Under federal and state laws, a pharmacy that fills prescriptions for Medicaid beneficiaries may not charge the government more than the drug’s “usual and customary” price. The whistleblower in this case came forward with evidence that Walgreens charged government programs more for prescription drugs than it charged some customers who were enrolled in the company’s Prescription Savings Club (“PSC”).
After the whistleblower filed a qui tam or whistleblower lawsuit “under seal” (that is, in secret), the government conducted an investigation using the evidence he provided. Walgreens ultimately settled the fraud claims by agreeing to pay back $60 million to federal and state Medicaid programs. As part of the settlement, the company admitted that the government “paid Walgreens more money in reimbursements than they would have paid if Walgreens had identified its PSC prices as its [usual and customary] prices.” It is unlikely that the fraud would have been discovered without help from a whistleblower on the inside. This case demonstrates the power of a single individual to save the government – and taxpayers – tens of millions of dollars by coming forward with evidence of fraudulent claims. It is also another example of the significant rewards that are available to whistleblowers who help the government uncover fraud, waste, and abuse in our healthcare programs. The whistleblower laws, however, are complicated. This is not something a whistleblower can or should handle on their own. If you have evidence of false claims submitted to Medicare or Medicaid, then you should consult with an attorney immediately to understand and protect your rights. To schedule a consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. William LaCorte, a physician in Louisiana, has earned a $59 million whistleblower reward after Pfizer agreed to pay $784 million to settle allegations of false claims to Medicaid for Protonix, a heartburn medication. The complaint alleged that Pifzer’s subsidiary, Wyeth, failed to pay rebates to Medicaid to account for price discounts that Wyeth had provided to other customers.
Dr. LaCorte is no stranger to high-stakes whistleblower litigation. He received $38 million in whistleblower rewards from prior qui tam or whistleblower lawsuits against other pharmaceutical companies, including one in which Merck agreed to pay $250 million to settle allegations that it offered hospitals better terms than Medicaid for its heartburn medicine, Pepcid. Because of whistleblowers like Dr. LaCorte, the government recovered $2.8 billion in settlements last year under the False Claims Act, which allows individuals to commence whistleblower lawsuits on behalf of the government and share in any recovery. In return, the government paid whistleblower rewards totaling $597 million. Pharmaceutical cases tend to result in the largest whistleblower rewards. For example, a former sale representative for Endo Pharmaceuticals recently collected a $33.6 million whistleblower reward after the company agreed to pay $140 million to settle allegations that it engaged in off-label marketing of Lidoderm, a pain medication. In 2012, the government distributed $300 million in whistleblower rewards when GlaxoSmithKline agreed to pay $2 billion to settle allegations of off-label marketing and illegal kickbacks involving a number of its drugs. The key to a successful whistleblower case is having evidence of fraud or false claims submitted to Medicare or Medicaid. Mere allegations or suspicions of fraud are not enough. A successful whistleblower case requires evidence. And that creates some risks for potential whistleblowers. Gathering the evidence to support Medicare or Medicaid fraud claims may expose whistleblowers to allegations that they violated HIPAA privacy restrictions, company confidentiality policies, and even criminal statutes such as the Federal Computer Fraud and Abuse Act. If you have evidence of healthcare fraud or false claims submitted 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 legal protections as a whistleblower. But you also need legal advice to comply with your own obligation to maintain the privacy of confidential information. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. A former Abbott Laboratories employee will receive a $1 million whistleblower reward for reporting kickbacks between the pharmaceutical giant and the second largest nursing home consulting pharmacy in the country.
Meredith McCoyd and another former Abbott Laboratories employee brought lawsuits under the qui tam or whistleblower provisions of the False Claims Act. Under that law, an individual citizen who has evidence of false claims submitted to government programs may start a lawsuit on behalf of the government. The lawsuit is filed “under seal” (in secret) and the evidence is disclosed only to the government. The government then investigates the claims and decides whether to pursue the suit. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered. Ms. McCoyd filed a qui tam lawsuit alleging that Abbott Laboratories paid kickbacks to pharmacies in exchange for promoting the company’s prescription drug Depakote for nursing home patients. She alleged that the kickbacks were disguised as rebates, educational grants and other financial support. Under the Anti-Kickback Law, it is illegal for a pharmaceutical company or healthcare provider to offer or pay anything of value in return for referrals of Medicare or Medicaid patients. If kickbacks are paid, then every resulting claim for reimbursement is deemed a “false claim.” Both the entity that pays the kickbacks and the entity that receives the kickbacks may be liable for treble damages and penalties. In this case, the consulting pharmacy agreed to pay $6.5 million to the federal government and $2.5 million to state governments to resolve claims that it accepted kickbacks from Abbott Laboratories. The whistleblower who started the qui tam lawsuit will receive a reward of $1 million from the federal government. She may also receive whistleblower rewards from the state governments under their false claims acts. If you have evidence that a pharmaceutical company or healthcare provider is paying or receiving anything of value in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial reward and legal protections as a whistleblower. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. |