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Drug and DME Pricing

This archive displays posts tagged as relevant to drug and durable medical equipment pricing. You may also be interested in our pages:

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April 9, 2019

A number of telemedicine and durable medical equipment companies, the principals of those companies, and three healthcare providers, were charged with submitting over $1.7 billion in false claims in a scheme to pay unlawful kickbacks and bribes from DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary DME including back, shoulder, wrist and knee braces.  DOJ; USAO MD FL; USAO NJ; USAO SC.

March 11, 2019

Pfizer will pay $975,000 to the State of Oregon to resolve allegations that the pharmaceutical company distributed misleading advertising materials and coupons to state residents.  The materials advertised Pfizer's drugs the Flector Patch, Estring, Quillivant, and Quillichew, claiming that consumers would "pay no more than" specified amounts -- $15, $20, or $25.  In fact, consumers ended up paying more than advertised for the Pfizer drugs, despite the availability of cheaper generic alternatives.  A large portion of the settlement, $620,000, will go to Oregon nonprofits that provide medical care to low-income uninsured and underinsured, including migrant and seasonal farmworkers.  In addition, consumers who used the coupons will receive refunds.  OR AG

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....

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $60 million to settle a False Claims Act case brought by a whistleblower alleging that the retail pharmacy chain knowingly overcharged Medicaid when it charged the healthcare program more than "usual and customary price" for medications that participants in Walgreens "Prescriptions Savings Club" received at a lower price.  Of the settlement, approximately $32 million will be paid to the U.S. and $28 million to the affected states.  Whistleblower Marc D. Baker will receive a share of the total settlement, to be determined at a later date.  USAO SDNY

January 11, 2019

 Teva Pharmaceuticals USA Inc. will pay $135 million to the state of Illinois to settle allegations that published fraudulently inflated Average Wholesale Prices (AWPs) for numerous prescription drugs.  Illinois's Medicaid program bases its drug reimbursements for Medicaid beneficiaries on AWPs, and the inflated AWPs caused Illinois to overpay. IL AG

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  

January 4, 2018

Kmart Corporation agreed to a $1 million settlement with the California Department of Insurance to resolve a whistleblower claim brought under the California Insurance Fraud Prevention Act.  KMart contracted with insurance companies to be reimbursed at a rate based on the company's charges to cash-paying customers, but was alleged to have submitted claims to private insurers in amounts that exceeded the agreed-upon rates.  CA

December 22, 2017

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation, agreed to pay $32.3 million to settle allegations that Kmart violated the False Claims Act through Kmart pharmacies offering discounted generic drug prices to cash-paying customers through various club programs without disclosing those prices when reporting to federal health programs its usual and customary prices. Usual and customary pricing is typically used by Medicare and the other federal health programs to establish reimbursement rates. The settlement is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by James Garbe. He will receive a whistleblower award of $9.3 million. DOJ

August 17, 2017

Pharmaceutical companies Mylan Inc. and Mylan Specialty L.P. agreed to pay $465 million to settle charges they violated the False Claims Act by purposely misclassifying EpiPen as a generic drug to avoid paying higher Medicaid rebates.  Under the Medicaid Drug Rebate Program, state Medicaid programs are entitled to larger rebates for brand-name drugs compared to generics.  According to the government, Mylan circumvented this program and its purpose by erroneously reporting EpiPen as a generic drug to Medicaid so it could demand massive price increases in the private market while avoiding its corresponding rebate obligations to Medicaid.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by competing pharmaceutical manufacturer Sanofi-Aventis US.  Sanofi will receive a whistleblower award of roughly $38.7 million from the proceeds of the government’s recovery. Whistleblower Insider

Mylan Agrees to Pay $465 Million in a False Claims Act Settlement

Posted  08/21/17
By the C|C Whistleblower Lawyer Team Last Friday, the Department of Justice (“DOJ”) announced a $465 million settlement with Mylan, Inc. to resolve claims that it violated the False Claim Act. The suit was brought by a whistleblower under the False Claims Act qui tam provisions and involved the alleged improper misclassification of the EpiPen as a generic drug to avoid paying rebates owed mainly to Medicaid....
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