Kickbacks to Induce Unnecessary Hospital Admissions

EmCare, Inc. paid more than $30 million to settle qui tam claims brought by VSG clients and another set of relators, alleging that EmCare received kickbacks from a major hospital chain in exchange for pressuring hospital emergency room (ER) doctors to increase the rate of ER-to-hospital admissions. EmCare also entered into a confidential settlement with VSG’s client on her unlawful retaliation claim.

Drug Manufacturer Kickback on Specialty Medications

Novartis Pharmaceuticals Corporation paid $390 million to settle a False Claims Act lawsuit brought by a VSG client who alleged the company paid kickbacks to specialty pharmacies so they would recommend to doctors and patients six of Novartis’ specialty medications. The $465 million aggregate recovery in the case was, at the time, the largest recovery ever in a qui tam suit based solely on a kickback theory. Read Press Release

Drug Manufacturer Kickbacks to Specialty Pharmacies

Accredo Health Group, Inc. and Bioscrip, Inc. two specialty pharmacy chains, paid a combined total of $75 million to settle qui tam whistleblower claims in a False Claims Act lawsuit that also named as a defendant the Swiss drug manufacturer, Novartis Pharmaceuticals Corp. The case alleged the companies participated in a kickback scheme involving the iron-chelating drug Exjade, a specialty drug that costs government health programs thousands of dollars per month to cover a single prescription. Read Press Release

Off-Label Marketing

Pfizer Inc. paid $491 million to settle allegations raised by a firm client that Wyeth Inc., a pharmaceutical manufacturer acquired by Pfizer, had illegally marketed the kidney transplant drug Rapamune for uses that had not been approved by the Food & Drug Administration. The firm’s client shared the relator share award with whistleblowers in another case with partially overlapping allegations. Read Press Release

Kickbacks to Long Term Care Pharmacy

Johnson & Johnson, Inc., paid $149 million to settle allegations in cases filed by two qui tam whistleblowers, including a firm client, that the pharmaceutical giant paid kickbacks to long term care pharmacy chain Omnicare to induce Omnicare to recommend the atypical antipsychotic Risperdal for residents of nursing homes serviced by Omnicare. Read Press Release

Billing Fraud by Medical Device Manufacturer

Becton Dickinson & Co., a medical device manufacturer, paid $3.3 million to settle a qui tam whistleblower case alleging that the contractor overcharged the Department of Veterans Affairs for devices after failing to disclose more favorable prices provided to commercial customers.

Medicare Carrier Quality Control Fraud

Blue Shield of California, a Medicare carrier, paid $12 million to settle allegations in a qui tam whistleblower action that it misrepresented the quality of claims processing services it was providing for the Medicare program.

Medicare Intermediary Quality Control Fraud

BlueCross/Blue Shield of Michigan, the fiscal intermediary for Medicare in Michigan, paid more than $27.6 million to settle qui tam whistleblower claims alleging that it cheated on quality control tests in order to misrepresent the quality of the auditing services it was providing for the Medicare program.

Medically Unnecessary Services (Laboratories)

UroCor, Inc., and Dianon Systems, Inc. medical laboratories, paid $9 million and $4.8 million, respectively, to resolve claims in qui tam whistleblower lawsuits alleging that they billed Medicare for medically unnecessary lab tests that physicians did not know they were ordering.

Medical Device Manufacturer Kickbacks

Blackstone Medical Inc., a medical device manufacturer, and former orthopedic surgeon Patrick Chan, paid $3.3 million to settle allegations in a qui tam whistleblower action that Blackstone paid kickbacks to surgeons who used Blackstone products.

Durable Medical Equipment Fraud

Home Americair of California, Inc., a durable medical equipment company that supplied home oxygen, paid $5 million to the Government to settle claims in a qui tam whistleblower case that it used false records to support claims to Medicare.

Defective Medical Devices

LifeScan, Inc., a medical device manufacturer, paid $30.6 million to settle allegations in a qui tam lawsuit that it sold defective blood glucose monitors to Medicare patients and failed to report adverse events to the FDA.