Allegations of Illegal Kickbacks in Sales of Cancer Drug
Allegations Of Falsified Eligibility Records And Pressure To Cover Patient Co-Pays
$3.59 Million As Reward For Former Executive
The government, and private individuals suing on behalf of the government, rely on a number of statutes to combat fraud within the healthcare industry. These enforcement tools are important because healthcare fraud continues to be the primary form of fraud against the government and costs taxpayers billions of dollars every year. The primary anti-fraud enforcement statute against wrongdoers used by individuals and the government is the 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 drug prescriptions, or referrals for medical services or procedures, including inpatient services. Illegal kickbacks for inducements or referrals 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 in Los Angeles, Orange County or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).
Illegal Kickbacks When Drug Maker Covers Co-Pays
In a recent settlement announced by the U.S. Department of Justice, a pharmaceutical company purportedly used an independent foundation as a conduit to pay the copays of certain federal health program beneficiaries taking a drug produced by the company approved to treat bone marrow cancer. The DOJ alleged that the drug maker was the sole donor to a fund that assisted patients in making their co-pays provided they used the drug made and sold by the company, not just any drug for treatment. The government alleges that the company used the fund to pay the copays of federal beneficiaries taking the approved medication even when in actuality the patients were ineligible for assistance from the fund because they did not have the form of cancer treated by the drug. 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 third-party distributor allegedly helped ineligible patients to complete application forms submitted to the non-profit fund for assistance. The government alleges that through this conduct, the company caused false claims to be submitted to Medicare and TRICARE.
“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.”
“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.”
Former Pharmaceutical Executive Will Receive Reward
A former executive of the company will receive a $3.59 million reward for first bringing the False Claims Act/Anti-Kickback Statute qui tam case on behalf of the government. Although this relator was a former executive of the drug maker, currently employed individuals often have knowledge of fraud against government programs. Current employees, agents, executives, officers, and others 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.
If you have credible information of government contractor fraud against Medicare or Medi-Cal call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:email@example.com”>firstname.lastname@example.org</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.
 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.)