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Stark Law 19 articles

CVS Caremark to pay $6 million to settle whistleblower allegations of Medicaid false claims

Caremark LLC, a pharmacy benefit management giant operated by CVS Caremark Corporation, will pay the U.S. $6 million to settle allegations brought by a whistleblower under the False Claims Act that the company knowingly defrauded federal and state Medicaid programs by failing to reimburse the taxpayer-funded programs for drug expenses that should have been paid by the private insurer. Individuals who are covered by both Medicaid and a private health plan are classified as “dual eligible.” U.S. law mandates that the private insurer, rather than taxpayer-funded government programs, must assume the costs of health care for dual eligible beneficiaries. Should Medicaid erroneously ... Read More

Shire settles whistleblower allegations of improper drug marketing for $56.5 million

Shire Pharmaceuticals has agreed to pay the U.S. $56.5 million to settle two whistleblower lawsuits filed by former employees of the company who alleged the company illegally marketed several drugs for unapproved, off-label purposes and then billed Medicare, Medicaid, and other taxpayer-funded health care programs for them. Dublin, Ireland-based Shire operates in the U.S. out of its facility in Wayne, Penn. The company makes and markets Adderall XR, Vyvanse, and Daytrana, which are approved for the treatment of attention deficit hyperactivity disorder (ADHD), and Pentasa and Lialda, which are approved for the treatment of mild to moderate ulcerative colitis. The ... Read More

Feds widen crackdown on $56-million Medicare fraud scheme in New Orleans

Federal prosecutors have widened their crackdown on a $56-million health care fraud scheme in the New Orleans area, announcing charges against seven more individuals, including two physicians, who allegedly billed Medicare for home health care services that were not medically necessary or were never provided. The U.S. Justice Department announced Thursday that a New Orleans grand jury indicted the seven individuals, bringing the total number involved in the alleged fraud scheme to 13 defendants. The indicted individuals operated six health care companies. Federal prosecutors say the individuals participated in the scheme through these companies, billing Medicare for home health services ... Read More

U.S. Attorney General Holder calls for better whistleblower rewards in financial industry

Whistleblowers who help expose fraud and other misconduct in the financial world could earn bigger rewards in the future in exchange for the efforts, if U.S, Attorney General Eric Holder has his way. Threats brewing in the financial industry today have come to resemble some of the dubious greed-driven behaviors that devastated the U.S. economy in 2008 despite the government’s efforts to prevent a similar catastrophe from recurring in the coming years. “We are already witnessing a troubling return to some of the very same profit-driven risk-taking that contributed to the 2008 collapse,” Mr. Holder said in a speech Wednesday ... Read More

Whistleblower lawsuits accusing Merck of mumps vaccine deceptions will proceed to court, judge decides

Two lawsuits accusing Merck & Co. of lying about the efficacy of its mumps vaccines to keep competitors from introducing similar vaccines to the market will be proceed to trial after a federal judge in Pennsylvania refused to dismiss the suits. U.S. District Judge C. Darnell Jones II ruled that one of the lawsuits, filed by a pair of whistleblowers who worked as virologists for Merck, provided enough evidence that the pharmaceutical giant lied about the vaccine’s efficacy to the federal government. The judge also ruled that the other lawsuit, filed by a group of physicians and direct buyers, could ... Read More

Whistleblower lawsuit targets medical companies, professionals for unnecessary spinal surgeries

The U.S. government has intervened in a whistleblower’s False Claims Act lawsuit against a Michigan neurosurgeon, a spinal implant company, two distributors, and the companies’ owners, alleging that the defendants conspired to perform medically unnecessary and excessive surgeries on patients for profit. The Justice Department also said that in addition to taking over the whistleblower lawsuit, it has filed a separate complaint against the same defendants for engaging in an illegal kickback scheme that put profits above patients’ needs. The whistleblower lawsuit was filed under the qui tam provisions of the False Claims Act by Dr. Caty Savitch and Dr. ... Read More

Judge allows whistleblower’s False Claims Act lawsuit against Novartis to move forward

A New York federal judge has rejected Novartis Pharmaceutical Corp.’s bid to dismiss a whistleblower lawsuit alleging the company engaged in illegal kickback schemes involving two of its drugs, which resulted in false claims to Medicare and 27 state Medicaid programs. The lawsuit, filed under seal by whistleblower David Kester in 2011, was amended by the U.S. government in January, about nine months after it chose to intervene and take over the case as the U.S. False Claims Act allows it to do. Mr. Kester worked for seven years as an account manager for Novartis, a position that required him ... Read More

Savannah hospital faces whistleblower allegations of false claims, wrongful retaliation

SAVANNAH, Ga. — The federal government has filed a lawsuit against Memorial Health Inc. and an affiliated physicians group for filing allegedly fraudulent claims for Medicare reimbursement that stemmed from improper physician referrals and illegal financial relationships. The lawsuit, filed in a Savannah federal court, is based on the allegations of a whistleblower lawsuit filed by former Memorial Health President/CEO Phillip Schaengold in April 2011 under the False Claims Act, which allows private individuals to sue on behalf of the U.S. government. After Memorial Health hired him in June 2009, Mr. Schaengold began a comprehensive analysis of the hospital’s financial ... Read More

Top U.S. hospital system will pay $98 million to resolve whistleblowers’ fraud allegations

A Tennessee-based hospital system has agreed to pay the U.S. more than $98 million to resolve lawsuits filed by several whistleblowers who alleged the company cheated Medicare, Medicaid, and other taxpayer-funded health care programs through fraudulent billing practices. The U.S. Justice Department said that Community Health Systems Inc., the largest operator of acute-care hospitals in the U.S., will pay $98.15 million to resolve the lawsuits, which multiple physicians, nurses, other caregivers, and administrators filed under the qui tam or “whistleblower” provisions of the False Claims Act. The whistleblowers accused 119 Community Health Systems hospitals of improperly billing the federal government ... Read More