Healthcare and Pharma Cases


Whistleblower Awards in Walgreens Medicaid Fraud Case to Surpass $22 Million

Whistleblower Awards in Walgreens Medicaid Fraud Case to Surpass $22 Million

Retail pharmacy giant Walgreen Co. will pay $60 million to settle claims that it overcharged Medicaid for prescription drugs. The alleged scheme was brought forward in a whistleblower lawsuit filed in 2012. This is the second settlement in that case, which involves alleged fraud against 39 states and the federal government.

The whistleblower, Marc Baker, was once a Walgreens pharmacy manager in Florida. Due to the nature of his work for the company, Baker was in a position to witness how the pharmacy chain knowingly offered illegal kickbacks to lure Medicaid-covered patients and overcharged government programs for prescription drugs. In January 2017, there was a first settlement relating to some of Baker´s allegations. As a result of that agreement, he received a $9.7 million whistleblower award. Now, following the new resolution, he stands to get an additional $12.6 million.  

Upon the announcement of the settlement, a spokesperson for Baker commented, “This unprecedented case exemplifies the importance of whistleblowers in the public-private partnership to prevent government fraud. It illustrates the power of one individual to expose and stop fraud against the government – and, ultimately, U.S. taxpayers who foot the bill.”...


Abbott and AbbVie Will Pay $25 Million Over Alleged TriCor Kickbacks, Attorney John Uustal Secures $6.5 Million for Whistleblower

Abbott and AbbVie Will Pay $25 Million Over Alleged TriCor Kickbacks, Attorney John Uustal Secures $6.5 Million for Whistleblower

The U.S. Attorney for the Eastern District of Pennsylvania has just announced a $25 million settlement to resolve allegations that Abbott Laboratories and its spinoff AbbVie Inc. unlawfully marketed its drug TriCor to physicians, offering kickbacks and promoting off-label uses. The alleged misconduct resulted in fraudulent claims being submitted to Medicaid and Medicare, amounting to millions of dollars.  

TriCor has been approved by the FDA to treat certain types of cholesterol imbalance. Misconduct involving marketing of the drug was first brought to light in a whistleblower lawsuit filed by the Kelley/Uustal law firm in 2012. The insider information that eventually led attorney John Uustal’s team to secure a settlement, was provided by Amy Bergman, who used to be a sales rep. at Abbott.  

The False Claims Act allows whistleblowers to file a qui tam action on behalf of defrauded U.S. taxpayers. When the information they provide is original and useful for holding fraudster’s accountable, the tipsters receive a reward between 15 and 30 percent of the total recoveries...


Amerisource Pays $625 Million to Resolve Pharmaceutical Fraud Claims

Amerisource Pays $625 Million to Resolve Pharmaceutical Fraud Claims

Three whistleblower suits have unveiled a large scam involving unlawful repackaging and reselling of drugs by AmerisourceBergen Corporation. The lawsuits were filed by Michael Mullen, former Amerisource employee, Omni Healthcare Inc., an oncology practice, and pharmacy workers Daniel Sypula and Kelly Hodge. To resolve civil liability, the company settled for $625 million.

According to The Department of Justice, the wholesale medical company had been contaminating drugs, bribing, illegally labeling drugs, and creating sham patients for at least thirteen years, via a company named Medical Initiatives Inc., which shut down in 2014. This is not the first time Amerisource has been taken to court or forced to pay in relation to criminal activity. In 2017, it paid $260 million in a misbranded drugs case.

According to allegations, Medical Initiatives took part in a massive fraudulent scheme between 2001 and 2014. They purchased bottles of several drugs and transferred the drugs into prefilled syringes. Some of the drugs involved were Procrit, Aloxi, Kytril, Anzemet, and Neupogen. All these are used by cancer patients undergoing chemotherapy treatment. By selling those prefilled syringes, the company unlawfully produced more doses than it purchased, profiting to the tune of around $100 million. ...


REPORT: Hospice Schemes & Fails Hurt Taxpayers and Medicare Beneficiaries

REPORT: Hospice Schemes & Fails Hurt Taxpayers and Medicare Beneficiaries

A new report by the Office of the Inspector General outlines the widespread utilization of hospice services covered under Medicare, while also highlighting the sytem’s flaws and some central vulnerabilities.

Because of the solace it can provide for people in the later stages of life, and their families, many Medicare beneficiaries opt for hospice care. In 2016 alone, Medicare paid $16.7 billion for hospice services utilized by 1.4 million individuals participating in the program.

Unfortunately, Medicare’ steep bills for hospice care do not always translate into quality care for its beneficiaries. The OIG found that hospices often left beneficiaries in pain, failed to provide medication, and responded poorly to a variety of health complications.

According to the report, Medicare beneficiaries are often left in the dark about crucial decisions impacting their care. In addition, hospices were found to routinely bill for the most expensive level of care without medical necessity....


8 Physicians Identified in Beaumont Hospital $84.5M Illegal Kickback FCA Settlement

8 Physicians Identified in Beaumont Hospital $84.5M Illegal Kickback FCA Settlement

Detroit’s William Beaumont Hospital system has agreed to pay $84.5 million to resolve allegations that eight physicians accepted illegal kickbacks for patient referrals in violation of the False Claims Act (“FCA”), the Department of Justice announced Thursday.

Whistleblower Dr. David Felten is set to receive a soon-to-be-determined cash whistleblower award for filing the initial qui tam lawsuit that led to the government’s recovery.

Felten Claims Beaumont Trades Cash and Office Rent for Patient Referrals

After joining Beaumont in 2005 as Vice President of Research, the globally recognized neuroscientist Dr. David Felten, (then 57) noticed several arrangements between Beaumont and its physicians that appeared to violate of the Anti-Kickback Statute and Stark Law....


Dermatologist Exposes False Claims Act Violations Leading to $850,000 Medicare Fraud Recovery

Dermatologist Exposes False Claims Act Violations Leading to $850,000 Medicare Fraud Recovery

Minnesota-based Skin Care Doctors (SCD) has agreed to pay $850,000 to resolve allegations of false Medicare billings and unnecessary surgical procedures. The alleged misconduct was brought to light in a whistleblower lawsuit filed by a dermatologist who had previously worked under Skin Care's CEO, Michael J. Ebertz.

According to the False Claims Act lawsuit filed by whistleblower Dr. Jeff Samuelson, Dr. Ebertz, who is also a dermatologist, knowingly treated benign lesions as if they were pre-cancerous, routinely billing Medicare for unnecessary procedures.

he complaint also states that Ebertz overbilled Medicare for his patients' visits and encouraged other Skin Care doctors to do the same. Samuelson was co-owner of the company at the time, but he was invited to leave after he spoke out about the alleged misconduct. Dr Samuelson currently practices in California....


Sightpath and Its CEO Will Pay $12 Million to Resolve Kickback Allegations Involving Ophthalmological Services and Products

Sightpath and Its CEO Will Pay $12 Million to Resolve Kickback Allegations Involving Ophthalmological Services and Products

Minnesota-headquartered Sightpath Medical, Inc. and a subsidiary will pay $12 million to resolve False Claims Act allegations raised in a lawsuit filed by whistleblower Kipp Fesenmaier.

The complaint stated that Sightpath and Precision Lens, a company that was targeted by another lawsuit, offered kickbacks to physicians in exchange for their use of their products and services, which include intraocular lenses, ophthalmic surgical equipment, and related services to hospitals. Some of the services and products in question were reimbursed by Medicare and other federal programs.

The alleged kickbacks paid to numerous ophthalmologists included luxury skiing, golfing, and fishing trips, improper consulting agreements. Sightpath, Precision Lens, and some of their executives allegedly used these enticements to induce physicians to use their products and services, which ultimately resulted in the submission of false claims to government programs.

The kickback scheme was exposed at length in a whistleblower lawsuit filed by Kipp Fesenmaier, a former Sightpath executive, in 2013. Fesenmaier, who is now Senior Director of Global Business Solutions at the Mayo Clinic, started working at Sightpath as National Manager in 1994. His last position with the company was VP-GM of Diagnostics, which lasted from January 2006 till December, 2007....


Florida Rehab Program Operator Arrested Over $58.2 Million in Fraudulent Billings

Florida rehab facility owner Eric Snyder has been arrested and charged with conspiracy to commit health care fraud. According to allegations first raised in a whistleblower lawsuit, Snyder fraudulently billed several insurance companies by $58.2 million.

Snyder’s accomplice Christopher Fuller, also charged with similar violations, used to recruit drug addicts at AA meetings and crack addict hangouts.

Allegedly, Snyder would later bill insurance companies for treatments and tests for the recruited patients. In order to get them to participate in the scheme, Snyder routinely offered kickbacks in the shape of plane tickets, strip club visits, and cash. 

Snyder had first come to Florida in 2009 as a recovering addict himself. After he started his outpatient treatment program, Real Life Recovery, his Facebook postings went from inspirational 12-step program quotes to depictions of a luxurious lifestyle.

Fuller, on the other hand, had been arrested 19 times prior to his involvement with Snyder....


Celgene Reaches $280 Million Settlement in Whistleblower Lawsuit Over Off-Label Marketing of Cancer Drugs

Celgene Reaches $280 Million Settlement in Whistleblower Lawsuit Over Off-Label Marketing of Cancer Drugs

New Jersey-headquartered Celgene Corporation will pay $280 million to settle claims that it cited non-FDA approved uses in its promotion of cancer treatment drugs Thalomid and Revlimid. The biotech giant decided to settle after a judge ruled last December that the case was fit to proceed to trial.

Judge George H. King believed the plaintiff had provided sufficient evidence that Celgene was promoting the drugs for uses the Food and Drug Administration had approved neither Thalomid nor Revlimid for.

As a consequence, the government ended up paying hundreds of thousands of dollars for “off-label” prescriptions. 

Not Just Off-Label Marketing but Kickbacks Too?

Both Thalomid and Revlimid are approved for use in cases of myeloma, but Celgene’s promotion went far beyond that in its claims of the drugs’ benefits for cancer patients. Celgene not only pitched the drugs to physicians making claims about off-label uses, but it also allegedly paid kickbacks to ensure the drugs would be abundantly prescribed....


Linde's Lincare Will Pay $20 Million to Settle Fraudulent Billing Allegations. Whistleblowers Receive $11 Million

Linde's Lincare Will Pay $20 Million to Settle Fraudulent Billing Allegations. Whistleblowers Receive $11 Million

Linde AG-owned Lincare, one of the largest respiratory therapy service providers in the US, will pay $20 million to resolve allegations that it fraudulently billed the government for oxygen and respiratory equipment.

The settlement resolves a whistleblower lawsuit filed by four former employees of the company. Originally filed in 2009 and 2010 as two separate suits by two pairs of Lincare insiders, the filings were consolidated into one in March 2014.

According to the text of the consolidated and amended lawsuit, “Lincare falsely and fraudulently billed the government for services and equipment that were non-reimbursable, were not medically necessary, were never provided, or were provided in direct violation of the applicable standards and regulations governing Lincare’s provision of oxygen equipment and services. As a result of these knowingly false and fraudulent claims, Lincare received payments from the United States of America that were inflated, excessive, unearned, and improper.”...