Pharma Fraud Archives - Page 3 of 39

Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

December 6, 2022

Centene will pay $17 million to the State of Oregon to resolve an investigation that the company, which served as a pharmacy benefit manager for the state’s Medicaid program, failed to provide certain pharmacy discounts in Oregon, resulting in inflated fees paid to Centene. OR

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud,

November 15, 2022

Walmart has agreed to pay $3.1 billion for its failure to oversee opioid dispensing in its pharmacies, helping to fuel the opioid crisis. Walmart will implement better policies and procedures and submit to increased oversight. Much of the settlement funding is designated for opioid treatment and recovery services, in addition to creating a Controlled Substance Compliance Director to oversee the settlement’s requirements. CA AG; NY AG; OR AG; DE AG; VA AG; KS AG

Tagged in: Pharma Fraud,

November 3, 2022

Teva Pharmaceuticals, Ltd., subsidiary Teva Pharmaceuticals USA, and its affiliates will pay $523 million to New York State for their role in fueling the opioid crisis. Injunctive relief includes a ban on high-dose opioids and prescription savings programs, prohibitions on marketing and funding third parties that promote opioids, restrictions on political lobbying, and monitoring and reporting of off-label use of fentanyl nasal spray products. NYAG

Tagged in: Healthcare Fraud, Off-Label and Unapproved Use, Pharma Fraud,

October 12, 2022

Four pharmacies have agreed to pay over $6.8 million to settle a qui tam suit that alleged they defrauded TRICARE and the Federal Employees Health Benefits Program, in violation of the False Claims Act. According to a former accountant for one of the pharmacies, DermaTran Health Solutions, LLC; Pharmacy Insurance Administrators, LLC; Legends Pharmacy; TriadRx; and Lake Side Pharmacy created a program to waive mandatory copays for beneficiaries of federal health insurers, overcharged the government for compounded pain creams, and traded out-of-network prescriptions with other pharmacies, which constituted a kickback. USAO NDGA

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

September 26, 2022

Biogen Inc. has agreed to pay $900 million to resolve allegations by former employee Michael Bawduniak that the pharmaceutical company paid illegal kickbacks to physicians in order to induce prescriptions of their multiple sclerosis drugs, causing false claims to be submitted to Medicare and Medicaid. According to Bawduniak, over a five-year period, Biogen paid kickbacks in the form of speaker honoraria, training fees, consulting fees, and free meals. The vast majority of the settlement proceeds (over $840 million) will go to the federal government, while the remainder will be divided among 15 states. USAO MA

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

September 14, 2022

Illinois-based pharmaceutical company Akorn Operating Company LLC has agreed to pay $7.9 million to resolve allegations of violating the False Claims Act by causing Medicare to pay for three generic drugs that stopped being eligible for coverage when their original manufacturers converted the brand name drugs from prescription only to over-the-counter. According to a whistleblower, the brand name drugs in question were converted in February 2020 and June 2021, but Akorn knowingly failed to seek conversion of their generics until a year later because it knew over-the-counter drugs were non-reimbursable. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Part D, Pharma Fraud, Whistleblower Case,

September 2, 2022

Bayer Corporation, together with its subsidiaries, will pay $40 million to settle claims initiated by a whistleblower alleging that the pharmaceutical manufacturer violated the False Claims Act by engaging in off-label marketing, unlawful kickbacks, and misreporting of safety risks with respect to its drugs Trasylol, Avelox, and Baycol. The whistleblower, former Bayer marketing employee Laurie Simpson, will receive approximately $11 million from the settlement. DOJ; USAO MN; USAO NJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

August 24, 2022

Centene will pay Washington State $19 million to resolve allegations that the company overcharged the state for pharmacy benefit management services. The state alleged that Centene failed to pass on discounts it received to the state Medicaid program, and inflated dispensing fees. WA

Tagged in: Drug and DME Pricing, Healthcare Fraud, Medicaid, Pharma Fraud,

August 11, 2022

Spivack, Inc., formerly operating as Verree Pharmacy, and owner-pharmacist Mitchell Spivack, have agreed to pay over $4.1 million in civil penalties for dispensing opioids despite numerous red flags the drugs were being diverted—all in violation of the False Claims Act and the Controlled Substances Act. In furtherance of the fraud, Spivack made false statements to drug distributors to maintain the façade of legitimacy, while concurrently drawing millions from the pharmacy and harming the public. In addition to their opioid fraud, Spivack and Verree effectuated their “Bill But Don’t Fill” scheme, where they would enter “BBDF” in their internal computer system, and would submit false claims to insurers for drugs not actually dispensed. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud,

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