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Anti-Kickback and Stark

This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.

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Page 18 of 61

July 1, 2020

Novartis Pharmaceuticals Corporation will pay a total of $678 million to resolve a case brought by a whistleblower, Oswald Bilotta, alleging that between 2002 and 2011 the pharmaceutical company violated the Anti-Kickback Statute and False Claims Act by providing doctors with cash payments and luxury travel and meals to induce them to prescribe Novartis cardiovascular and diabetes drugs reimbursed by federal healthcare programs.  The total settlement consists of $591.4 million as federal FCA damages, $48.2 million as state FCA damages for Medicaid false claims submitted to 28 states and the District of Columbia, and $38.4 million as forfeiture under the Anti-Kickback Statute.  The whistleblower award has not yet been determined.  In addition to the monetary settlement, Novartis entered into a Corporate Integrity Agreement obligating the company to, among other things, significantly reduce its volume and spending on paid speaker programs.  DOJ; USAO SDNY; CA AG; MI AG; NY AG

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

July 1, 2020

Novartis Pharmaceuticals Corporation will pay $51.25 million to resolve claims that it unlawfully funneled money to three different foundations – The Assistance Fund, the National Organization for Rare Disorders, and the Chronic Disease Fund – so that those organizations could fund co-payments owed by Medicare beneficiary patients prescribed the Novartis drugs Gilenya (for multiple sclerosis) and Afinitor (for renal cell carcinoma and certain pancreatic cancers).  The payments were alleged to be in violation of the Anti-Kickback Statute and False Claims Act.  USAO Mass; DOJ

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

June 25, 2020

George Philip Tompkins of Houston, Texas, the former owner of Piney Point Pharmacy, was sentenced to ten years in prison following his conviction on charges of healthcare fraud, unlawful kickbacks, money laundering, and wire fraud.  Tompkins billed $21.8 million to federal and state worker’s compensation programs for medically unnecessary compound gels and creams, paying kickbacks to generate prescriptions while claiming that the kickbacks were legitimate marketing expenses. Thompson was also ordered to pay restitution of $12.3 million. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

Regeneron: The Government’s Latest Stand against Patient Kickbacks

Posted  06/25/20
pills, syringes, and money scattered around
This week, Boston-based prosecutors have filed a new False Claims Act case against Regeneron, a pharmaceutical company, alleging that it paid patients kickbacks aiming to steer them into using Regeneron’s macular degeneration drug, Eylea. Regeneron allegedly disguised the kickbacks as charitable contributions to a foundation. Prosecutors say that Regeneron only donated exactly enough money to the foundation, called...

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

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June 25, 2020

Georgia-based Piedmont Healthcare, Inc. has agreed to pay $16 million to resolve whistleblower-brought allegations that it violated the Anti-Kickback Statute and False Claims Act.  The relator in this case, a former Piedmont physician, alleged that between 2009 and 2013, Piedmont’s case managers overturned physician recommendations for outpatient care by submitting claims for more expensive inpatient care to Medicare and Medicaid.  Furthermore, when the healthcare system acquired the Atlanta Cardiology Group in 2007, it allegedly paid far above fair market value for a catherization lab that was partly owned by the practice group.  For bringing a successful enforcement action, the unnamed relator will receive a share of nearly $3 million of the settlement proceeds. USAO SDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 10, 2020

Alutiiq International Solutions LLC (AIS), an Alaskan Native Corporation and government contractor, has agreed to pay $1.25 million and enter into a non-prosecution agreement to settle allegations of violating the Anti-Kickback Act in connection with a multi-million dollar General Services Administration (GSA) contract to modernize the Harry S. Truman Federal Building in Washington, D.C.  Beginning in 2010, a project manager formerly employed by AIS allegedly accepted kickbacks from a subcontractor in exchange for steering more work to the subcontractor, while also fraudulently billing GSA for a non-existent on-site supervisor and overinflating costs from its subcontractor.  AIS and its parent company, Afognak Native Corporation, cooperated fully with the investigation and have since engaged in extensive remedial actions.  DOJ

Tagged in: Anti-Kickback and Stark, Bribery and Bid-Rigging, Criminal Proceedings, Government Procurement Fraud,

May 1, 2020

Milwaukee-based Center for Pain Management, S.C. and its owner, Nosheen Hasan, will pay at least $1.35 million to resolve claims that they received unlawful kickbacks in exchange for ordering medically unnecessary tests from a urine drug testing laboratory, Midwest Laboratory Sales & Consulting, LLC, in violation of the False Claims Act.  The investigation was initiated by a whistleblower, who will receive a share of the settlement.  USAO ED WI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud, Whistleblower Case,

April 27, 2020

North Carolina based clinical laboratory Genova Diagnostics Inc. will pay up to $43 million to resolve a lawsuit brought by whistleblower Darryl Landis, who will receive up to $6 million.  The laboratory allegedly billed Medicare, TRICARE, and other government healthcare programs for IgG allergen, “NutrEval,” and “GI Effects” lab tests that were not medically necessary, and also paid unlawful compensation to three phlebotomy vendors in violation of the Stark Law  The settlement amount consists of the forfeiture of $17 million in claim funds held in suspension by Medicare and TRICARE, as well as an additional $26 million to be paid based on certain financial contingencies over the next five years.  DOJ; USAO WD NC

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

April 22, 2020

Hospital chain Centra Health Inc. and physician group Blue Ridge Ear, Nose, Throat and Plastic Surgery, Inc., will pay a total of $9.35 million to resolve claims that they entered into an improper financial arrangement in violation of the Stark Law, Anti-Kickback Law, and False Claims Act.  The improper agreements included guaranteed physician compensation, physician compensation arrangements that took into account the value of referrals, and financial arrangements with physicians that were not memorialized in a written and executed contract.  A former Blue Ridge ENT physician, who filed a qui tam action regarding the improper arrangements, will receive an undisclosed share of the settlement.  USAO WD VA

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

April 6, 2020

Following a $7.1 million settlement with seven co-defendants in October 2019, a chiropractor in New Jersey who allegedly concocted the scheme to bill Medicare for medically unnecessary injections and knee braces has agreed to pay $2 million to resolve his liability.  A critical analysis of Medicare claims data revealed that while treating for osteoarthritis, David Podell caused his clinic and seven Osteo Relief Institutes to bill Medicare for viscosupplementation injections—gel-like fluids injected into the knee that act as lubricant—as well as custom knee braces for beneficiaries who did not need them.  Additionally, the claims for the custom knee braces were tainted by illegal kickbacks that Podell solicited and received from the manufacturer.  DOJ; USAO MN

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

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