Medicaid or Medicare Fraud

A settlement has been reached in a whistleblower class action lawsuit brought against Biotronik Inc who is accused of  paying kickbacks to induce physicians to use its products, causing hospitals and ambulatory surgery centers to submit false claims to Medicare and Medicaid.

Biotronik agreed to pay a $4.9 million settlement with the federal government and the whistleblower will receive $846,000 of the total settlement.

Filed in 2009, the whistleblower lawsuit alleged that Biotronik Inc paid for expensive restaurant meals and inflated membership fees on a physician advisory board to induce electrophysiologists and cardiologists in Nevada and Arizona to use Biotronik devices.

A settlement has been reached in a whistleblower class action lawsuit brought against HealthSouth Corporation who is accused of defrauding Medicare and other government health programs.

The settlement grew out of a lawsuit filed in San Antonio by several whistle-blowers under the federal False Claims Act. One of the whistleblowers will receive $8.1 million of the settlement, with others receiving lesser amounts.

Under the agreement, HealthSouth will pay:

• $169 million for improper reimbursement claims for outpatient physical therapy services provided under Medicare, Defense Department or Labor Department programs.

• $89 million for unallowed costs HealthSouth included on its Medicare hospital cost reports and home office cost statements.

• $65 million for other unallowable costs submitted to Medicare.

• $1.7 million for improper skilled nursing costs billed to Medicare and unallowed costs submitted by a subsidiary in Bakersfield, Calif.

A settlement has been reached in a whistleblower class action lawsuit brought against Allergan Inc who is accused of unlawful promotion of its biological product, Botox Therapeutic, for uses not approved as safe and effective by the Food and Drug Administration.

The civil complaint alleged practices by the company including developing and putting in place a wide-ranging marketing program that included paying commissions to doctors to induce them to prescribe Botox for certain conditions. Some of these were for pain and severe spasms in the limbs of children with cerebral palsy.

The company was also accused by Federal prosecutors of teaching doctors how to get reimbursement from Medicare and Medicaid for off-label uses by putting in the codes for an approved treatment. During the time period covered by the settlement, the FDA approved Botox as a treatment for four medical conditions. These included crossed eyes, involuntary blinking, involuntary neck muscle contractions and excessive underarm sweating. It was also approved for the cosmetic use of smoothing vertical wrinkles between the eyebrows.

Allergan Inc agreed to pay $600 million to resolve its criminal and civil liability.  The resolution includes a criminal fine and forfeiture totaling $375 million and a civil settlement with the federal government and the states of $225 million.

The civil settlement resolves three whistleblower lawsuits filed in federal court in the Northern District of Georgia under the provisions of the False Claims Act.  The whistleblowers will receive $37.8 million from the federal share of the settlement amount.  

A settlement has been reached in a whistleblower class action lawsuit brought against a former Chicago area physician, who was sentenced last month to five years in prison for stealing millions of dollars from Medicare and more than 30 other public and private health care insurance programs.  The whistleblower will receive 17.5% of any amounts collected.

The physician has agreed to a $20 million settlement with the United States covering related civil claims, federal officials announced.

According to the civil lawsuit, the whistleblower contracted with the physician to cover hospital rounds and patients when the whisteblower was out of town or otherwise unavailable. The phsycian submitted false claims seeking payment from Medicare and Medicaid for services at the highest level of in-patient cardiac care when, in fact, those services were not performed.

The settlement was reached on behalf of the whistleblower and the U.S. Department of Health and Human Services Office of Inspector General; the Office of Personnel Management (OPM), which administers the Federal Employees Health benefits Program; the Railroad Retirement Board Office of Inspector General; TRICARE Management Activity (U.S. Defense Department); and the Illinois Department of Health and Family Services.

The agreement provides that any amounts recovered will be distributed as follows: Medicare—97.776 percent; Medicaid—0.004 percent; OPM—2.106 percent; TRICARE—0.114 percent. It also provides that any amounts paid to the United States as criminal restitution will be credited against the $20 million judgment.

A settlement has been reached in a whistleblower class action lawsuit brought against Bristol-Myers Squibb and a subsidiary who are accused of promoting off-label use of the antipsychotic drug Abilify, misreporting the price of antidepression drug Serzone, inflating prices of oncology and generic drugs and paying kickbacks to physicians and health care providers.

The settlement resolves in whole or in part allegations made in seven whistleblower cases brought under the False Claims Act.

Out of the $515 million settlement, $50 million will be paid to the seven different whistleblowers.

A settlement has been reached in a whistleblower class action lawsuit brought against Quest Diagnostics.

The whistleblower provided detailed allegations about problems with medical test kits that a Quest subsidiary, Nichols Institute Diagnostics Inc. (NID), manufactured and sold to medical testing labs across the country from 2000 to 2006 despite complaints of inaccurate test results, putting the health of hundreds of thousands of dialysis patients at risk.

This civil settlement resolves allegations that NID manufactured, marketed and sold the Intact PTH and Bio-Intact PTH test kits, despite knowing that between May 1, 2000, and April 30, 2006, some of these kits produced results that were materially inaccurate and unreliable, thereby causing: (a) some clinical laboratories that purchased and used the Intact PTH and Bio-Intact PTH test kits to submit false claims for reimbursement to federal health programs; and (b) some medical providers to submit false claims for reimbursement to federal health programs for unnecessary treatments.

A settlement has been reached in a whistleblower class action lawsuit brought against Merck & Co who is accused of overcharging government health programs for four popular drugs and giving doctors fees and gifts to induce them to prescribe its drugs.

The settlement allows for $360 million for the government while 49 states and the District of Columbia receive $290 million. The whistleblower will receive $64 million from the federal and state shares.

The investigation, that began in 2000, was led by the federal government and several states and resulted from two separate lawsuits.

A settlement has been reached in a whistleblower class action lawsuit brought against Walgreens Co who is accused of boosting the price for prescriptions paid by Medicaid by switching from capsules to tablets, or vice versa, depending on which was most expensive.

Walgreens Co agreed to pay $35 million to the federal government, 42 states and Puerto Rico. The federal share of the settlement is roughly $18.6 million, with the states and Puerto Rico sharing $16.4 million under separate settlement agreements. A whistleblower will receive $5 million of the total to resolve the original lawsuit filed in 2003.