Catch of the Week — Actelion Pharmaceticals
Posted 12/7/18
Archive
Catch of the Week — Health Management Associates
Posted 09/27/18
Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica
Posted 09/7/18
Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud,...
Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships
Posted 08/31/18
Catch of the Week -- William Beaumont Hospital
Posted 08/3/18
Catch of the Week -- Health Quest Systems and Putnam Hospital Center
Posted 07/13/18
This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week.
The settlement resolves allegations stemming from three separate lawsuits bought by...
How Copayment Waivers can Give Rise to a Whistleblower Claim
Posted 06/8/18
What’s not to like about a doctor waiving a patient’s copayment, or a pharmaceutical company offering a prescription drug assistance program? Turns out there are plenty of reasons to be concerned about such activities. And, as a recently announced $24 million settlement with Pfizer illustrates, unlawful patient cost waivers can result in big liability for defendants.
Patient cost-sharing is a core principle...
US Obtains $114M FCA Judgement in Kickbacks Case
Posted 05/31/18
On May 23, the US District Court in South Carolina issued judgment for the US for roughly $114M against three individuals, LaTonya Mallory, Floyd Dent III, and Robert Johnson, for violating the FCA by paying kickbacks to doctors in exchange for patient referrals. The defendants also caused two labs to bill Medicare, TRICARE, and Medicaid for medically unnecessary tests. The judgment follows a January jury verdict that...
Pfizer Agrees to Pay $23.85 Million to Resolve False Claims Act Liability for Paying Kickbacks
Posted 05/24/18
The Department of Justice today announced that Pfizer agreed to pay $23.85 million to resolve allegations that it used a foundation as a conduit to pay the copays of Medicare patients taking three Pfizer drugs. Medicare Part B or D beneficiaries typically make a partial payment when obtaining prescription drugs in the form of a copay, coinsurance, or deductible. Under the Anti-Kickback Statute, pharmaceutical...
Michigan Home Health Agency Owner Pleads Guilty to Health Care Fraud Charges
Posted 05/18/18
The owner of a Michigan home health agency pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services that were procured through the payment of illegal kickbacks. Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to pay and...