Kickbacks Allegedly Were Disguised as “Consulting Agreement” Compensation Teva Pharmaceuticals will pay $27.6 million to settle claims that it violated the False Claims Act by paying kickbacks to induce a physician to write more prescriptions for an anti-psychotic drug. The settlement resolves claims that the pharmaceutical company paid a physician to induce him to write prescriptions for generic clozapine, an anti-psychotic medication. Clozapine is usually considered a drug of last resort because it has serious potential side effects, especially for elderly patients. The side effects include a potentially deadly decrease in white blood cells, seizures, inflammation of the heart muscle, and increased mortality in elderly patients. The complaint alleged that the kickbacks were disguised as compensation under a “consulting agreement.” Under that agreement, the pharmaceutical company allegedly paid the doctor $50,000 per year and other benefits to induce him to switch his patients to generic clozapine. The other benefits included all-expenses paid trips to Miami for the doctor, his wife, and several of his employees. After entering into the “consulting agreement,” the doctor quickly became the largest prescriber of generic clozapine in the United States. The government claims that the payments and other benefits continued for many years, resulting in Medicare and Medicaid paying for thousands of generic clozapine prescriptions. The Anti-Kickback Statute prohibits pharmaceutical companies from offering or paying anything of value to induce prescriptions covered by Medicare or Medicaid. This kickback prohibition is designed to ensure that a physician’s medical judgment is based solely on the best interests of the patient and not compromised by improper financial incentives. Individuals who help the government uncover these types of healthcare frauds are entitled to significant rewards – up to 30% of the amount the government recovers. But you must follow a specific, confidential process to qualify. If you go to the government on your own or give your evidence to the media, you may lose your right to a reward. If you have evidence that a pharmaceutical company, hospital, or other healthcare provider is paying kickbacks in return for prescriptions or patient referrals, then you should consult with an experienced whistleblower attorney immediately to protect your rights. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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What To Do When The Bureau of Fraud Investigation Asks For Your Tax Returns Every year, more than 5,000 families are investigated by the NYC Bureau of Fraud Investigation. The investigations begin when investigators believe that you provided incorrect or incomplete information on an application for Medicaid or Family Health Plus benefits. If the investigators find that you intentionally provided false or incomplete information, they can send your case to the District Attorney for criminal prosecution. The penalties can be severe. If convicted of a felony, you could be sentenced to between one and seven years in prison. Even if you are convicted of only a misdemeanor, you could be sent to jail for up to one year. However, many cases are settled without any criminal charges at all. The settlement usually involves paying back the value of any benefits you received when you were not eligible. A settlement means no criminal charges, no criminal record, no imprisonment or fines, no impact on your credit report, and no adverse immigration action. Why do some cases settle without any criminal charges, while other cases result in criminal convictions and prison sentences? It all depends on how you handle the investigation. Every situation is different. Just keep in mind that anything you say to the investigator may be used against you. If you are contacted by the Bureau of Fraud Investigation, you should consult with an experienced Medicaid and Family Health Plus fraud attorney. Your lawyer can help you understand whether you have a problem, how severe the problem is, and the best strategy for resolving the investigation without criminal charges. To arrange a free and confidential consultation with an experienced Medicaid and Family Health Plus fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. Hospital Settles Medicare Fraud Claims Based on Stark Law Violations Halifax Hospital Medical Center and an affiliate will pay $85 million to settle claims that they submitted false claims to Medicare for services that violated the physician self-referral provisions of the Stark Law. The Stark Law prohibits hospitals from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital. The financial relationship may take the form of salaries, benefits, consulting contracts, or below-market office space. The whistleblower complaint in this case alleged that contracts between Halifax and six medical oncologists violated the prohibition on physician self-referrals in the Stark Law. Specifically, the contracts provided an incentive bonus based on the value of prescription drugs and tests that the oncologists ordered and the hospital then billed to Medicare. The complaint also alleged that the hospital violated the Stark Law by paying three neurosurgeons who referred patients to the hospital more than the fair market value of their services. The settlement resolves a whistleblower lawsuit brought by a former hospital employee under the qui tam or whistleblower provisions of the False Claims Act. The qui tam provisions allow an individual citizen to file a lawsuit “under seal” (in secret) on behalf of the government and share in the amount the government recovers. After investigating the claims, the government may choose to take over the lawsuit or allow the whistleblower to proceed on its behalf. The whistleblower in this case, Elin Baklid-Kunz, will receive a $20.8 million reward for helping the government uncover the fraud and prove the allegations. Qui tam or whistleblower lawsuits are different from ordinary lawsuits in several respects. The procedures for filing the lawsuit and disclosing evidence to the government must be followed correctly or the case will be dismissed. In addition, the whistleblower must produce evidence of the false claims, not merely allegations, at the very beginning of the lawsuit. If you have evidence that a hospital is violating the Stark Law or making other types of false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and other whistleblower protections if you prepare your case properly. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. Whistleblowers Will Share in $2.7 Million Reward Three whistleblowers will share more than $2.7 million in rewards for helping the government uncover false claims for 3D reconstructions of CT scans and other diagnostic tests. The whistleblower lawsuit alleged that Diagnostic Imaging Group submitted claims to Medicare and Medicaid for diagnostic tests that were not performed or not medically necessary. The lawsuit also alleged that the diagnostic testing company paid kickbacks to doctors in return for patient referrals. Diagnostic Imaging Group agreed to settle the lawsuit for $15.5 million. As their reward, the whistleblowers will be paid about 17% of the settlement amount or $2.7 million. Mark Novick, M.D. will receive a $1.5 million reward. Rey Solano will receive a $1.07 million reward. Richard Steinman, M.D. will receive a $209,250 reward. The whistleblowers alleged that the diagnostic testing company paid kickbacks to doctors in return for patient referrals. The kickbacks allegedly were disguised as payments to physicians for supervising patients who underwent nuclear stress testing. The payments, however, allegedly exceeded fair market value of the physician’s services and were, in fact, designed to reward physicians for patient referrals. The Anti-Kickback Statute prohibits a healthcare provider from giving anything of value in return for patient referrals. In addition, when kickbacks are paid, all resulting claims for reimbursement from Medicare and Medicaid are considered false claims. The whistlebowers also alleged that the diagnostic testing company submitted false claims to Medicare and Medicaid for tests that were not performed or not medically necessary. According to the complaint, the diagnostic testing company bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. The complaint also alleged that the diagnostic testing company submitted false claims to Medicare and Medicaid for 3D reconstructions of CT scans that were never performed or interpreted. The lawsuit was brought under the qui tam provisions of the False Claims Act. In a qui tam lawsuit, individual citizens can file a lawsuit on behalf of the government and then share in any recovery. Whistleblower rewards can range from 15% to 30% of the total amount recovered by the government. If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and other whistleblower protections. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. ILLEGAL KICKBACKS, OFF-LABEL MARKETING, AND SUBSTANDARD MANUFACTURING The federal government recovered more than $4.3 billion from companies and individuals who were accused of healthcare fraud last year. Of that amount, $3.75 billion – or 87% of the total – was recovered from pharmaceutical companies. Several pharmaceutical companies paid hundreds of millions of dollars to settle claims that they paid kickbacks to doctors and pharmacists in exchange for prescribing the companies’ drugs. For example, Amgen paid $762 million to settle claims that it paid kickbacks and engaged in other illegal marketing tactics to promote three of its drugs for off-label uses. Sanofi paid $109 million to settle allegations that it gave doctors free units of the knee injection drug Hyalagan to persuade them to prescribe more of the drug. The Anti-Kickback Statute prohibits paying anything of value in return for patient referrals or prescriptions. The law is designed to ensure that patients are prescribed drugs based solely on their medical needs, not because the doctor or pharmacist is being paid by the pharmaceutical company to prescribe a particular drug. In addition, the law seeks to prevent claims for reimbursement from Medicare and Medicaid for prescriptions that are not medically necessary. Other healthcare frauds by pharmaceutical companies involved the sale of drugs that did not comply with FDA manufacturing standards. Ranbaxy Laboratories paid $500 million for violating manufacturing standards and attempting to cover up its substandard products by making false statements in its manufacturing reports to the FDA. According to the government, Ranbaxy made and sold drugs whose potency, purity, or quality were not within FDA requirements. Other cases against pharmaceutical companies involved off-label marketing of pharmaceuticals for uses not approved by the FDA. An off-label use is one that is not approved by the FDA. While a physician may prescribe a drug for an off-label use based on her or his professional judgment, the pharmaceutical companies are not permitted to promote their drugs for any use not approved by the FDA. Abbott paid $1.5 billion to settle claims that it promoted Depakote, a seizure drug also used to treat bipolar disorder, for off-label uses such as controlling agitation and aggression in elderly dementia patients. Wyeth Pharmaceuticals, a subsidiary of Pfizer, paid more than $490 million for marketing the kidney transplant drug Rapamune for unapproved uses and for engaging in a campaign to switch patients to Rapamune from other drugs. Many of the healthcare fraud cases against the pharmaceutical companies were brought by whistleblowers – current or former employees who came forward with evidence of substandard drugs, improper marketing activities, or illegal kickbacks. Under the False Claims Act, these whistleblowers are entitled to receive large rewards of between 15% and 30% of the amount recovered by the government. If you have evidence that a pharmaceutical company is engaged in off-label promotion, kickbacks, or other improper or illegal conduct, you should consult with an experienced whistleblower lawyer to protect your rights. You may be entitled to a large reward and other protections. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. FALSE CLAIMS ACT WHISTLEBLOWER WILL RECEIVE A $400,000 REWARD Pharmacy company Omnicare Inc. has agreed to pay more than $4 million to settle a whistleblower lawsuit alleging that it accepted kickbacks from pharmaceutical company Amgen Inc. The kickbacks allegedly were paid in the form of “rebates” to induce the pharmacy to switch Medicaid beneficiaries from a competitor drug to Amgen’s product Aranesp. The whistleblower’s complaint alleged that so-called “performance-based rebates” were actually kickbacks paid to the pharmacy in return for switching patients from their existing medications to Amgen’s Aransep product. The complaint also alleged that more traditional forms of kickbacks were paid disguised as grants, speaker fees, consulting services, data fees, dinners and travel. According to the whistleblower complaint, the pharmaceutical company agreed to a “rebate contract” that gave the pharmacy an incentive to convert patients at long-term care facilities from Procrit to Aranesp. The pharmacy allegedly earned rebates based on a sliding scale. For example, if the pharmacy purchased $9.9 million or more of Aranesp during one quarter, it would earn a 3% rebate. But if it purchased $13.4 million or more of Aranesp, the pharmacy would receive a 23% rebate. The Anti-Kickback Statute prohibits healthcare providers from soliciting or accepting anything of value in return for patient referrals or the selection of a particular pharmaceutical product. The purpose of the Anti-Kickback Statute is to ensure that decisions affecting Medicare and Medicaid beneficiaries, particularly vulnerable patients in skilled nursing facilities, are based on the best interests of the patients and are not improperly influenced by financial incentives. This settlement resolves a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act. Whistleblowers who help the government recover money for false claims to Medicare and Medicaid earn rewards based on the amount of money recovered. The whistleblower who brought the lawsuit in this case will receive a reward of almost $400,000. If you are aware that a pharmaceutical company, hospital, or other healthcare provider is giving pharmacists or doctors anything of value -- rebates, cash, or below-market office space and staff -- in return for patient referrals or prescriptions, then you should contact an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and other whistleblower protections. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
John Howley, Esq.
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