Allegations Of Unauthorized Prescriptions
Allegedly Misleading Statements Of Drug’s Effectiveness
Former Employee Whistleblower Will Receive $200,000 Reward
Health care fraud costs taxpayers billions of dollars every year. Much of that fraud comes under the government’s Medicare and Medicaid (Medi-Cal in California programs, including payments for medications that are unapproved or unauthorized. Under the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., individuals with knowledge of any fraud are entitled to bring actions (known as “qui tams”) under the FCA for recovery of government funds and they can be rewarded if the government recovers. 31 U.S.C. § 3730(d). The individuals bringing the qui tam cases are known as “relators.” If you have credible information of healthcare fraud in Orange County, Los Angeles 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).
Pharmacist Settles FCA Allegations For $1 Million
In a recent settlement announced by the U.S. Department of Justice, a pharmacist, along with two specialty pharmacies he formerly owned and operated, have agreed to pay the United States $1 million to resolve allegations that they submitted false claims for an injectable drug indicated for use to reverse opioid overdose. The drug allegedly was the highest-priced version of this type of drug on the market, and insurers frequently required the submission of prior authorization requests before they would approve prescriptions of it. The government contends that defendants submitted false and misleading prior authorization requests that contained clinical assertions for which the pharmacies lacked any factual basis. According to the government, the pharmacies also included assertions in prior authorization requests purportedly authored by prescribing physicians regarding the comparative effectiveness of the drug that defendants actually authored. The prescribing physicians did not review, sign or submit the prior authorizations at issue.
“Pharmacies that take shortcuts to increase their profits by submitting false claims for expensive drugs increase medical costs for all of us,” said Special Agent in Charge Joseph R. Bonavolonta of the FBI Boston Division. “Today’s settlement should deter anyone thinking about abusing our federal health care programs that so many rely on for their health care needs.”
Starting A Qui Tam Case
Qui tam cases begin with filing a complaint in the federal district court where the allegedly fraudulent conduct occurred. 31 U.S.C. § 3730(b). The complaint is filed under seal . The government has sixty days to review the allegations and decide whether to intervene. This review period can be extended. If the government decides to intervene, the government essentially takes over the litigation. 31 U.S.C. § 3730(c). If the government decides not to intervene, the relator has the right to continue the litigation on his or her own. If the relator continues the litigation alone, he or she receive a larger percentage of the amount the government eventually recovers. 31 U.S.C. § 3730(d). The relator may also pursue claims for wrongful retaliation against the defendant if the relator was fired or demoted as a result of blowing the whistle. 31 U.S.C. § 3730(h).
If you have credible information of government fraud 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:firstname.lastname@example.org”>email@example.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.
 Evans Law Firm, Inc. was not involved in the case in any way. The qui tam case is captioned United States ex rel. Socol v. Plymouth Towne Care Pharmacy, Inc., 18-cv010050-RGS (D. Mass.) (under seal).