Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

 

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

By |2024-03-14T10:01:52-04:00May 15, 2018|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

By |2024-03-14T10:01:28-04:00May 15, 2018|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

New DOJ Memo Shifting Government Policy in False Claims Act Cases Should make Healthcare Providers Happy!

Headshot of attorney George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On January 29, 2018, the U.S. Department of Justice (DOJ) released a new internal memorandum that we believe signals a backing-off of government support for False Claims Act cases. The memorandum sent by Associate Attorney General Rachel Brand, references “vast reams” of government agency guidance explaining the government’s views and interpretation of various laws. It includes laws related to requirements for accurate billing of Medicare and Medicaid by healthcare providers.

The “Brand Memorandum.”

In the memo, Brand said the DOJ “may not use its enforcement authority to effectively convert agency guidance documents into binding rules.” The memo is a product of Attorney General Jeff Sessions’ move in November 2017, to curtail “regulation by guidance.”

It states that it specifically applies to civil enforcement of laws, including the False Claims Act (FCA), that the Associate Attorney General oversees.

Click here to view the DOJ’s Brand Memorandum in full on our website.

Implications of the Brand Memorandum.

Brand’s memorandum stopped short of completely forbidding the use of agency guidance in support of DOJ cases. The memorandum indicates that, while violations of agency guidance can’t be used to prove violations of law, they can still be used “to help prove that the party had the requisite knowledge” of its legal obligations, Brand wrote.

FCA cases can be affected by many types of guidance. Medicare contractors provide guidance on billing when appropriate and the U.S. Food and Drug Administration (FDA) issues guidance on illicit off-label promotion. Additionally, the Office of the Inspector General (OIG) issues guidance and bulletins related to kickbacks and improper physician referrals.

To learn more about the DOJ’s role in health care fraud and compliance, click here to read one of my prior blogs.

Visit our website to find out how The Health Law Firm can assist you with Medicaid fraud defense, Medicare fraud defense and False Claims Act defense cases.

What Will the Long Term Effects Be?

We see these latest actions by the DOJ to announce a policy of allowing big corporations unbridled discretion to steal from the tax payers. We believe it signals a change to discouraging False Claims Act cases from being brought. It is difficult to see why DOJ is easing off of matters that help the prosecution of False Claims Act cases, especially those by individual relators (whistle blowers). Whistle blower or qui tam cases brought by hundreds of individual whistle blowers are now recovering billions of dollars each year in Medicare and Medicaid fraud. Why would anyone want to stifle such a successful program?

It is argued by DOJ that the DOJ’s budget is limited and U.S. Attorneys need to be freed up to go after serious crime, but that is exactly why the False Claims Act was passed in the first place. If the government doesn’t have the resources, personnel or, more importantly, the interest in pursuing those who files false claims and state form the tax payer, then private whistle blowers or relators are authorized to do this. All the government has to do is to decline to intervene in the case and then the relator can go ahead and pursue the case on its own, without costing the government anything. It was because of war profiteers’ treating the U.S. treasury as a piggy bank, to be looted anytime they felt like it, that caused the False Claims Act’s passage in the Civil War era.

There is also a big concern that if there is less guidance on such complex topics as how to properly document valid medical services and procedures delivered to patients, then how can busy doctors, health care professionals and health facilities hope to understand what is require of them. It is my understanding that such “guidance” is for just such a purpose, to guide those who are trying to comply.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Overley, Jeff. “New DOJ Memo Will Make Waves In Fraud Cases.” Law360. (January 29, 2018). Web.

“New DOJ Memo Will Make Waves In Fraud Cases.” Institute for Legal Reform. (January 29, 2018). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Fraudulent billing defense attorney, fraudulent billing representation, Medicare fraud defense attorney, Medicaid fraud defense attorney, representation for health care fraud, representation for Medicare fraud, representation for Medicaid fraud, False Claims Act (FCA) attorney, FCA defense attorney, FCA representation, false filling representation, false billing defense attorney, health care fraud defense attorney, U.S. Department of Justice (DOJ) guidance representation, DOJ investigation representation, DOJ defense attorney, DOJ investigation defense attorney, OIG investigation representation, OIG defense attorney, health care professional defense attorney, health care professional representation, health care compliance representation, health care compliance attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

3 Sentenced in Florida for $175 Million Drug Compounding Fraud Scheme

11 Indest-2008-8By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 24, 2017, three participants were sentenced in Florida federal court, for a scheme that used call centers and kickbacks to generate fake prescriptions for compounding pharmacies. The scheme was able to scam the government and private insurers for $175 million.

U.S. District Judge Daniel T.K. Hurley, sentenced one of the defendants, Todd Stephens, to ten years. He sentenced Todd Hanson to eight years and one month. He sentenced Christopher Mucha to 30 months in prison. Each defendant also received three years of supervised release (probation) after they are released from prison.

Illegal Enterprise.

Stephens, Hanson and Mucha were among 16 defendants the federal government charged in September 2016. The U.S. Department of Justice (DOJ) described an extensive enterprise that operated from 2013 to 2015. According to the DOJ, the enterprise controlled numerous stops along the supply chain, including the selection of ingredients for compounded drugs, solicitation of patients for unnecessary prescriptions, and funneling of kickbacks to “corrupt physicians.”

To learn more about the defendants being charged, click here.

According to prosecutors, the participants purchased pharmacies that functioned as fronts for the illegal conduct and held licenses that made the operation possible. Specific drugs were chosen and produced by the pharmacies based on the amount of money reimbursed by the military health care program TriCare, as well as other private insurers. More than $175 million was eventually paid out in false claims, prosecutors alleged.

Key Component of the Scheme.

The defendants used call centers as a major part of the scheme to generate bogus prescriptions. The call center staff obtained information on potential patients, including military veterans, who had previously been prescribed medications. They then proceeded to contact the patients to convince them to authorize the faxing of the medically unnecessary prescriptions to doctors’ offices.

A group of “corrupt” physicians would then issue prescriptions for compounded medications for the patients regardless of the absence of medical necessity. It was alleged that this was done in exchange for illegal compensation to the doctors such as cash, gift cards and free consulting. The defendants disguised the illegal payments as reimbursement for “data collection.” These were allegedly distributed through a phony software company called ClinicalCorp LLC, prosecutors said.

To read the sentencing memorandum in full, click here.

To read about a similar health care fraud case involving TRICARE, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Pharmacists, Pharmacies, and Other Health Care Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes pharmacists, pharmacies, physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

To contact The Health Law Firm, please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.

Sources:

Hale, Nathan. “3 Sentenced In Fla. For $175M Health Care Fraud Scheme.” Law360. (March 24, 2017). Web.

McMahon, Paula. “Feds charge 16 in massive $175M prescription cream fraud based in South Florida.” Sun-Sentinel. (September 1, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for allegations of violating Anti-Kickback Statute, TRICARE false claims legal defense attorney, TRICARE physician representation, pharmaceutical fraud lawyer, compounding pharmacy attorney, legal representation for military physicians, fraudulent practices of pharmaceutical companies, financial interest in physician referrals, TRICARE fraud attorney, compounding pharmacy lawyer, legal defense of military physicians, legal defense of TRICARE providers, attorney reviews of The Health Law Firm, Veterans Administration (VA) physician defense attorney, The Health Law Firm attorney reviews, Health care fraud defense attorney, legal representation for health care fraud, legal counsel for allegations of health care fraud, AKS defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA claims, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for DOJ investigations, DOJ investigation defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

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