under current law, whistleblowers who reported fraudulent activity in the government or other settings in the State of New York are typically barred from bringing other legal actions. Maybe not anymore. Last week, both the New York State Senate and Assembly signed off on a series of amendments aimed at providing greater protection for employees who notice and report illegal activity, and expanding the definition of a...

Tagged in: FCA State, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud, Retaliation, Whistleblower Eligibility, Whistleblower Protection Laws,

Catch of the Week — Wound Care Device Manufacturer ACell Inc.

Posted 06/14/19

Our Catch of the Week goes to ACell Inc., a Maryland-based medical device manufacturer that pleaded guilty to violating the Federal Food, Drug, and Cosmetic Act (FDCA) by failing to report that it had partially removed its wound-care product, MicroMatrix, from the market because it was contaminated with endotoxins, placing treated patients in danger of serious infection, even death, without informing the FDA that it...

Tagged in: Catch of the Week, FCA Federal, FDA Fraud, Medical Devices and DME, Whistleblower Case,

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Posted 05/23/19

The New York Times recently reported that the Metropolitan Museum of Art has decided to stop accepting gifts from members of the Sackler family linked to Purdue Pharma, the maker of OxyContin, one of the drugs at the center of the opioid epidemic that has killed more than 200,000 Americans in the past two decades. The Met’s decision follows that of other museums and universities, including the Tate Modern, the...

Tagged in: Healthcare Fraud, Pharma Fraud, Question of the Week,

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted 05/10/19

Handcuffed business-leader walking through jail.

In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Defendants, Dosage Fraud, Healthcare Fraud, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week,

Ohio Seeks to Recover Overcharges from OptumRx

Posted 02/21/19

After a 2018 investigation by the Ohio Bureau of Workers Compensation (BWC) of its prescription drug spending, the BWC pharmacy program manager, John Hanna, concluded that "we were being hosed." The BWC had contracted with OptumRx to act as a pharmacy benefits manager (PBM). PBMs act as middlemen between drugmakers, pharmacies, and payors such as worker's compensation programs, Medicaid, Medicare, and other...

Tagged in: FCA State, Medicaid, Other Government Health Programs, Pharma Fraud,

Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

Posted 02/11/19

Stethoscope with computer tablet saying "Opiod epidemic"

On Friday, the Justice Department announced that it has sued several pharmacies and pharmacists in Tennessee to stop them from illegally dispensing opioids. According to the complaint, both defendants have “fueled and profited from” the opioid epidemic by “repeatedly dispensing opioids and other controlled substances prone to abuse without a legitimate medical purpose and outside the usual course of professional...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Pharma Fraud,

Catch of the Week – Walgreens Pays Record $273 Million To Settle Three FCA Suits

Posted 01/25/19

Storefront of brick-faced Walgreens location

Three separate qui tam actions brought by whistleblowers against Walgreens Boots Alliance, Inc. (Walgreens) have resolved in what amounts to the largest settlement payouts for a retail pharmacy. In the first action, two former Walgreens pharmacists alleged that the company sought reimbursement for insulin pens it dispensed to Medicare and Medicaid beneficiaries who did not need them. Walgreens did so in two ways....

Tagged in: Catch of the Week, Drug and DME Pricing, FCA Federal, Pharma Fraud, Whistleblower Rewards,

Top Ten Healthcare Recoveries of 2018

Posted 01/15/19

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:

1. Amerisource Bergen Corporation - In...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Managed Care, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Risk Adjustment Fraud, Top 10,

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Posted 12/13/18

Pile of blister packs with medications of different colors and sizes

Imagine if at the end of Charles Dickens’ “A Christmas Carol,” Ebenezer Scrooge announced that he was giving the prize turkey to the Cratchit family for Christmas dinner, but that this “gift” was conditional upon Bob Cratchit agreeing to work even longer hours in the new year, the turkey being cooked in a certain way, and only certain family members eating it. Would we consider Scrooge to have been truly...

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

Catch of the Week — Actelion Pharmaceticals

Posted 12/7/18

Red and yellow capsules on top of U.S. currency

This week's Department of Justice "Catch of the Week" goes to Actelion Pharmaceuticals US, Inc., a California pharmaceutical company that sells various pulmonary arterial hypertension drugs, including Tracleer, Ventavis, Veletri, and Opsumit. Yesterday, Actelion agreed to pay $360 million to resolve allegations that it violated the Anti-Kickback Statute by indirectly paying drug copays for thousands of Medicare...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Pharma Fraud,

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New York Introduces Bills to Expand Whistleblower Protections

Catch of the Week — Wound Care Device Manufacturer ACell Inc.

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Ohio Seeks to Recover Overcharges from OptumRx

Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

Catch of the Week – Walgreens Pays Record $273 Million To Settle Three FCA Suits

Top Ten Healthcare Recoveries of 2018

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Catch of the Week — Actelion Pharmaceticals

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