All articles tagged with #false claims act
A federal judge ordered CVS Health's pharmacy benefit manager unit to pay nearly $290 million in damages and penalties for overcharging Medicare for prescription drugs, citing fraudulent billing practices motivated by financial gain. CVS plans to appeal the decision, which stems from allegations that CVS Caremark inflated claims submitted to Medicare since 2010, damaging public trust and violating the False Claims Act.
The United States has filed a complaint against Regeneron Pharmaceuticals, alleging that the company fraudulently manipulated Medicare reimbursement for its drug, Eylea, by knowingly submitting false average sales price (ASP) reports to Medicare. The complaint alleges that Regeneron inflated Eylea’s ASP by paying credit card processing fees for the benefit of physician-customers purchasing Eylea, without properly reporting these payments as price concessions to ASP, resulting in hundreds of millions of dollars in inflated reimbursements by Medicare. The government's investigation was prompted by False Claims Act allegations brought in a whistleblower lawsuit, and if found liable, Regeneron could face significant financial penalties.
The U.S. Department of Justice has issued a demand letter to the McKee Administration regarding the Washington Bridge failure, indicating an investigation under the False Claims Act. The letter, led by the Rhode Island District of the DOJ, focuses on the actions of the Rhode Island Department of Transportation and its contractors, including Barletta Heavy Division. The lead prosecutor, Bethany Wong, is seeking information dating back to 2015, and the investigation will encompass multiple companies involved in the Washington Bridge project over nearly a decade. The demand letter sets a deadline for the delivery of responsive documents and specifically targets documentation related to piers 6 and 7 of the bridge.
Community Health Network, an Indianapolis-based healthcare network, has agreed to pay $345 million to settle allegations that it violated the False Claims Act by knowingly submitting Medicare claims for services referred in violation of the Stark Law. The network allegedly engaged in a scheme to pay improper compensation to physicians to illegally refer patients to its hospitals and associated medical facilities. The network overcompensated its cardiologists, surgeons, and other physicians, sometimes paying double what they received through private practice. The settlement includes a five-year Corporate Integrity Agreement, and the network denies any wrongdoing.
Health insurance company Cigna has agreed to pay over $172 million to settle allegations that it knowingly submitted false diagnosis codes for Medicare Advantage plans between 2016 and 2021. The U.S. Department of Justice accused Cigna of violating the False Claims Act by not removing incorrect codes, resulting in increased payments. Cigna will also enter a corporate-integrity agreement for five years. This settlement comes as Cigna faces a separate class-action lawsuit regarding the use of an algorithm to deny medical claims and reduce labor costs.
The Boeing Company has agreed to pay $8.1 million to settle allegations that it violated the False Claims Act by submitting false claims and making false statements in connection with contracts to manufacture the V-22 Osprey for the U.S. Navy. The allegations state that Boeing failed to comply with contractual manufacturing specifications from 2007 to 2018, specifically regarding testing requirements for composite components. The settlement includes claims brought by former employees under the whistleblower provisions of the False Claims Act, with the relators receiving $1.5 million.
Texas has filed a lawsuit against Planned Parenthood, seeking the return of millions of dollars in Medicaid reimbursements and additional fines, in what appears to be the first such case brought by a state against the largest abortion provider in the U.S. The lawsuit does not revolve around abortion, as it has been banned in Texas since the Supreme Court overturned Roe v. Wade last year. Planned Parenthood argues that the attempt to recoup funds is an effort to weaken the organization after years of Republican-led laws that stripped funding and imposed restrictions. The case is being heard by U.S. District Judge Matthew Kacsmaryk, who previously invalidated the approval of the abortion pill mifepristone. Planned Parenthood warns that the fines could exceed $1 billion.
Martin's Point Health Care has agreed to pay over $22 million to settle allegations of Medicare fraud. The company was accused of abusing the Medicare Advantage program by assigning additional diagnoses to patients in order to receive higher reimbursements. A former manager at Martin's Point filed a whistleblower complaint in 2018, alleging violations of the False Claims Act. The settlement agreement states that the company knowingly submitted unsupported and invalid diagnostic codes, resulting in payments to which it was not entitled. Martin's Point denies liability but decided to settle to avoid the costs and uncertainty of litigation. The settlement does not release the company from the possibility of criminal charges.
Defense contractor Booz Allen Hamilton has agreed to pay $377 million to settle a lawsuit accusing the company of overcharging the U.S. government to cover losses in other areas of its business. The settlement, one of the largest under the federal False Claims Act, comes after a six-year investigation. A related criminal investigation was closed without charges, while a separate probe by the Securities and Exchange Commission remains open. The case was brought to light by a whistleblower who claimed the company fraudulently billed the government for excess fees. The whistleblower stands to receive nearly $70 million from the settlement.
A federal jury has found that a health clinic in Libby, Montana submitted 337 false asbestos claims, making patients eligible for Medicare and other benefits they shouldn't have received. The fraudulent claims caused over $1 million in damage to the government. The clinic, Center for Asbestos Related Disease (CARD), and its doctor, Brad Black, have been at the forefront of helping residents in the town, which was declared a Superfund site due to asbestos contamination. BNSF Railway, which filed the lawsuit against CARD, could be eligible for a percentage of any amount recovered by the government.
The US Supreme Court has upheld the Justice Department's power to dismiss whistleblower lawsuits filed under the False Claims Act, which allows whistleblowers to sue businesses on behalf of the government to recover taxpayer money paid to companies based on false claims. The ruling allows the government to dismiss lawsuits lacking merit, even if the whistleblower objects. The decision was made in a lawsuit against UnitedHealth Group's Executive Health Resources unit, which was accused of defrauding Medicare. The False Claims Act has resulted in $48.2 billion in recoveries from 1987 to 2021, with most of the money coming from cases in which the government intervened.
The US Supreme Court has upheld the Justice Department's power to dismiss whistleblower lawsuits filed under the False Claims Act, which allows whistleblowers to sue businesses on behalf of the government to recover taxpayer money paid to companies based on false claims. The ruling allows the government to dismiss such lawsuits even if the whistleblower objects, as long as the government intervened in the litigation at some point. The decision was made in a lawsuit against UnitedHealth Group's Executive Health Resources unit by a former employee who accused it of defrauding Medicare.
The US Supreme Court has revived two whistleblower lawsuits alleging that Safeway and SuperValu overcharged the government for prescription drugs to the tune of $200m. The cases involved allegations that major retail pharmacies across the country knowingly overcharged Medicaid and Medicare by overstating what their "usual and customary prices" are. The issue before the court was what the standard of proof is for determining whether the pharmacies acted "knowingly" under the False Claims Act, a federal law that dates back to the Civil War when it was enacted to combat fraud by private contractors who were overbilling or simply not delivering promised goods for the war effort.
The US Supreme Court has ruled that a lawsuit brought by whistleblowers against SuperValu and Safeway, who claimed the pharmacies overcharged Medicare and Medicaid for prescription drugs, can move forward. The court threw out a lower court's ruling that said the retail pharmacies could not be held liable for fraud under the False Claims Act. The whistleblowers contend that the pharmacies reported higher, non-discounted prices to the government instead of the discounted prices they actually charged. The Supreme Court sent the matter back to the Seventh Circuit to proceed consistent with the high court's opinion.
Precision Lens, a Bloomington-based eye lens distributor, has been ordered by a federal judge to pay $487 million in civil damages for funding a kickback scheme that included lavish vacations and trips to exclusive sporting events for eye surgeons in exchange for using their products in cataract surgeries reimbursed by Medicare. The company was found guilty of violating the False Claims Act.