A pair of whistleblowers has helped the U.S. government recover $63.7 million from DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with kidney disease.
The U.S. Department of Justice (DOJ) said that Patsy Gallian and Monique Jones, both former DaVita employees, filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging that the company was improperly billing Medicare and Medicaid and engaging in illegal kickback arrangements to boost its profits.
DaVita settled the whistleblower complaint ahead of trial, paying the U.S $63.7 million to resolve allegations that it billed the federal health care programs for prescription drugs that were never shipped, that were shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent.
The settlement also resolves allegations that DaVita violated the Anti-Kickback Statute by accepting manufacturer copayment discount cards in lieu of collecting copayments from Medicare beneficiaries, routinely writing off unpaid beneficiary debt, and extending discounts to beneficiaries who paid for their medications by credit card.
U.S. Attorney Erin Nealy Cox for the Northern District of Texas said that health care providers “should not make patient care decisions based upon improper financial incentives or encourage their patients to do the same. The U.S. Attorney’s Office has and will continue to work cooperatively with providers that bring such issues to light to redress the losses the federal health care system has incurred.”
DaVita’s settlement will repay approximately $22.2 million to federal health care programs and an additional $38.3 million to the U.S. as part of the settlement agreement, Additionally, $3.2 million has been allocated to cover Medicaid program claims by states that elect to participate in the settlement, the Justice Department said.
Ms. Gallian and Ms. Jones will receive a whistleblower award of $2.1 million for their roles in exposing Davita’s billing and kickback schemes.