Allegations Of False Authorizations For Expensive Prescription Drug
Alleged Kickbacks To Prescribing Physicians And Office Staff
Former Employee To Receive $2.5 Million Reward
The largest kind of fraud against the federal government occurs within the health care sector, primarily under government-sponsored programs like Medicare, Medicaid (Medi-Cal in California), the Veterans Administration (VA) and government employee health insurance. When the fraud occurs in the health care sector, the conduct often constitutes violations of the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., and the Stark Law, 42 U.S.C. § 1395nn (limitations on certain physician referrals) and the Anti-Kickback Statute, 42 U.S.C. §§ 1320a-7b(b)(prohibiting illegal kickbacks for referrals, products and services). The individual whistleblower cases are known as “qui tam” cases and are initiated under the FCA, with other causes of action for the other applicable legal violations. Whistleblowers may be eligible to receive up to 30% of any amounts the government recovers. 31 U.S.C. § 3730(d). If you have credible information of fraud against the government in San Mateo County or elsewhere in California, call Evans Law Firm, Inc. today at (415)441-8669 or toll free at (888)50EVANS 503-8267 and we can help.
Pharmaceutical Company False Claims Settlement
In one recently reported settlement of an FCA case, a pharmaceutical manufacturer has agreed to pay the United States $12.7 million to resolve allegations that it caused the submission of false claims for a drug it produced to reverse painkiller overdoses. The United States alleged that the defendant directed prescribing doctors to send prescriptions to certain preferred pharmacies that in turn (1) submitted false prior authorization requests that misrepresented to insurers that the prescribing physicians submitted the request when the pharmacies did so and/or contained false or misleading assertions about the patients’ medical histories, such as false statements that patients had previously tried and failed less costly alternatives to defendant’s drug, and (2) dispensed the drug without collecting or attempting to collect co-payment obligations from government beneficiaries. The United States contended that the defendant knew of or deliberately ignored this pharmacy misconduct, but nevertheless kept directing business to these pharmacies. The United States also alleged that the defendant provided illegal remuneration to prescribing physicians and their office staff in violation of the Anti-Kickback Statute to induce and reward their prescribing of defendant’s drug. As part of the resolution, the relator, a former employee, will receive $2,548,600.
Starting an FCA Case
An FCA qui tam case begins with credible information of the false claims usually possessed by an insider such as an employee or, as in the reported case above, a former employee. An experienced whistleblower attorney, such as the attorneys at Evans Law Firm, will then work that information into a complaint which is filed under seal in federal court. 31 U.S.C. § 3730(b). The plaintiff (also known as the “relator”) serves the Attorney General’s office with a copy of the sealed complaint and a disclosure statement that provides the government with the material evidence backing up the allegations. During the time that the complaint is under seal (60 days) the government decides whether it wishes to intervene in the case. If the government chooses not to intervene, the relator may continue the litigation on her own.
If you are an employee or other insider with original information of billing for unnecessary services, illegal referrals, kickbacks or other fraud against Medicare or Medicare Advantage, contact Ingrid M. Evans at Evans Law Firm at (415) 441-8669, or toll free at (888)50EVANS 503-8267 or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. In addition to FCA cases, Ingrid also handles cases involving bank fraud under FIRREA/FIAFEA, options, futures, and commodities trading fraud under the Commodities Futures Trading Commission Whistleblower Program, securities violations under the Securities and Exchange Commission Whistleblower Program, financial advisor fraud under the FINRA Whistleblower Office and offshore tax avoidance schemes and other tax fraud before the Internal Revenue Service Whistleblower Office.
 Evans Law Firm, Inc. was not involved in the case in any way. The case is captioned United States ex rel. Socol v. kaléo, Inc., 18-cv010050-RGS (D. Mass.).