Pharma Fraud
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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 14, 2018
Tamar Tatarian, owner of Akhtmar Pharmacy, was found guilty for her part in a scheme to defraud Medicare out of more than $1.3 million in false claims for prescription drugs. According to evidence presented during the two-day trial, Tatarian submitted false claims to Medicare Part D plan sponsors between October 2015 and October 2017 for prescription drugs that Akhtmar pharmacy had not actually ordered from wholesalers, and therefore were not dispensed to Medicare beneficiaries. Tartarian tried to cover up the fraud by generating fake invoices that included wholesale drug purchases by the pharmacy which had not, in reality, ever happened. Tatarian was convicted of one count of health care fraud and two counts of wire fraud. DOJWhen a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits
Posted 12/13/18
December 11, 2018
Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AGCatch of the Week — Actelion Pharmaceticals
Posted 12/7/18
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. DOJOctober 26, 2018
Abbott Laboratories and AbbVie, Inc. have agreed to pay $25 million to settle a case initiated by a whistleblower alleging that the pharma companies paid unlawful kickbacks and engaged in unlawful off-label marketing for the drug TriCor. The kickbacks took the form of gifts and payments for consulting and speaking engagements that were meant to induce or reward physicians for prescribing TriCor. The off-label marketing consisted of Abbott's advertising the drug for conditions for which it was not FDA-approved. The whistleblower, Amy Bergman, a former Abbott sales representative, will receive $6.5 million of the settlement. USAO E.D.Pa.October 22, 2018
A Kentucky-based medical equipment supplier has agreed to pay $5,254,912 to settle claims based on the False Claims Act that it defrauded many government insurers, including Kentucky Medicaid, Medicare, and CHAMPVA (under the Department of Veterans Affairs), by submitting fraudulent claims relating to certain compounded creams that it produced. According to the DOJ press release, in order to be properly reimbursed, Cooley Medical Equipment, Inc. was required to obtain prior authorization from Kentucky Medicaid and CHAMPVA before using certain powdered ingredients. Instead, Cooley claimed to use cream-based versions of the same ingredients, then submitted thousands of false claims to the insurers, and received millions of dollars in reimbursements. The company eventually came clean and self-disclosed to the US Attorney's Office, allowing it to pay a fine of 1.5 times instead of the usual 3 times loss suffered by the government. USAO EDKYCatch of the Week – AmerisourceBergen Corporation
Posted 10/12/18
