ATTORNEY NEWSLETTER
False Pricing Data
Final Judgment Nears $290 Million
Registered Nurse Blew Whistle On Fraud
Healthcare providers and drug and medical device manufacturers in the U.S., including pharmaceutical companies, sellers of medical products and devices, physicians, medical labs, and hospitals and clinics, are subject to a number of statutes to prevent any fraudulent billing under government programs like Medicare and Medicaid. One important such set of laws and regulations govern the data pharmacies and others must submit to the government for reimbursement under Medicare and Medicaid. When the providers violate those federal healthcare laws, they also violate the False Claims Act (“FCA”), 31 U.S.C. §§ 3729-3733, for submitting false claims for payment to the government. One of the underlying protections against fraud in the healthcare field is Individuals with information about this kind of scheme can be rewarded for bringing this kind of illegal practice to light. 31 U.S.C. § 3730(b). The California whistleblower attorneys at Evans Law Firm, Inc. represent individuals who bring FCA cases based for any kind of fraud against Medicare or Medicaid or other government-sponsored healthcare programs. If you have credible, original information of healthcare fraud, call us today at (415)441-8669 or toll-free at (888)-50EVANS (503-8267) and we can help.
Recent Judgment[1]
A registered nurse who brought a qui tam action under the False Claims Act (FCA) has secured a final judgment of nearly $290 million against a pharmacy benefits manager for knowingly causing Medicare Part D sponsors to submit false pricing data to CMS. Following an eight-day bench trial, the court found in favor of the whistleblower and assessed $95 million in actual damages, which were later trebled, along with additional statutory civil penalties
The lawsuit, filed on behalf of the United States, alleged that the pharmacy misrepresented the actual drug costs paid by Medicare beneficiaries in 2013 and 2014. These misrepresentations were conveyed through Direct and Indirect Remuneration (DIR) reports submitted by Part D sponsors Aetna and SilverScript, who contracted with defendant as their pharmacy benefits manager. The court found that defendant’s manipulation of pricing data led to over-subsidization by CMS and violated two key FCA provisions, knowingly causing false claims and submitting false statements to the government.
The court held that defendant was liable not only for the original $95 million in damages but also for treble damages, bringing the total to $285 million. In addition to trebling, the court imposed civil penalties for each false claim submitted, totaling $4.87 million. The whistleblower will receive a reward based on the judgment.
Starting A Qui Tam Action
Any False Claims Act whistleblower case begins by a relator filing a complaint under seal in the federal court usually for the United States District Court for the district where defendant is located or does business. At the same time, the relator submits a disclosure to the DOJ outlining the material evidence the relator has of the alleged false claims. 31 U.S.C. § 3730(b). The seal period of the complaint lasts 60 days during which the DOJ investigates the claims. 31 U.S.C. § 3730(b)(2). (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.) If the government decides to intervene in the case, the government essentially takes over the litigation. 31 U.S.C. § 3730(c)(1). If the government declines to intervene, the relator may proceed with the litigation on his or her own. 31 U.S.C. § 3730(c)(3).
Contact Us
If you have credible information of government fraud in San Francisco or elsewhere in California, 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: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 case in any way.
