ATTORNEY NEWSLETTER
Suit Alleged Three Years Of Illegal Kickbacks
Covering Patient Co-Pays For Medications
Former Executive Will Receive $3.59 Million As Reward
Fraud within the healthcare industry continues to be the primary form of fraud against the government. The government, and private individuals suing on behalf of the government, rely on a number of statutes as enforcement tools against wrongdoers. As the primary enforcement statute, individuals and the government bring cases under the False Claims Act, which prohibits fraud against the government generally. See False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq. A more particular enforcement law is the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, which prohibits offering, soliciting, or receiving any remuneration to induce referrals for medical services or procedures, including inpatient services., where the services are paid for by government programs. Illegal kickbacks are only one form of healthcare fraud actionable under the FCA; other types of fraud include overbilling, selling unapproved drugs or medical devices, false certifications and eligibility records or billing for services that were never provided. Individuals with knowledge of illegal kickbacks can be rewarded for bringing suit against the offending companies who defraud these programs. The suit is initiated by filing complaints known as “qui tam” complaints. 31 U.S.C. § 3730(b)(federal). If you have credible information of illegal kickbacks or other healthcare fraud here in San Francisco or elsewhere in California, call us today at (415)441-8669 and we can help.
Payment of Patient Co-Pays May Be Illegal Kickbacks
In a recent settlement announced by the U.S. Department of Justice,[1] a pharmaceutical company purportedly used an independent foundation as a conduit to pay the copays of certain federal beneficiaries taking a drug produced by the company approved to treat myleofibrosis in 2011. Specifically, the company was allegedly the sole donor to a fund that was opened in November 2011 to assist only myleofibrosis patients. After the fund opened, the government alleges that the company used the fund to pay the copays of federal beneficiaries taking the approved medication who were in actuality ineligible for assistance from the fund because they did not have myleofibrosis. The suit alleged that company managers pressured the foundation, through phone calls and emails, to provide economic assistance to these ineligible patients, and the company’s sales contractor allegedly helped ineligible patients to complete applications submitted to the fund for assistance. The government alleges that through this conduct, the company caused false claims to be submitted to Medicare and TRICARE.
“Drug companies undermine the integrity of federal health care programs and contribute to rising drug costs when they illegally use foundations to cover patients’ costs for their own drugs,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “This resolution reflects the government’s continuing commitment to hold pharmaceutical companies accountable for this conduct.”
“Pharmaceutical companies cannot skirt the anti-kickback rules by disguising their inducements to federally-insured patients as charitable donations,” said Acting U.S. Attorney Jennifer Williams for the Eastern District of Pennsylvania. “This resolution shows our office’s continuing commitment to holding drug companies accountable for this conduct.”
Former Company Executive Will Receive Reward
A former executive of the company will receive a $3.59 million reward for first bringing this case on behalf of the government. Although this relator was a former employee of one of the defendants, currently employed individuals often have knowledge of fraud against government programs and are protected from employer retaliation for bringing false claims qui tam cases. 31 U.S.C. § 3730(h). If you are fired because you brought any fraud to light, you can fight back under the False Claims Act which prohibits retaliation against you for exposing the wrongdoing. You may be entitled to sue your employer in court and seek double back pay (with interest), reinstatement, reasonable attorneys’ fees, and reimbursement for certain costs in connection with the litigation. 31 U.S.C. § 3730(h)(2). Evans Law Firm, Inc. can represent you in any action for retaliation as well as represent you in your underlying whistleblower application.
Contact Us
If you have credible information of government contractor fraud against Medicare or Medi-Cal call Ingrid M. Evans at (415) 441-8669, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to FCA and CFCA whistleblower cases, Ingrid and Evans Law Firm, Inc. also handle bank fraud whistleblower cases under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program.
[1] Evans Law Firm, Inc. was not involved in the cases in any way. The qui tam case is captioned U.S. ex rel. Dillon v. Incyte Corp., No. 2:18 -cv-2642 (E.D. Pa.)
