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Top Ten Healthcare Recoveries of 2018

Posted  January 15, 2019

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:

    1. Amerisource Bergen Corporation – In October 2018, DOJ announced that wholesale drug company Amerisource Bergen Corporation agreed to pay $625 million to resolve charges it removed cancer patient drugs from the original vials, then repackaged and sold the adulterated drugs as pre-filled syringes. The pharma fraud scheme allowed the company to create additional doses and double bill for the same vial of drug. The settlement also resolved charges the drug company paid kickbacks to induce doctors to buy the pre-filled syringes.
    2. Actelion Pharmaceuticals US, Inc. – In December 2018, drug maker Actelion Pharmaceuticals US, Inc. reached a $360 million settlement with the government, resolving kickbacks claims related to its copay assistance program for hypertension drugs. According to the government, Actelion set up a foundation to cover copayments for just its drugs, then referred Medicare patients to the foundation, resulting in tainted claims to Medicare for the remaining drug costs.
    3. Healthcare Partners Holdings LLC – In October 2018, DaVita entity Healthcare Partners Holdings LLC agreed to pay $270 million to settle charges the California-based doctor group directed its physicians to use inappropriate diagnosis coding standards, inflating the risk adjustment payments it received from the Medicare Advantage program.
    4. Health Management Associates, LLC – In September 2018, Florida-based hospital chain Health Management Associates reached a $260 million settlement for defrauding federal healthcare programs by billing outpatient services as costlier inpatient services, overcharging on emergency department fees, and paying kickbacks to doctors. The hospital chain, which has since been acquired by Community Health Systems, Inc. admitted to increasing emergency room admissions by setting mandatory admission rate benchmarks and coercing physicians and medical directors to meet those targets regardless of medical necessity.
    5. AstraZeneca – In August 2018, pharmaceutical company AstraZeneca agreed to pay the state of Texas $110 million to resolve off-label marketing claims. AstraZeneca allegedly marketed its antipsychotic medication Seroquel to Medicaid providers treating children and adolescents for whom the drug was not approved by the FDA, and illegally paid state hospital doctors to increase Seroquel prescriptions. Prosecutors also accused the company of engaging in abusive and misleading marketing practices to sell more of its cholesterol-lowering statin drug Crestor and downplaying associated risks.
    6. William Beaumont Hospital – In August 2018, Detroit-based hospital system William Beaumont Hospital settled Anti-Kickback and Stark Law claims with the federal government and the state of Michigan for a combined $84.5 million. From 2004 to 2012, the hospital allegedly secured referrals for patients insured by federal healthcare programs by improperly compensating eight physicians at rates above fair market value and providing office space at below-market rates.
    7. Prime Healthcare Company – In August 2018, Prime Healthcare Services, its CEO Dr. Prem Reddy, and several affiliated entities, agreed to a $65 million settlement to resolve allegations that 14 of its California hospitals admitted patients who could have been treated in a less expensive outpatient setting and falsely upcoded patient diagnoses to increase payments from the government.
    8. Signature HealthCARE LLC – In June 2018, Signature HealthCARE LLC reached a $30 million settlement with the federal and state of Tennessee governments, resolving charges it submitted false skilled nursing claims. Signature allegedly billed the government for rehabilitation services that were not reasonable, necessary, and skilled because it defaulted to the highest therapy reimbursement level notwithstanding patient need, discouraged therapy beyond the minimum required number of minutes to bill at a given level, and pressured therapists and patients to complete unwanted therapy.
    9. Alere Inc. – In March 2018, medical device maker Alere Inc. agreed to a $33.2 million settlement over allegations it knowingly sold unreliable point-of-care diagnostic testing devices called Triage. The Triage devices were marketed for use in emergency departments to assist in diagnosing serious conditions including acute coronary syndromes, heart failure, and drug overdose. According to the government, Alere was on notice the devices produced both false positives and false negatives but failed to adequately address the problem until FDA inspections prompted a nationwide recall.
    10. Abbott Laboratories and AbbVie Inc. – In October 2018, Abbott Laboratories and AbbVie, Inc. reached a $25 million settlement for allegedly paying kickbacks to physicians to induce them to prescribe the drug TriCor. The settlement also resolved off-label marketing charges.

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Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Managed Care, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Risk Adjustment Fraud, Top 10,