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Chicago, Illinois 60603-5792
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Durable Medical Equipment Provider Agrees To Pay $1.6 Million To Resolve False Claims Allegations

U.S. Attorney for Utah, John W. Huber, announced on December 11, 2018, that the durable medical equipment ("DME") company Western Medical Group agreed to pay $1,634,844 million to settle False Claims Act allegations.  The settlement is the result of two qui tam actions filed by whistleblowers in December 2013 and February 2014.  More

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Drug Maker Actelion Agrees to Pay $360 Million to Settle False Claims Act Investigation Into Kickbacks

The pharmaceutical company Actelion Pharmaceuticals US, Inc. ("Actelion"), based in South San Francisco, California, has agreed to pay $360 million to resolve claims that it illegally funneled kickbacks through a patient-assistance charity.  Federal prosecutors allege in a press release on December 6, 2018 that Actelion "illegally used a foundation as a conduit to pay the copays of thousands of Medicare patients taking Actelion's pulmonary arterial hypertension drugs." These actions are in violation of the False Claims Act.  More

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Largest Ever Recovery in a Single-State False Claims Act Lawsuit: $330 Million Settlement with Sprint Communications

New York Attorney General Barbara D. Underwood and Acting Tax Commissioner Nonie Manion announced a record $330 million settlement with Sprint Communications on December 21, 2018.  This settlement is not only the largest-ever recovery by the New York Attorney General resulting from an action filed under the New York False Claims Act, but it is also the largest-ever recovery by a single state in an action brought under a state false claims act.    More

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The Virginia Birth-Related Neurological Injury Compensation Program Settles for $20.7 Million

The Virginia Birth-Related Neurological Injury Compensation Program ("The Program") and the Virginia Birth-Related Neurological Injury Compensation Fund ("The Fund") have recently agreed to pay a $20.7 million settlement to resolve FCA allegation brought against them by a whistleblower suit.  Relators allege that the defendants knowingly caused numerous Program participants to submit false claims to Medicaid.  By law, Medicaid is the "payer of last resort" for all healthcare claims for a covered beneficiary, meaning if another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay all of or part of the costs of the claim before Medicaid makes any payment.  If a third party is liable to pay for part of a Medicaid participant's care, "Medicaid will only pay that part of the care which is over and above the amount covered by the third party."[1]   The text of Va. Code Ann. §38.2-5009 specifically says that the Program will not cover any items or expenses that would be covered "under the laws of any state or the federal government except to the extent prohibited by federal law."  However, the Program and the Fund made themselves the de facto payers of last resort, improperly shifting payment onto the Medicaid program.  More

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Why Do So Many False Claims Cases Settle Before Trial?

It is widely recognized that many more False Claims Act (FCA) cases settle than go to trial.[1] While it is difficult to determine the exact proportion of cases that settle vs. cases that are tried, comprehensive reports on FCA developments published semi-annually indicate about a 16:1 ratio of notable settlements to verdicts/ judgments.[2] More

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Medicare Advantage Provider to Pay $270 Million to Settle False Claim Act Liabilities

HealthCare Partners Holdings LLC, doing business as Davita Medical Holdings LLC (DaVita), has agreed to settle a False Claims Act liability case and will pay $270 million to the United States Government.  DaVita, headquartered in El Segundo, California, did not admit fault.  Relators allege that DaVita was providing inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments.  More

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The Government Fights Back Against Ambulance Fraud: A Recent $21 Million Settlement and Other Related Cases

The U.S. Government has successfully combatted several instances of ambulance fraud this past year, by intervening in False Claims Act (FCA) qui tam suits and by pursuing a criminal health care fraud case against an ambulance company owner. These cases against AmeriCare, Hart to Heart, and the owner of Tonieann EMS and Rosenberg EMS, mainly involve allegations that these companies systematically billed government-provided insurance for medically unnecessary ambulance transports. However, a recently-resolved case against Paramedics Plus and several affiliates involved allegations of an illegal kickback scheme enacted to win and maintain exclusive ambulance contracts. More

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Walgreens Agrees to Settle Three Civil Fraud Lawsuits Totaling Over $270 Million

Walgreens Boots Alliance, Inc. ("Walgreens") has agreed to pay $269.2 million to settle two whistleblower lawsuits accusing it of overbilling federal healthcare programs for over a decade.  In both settlements, Walgreens "admitted and accepted responsibility for conduct the Government alleged in its complaints under the False Claims Act".  The U.S. Department of Justice made the announcement on January 22, 2019. In addition, Walgreens recently settled another False Claims Act claim, although the monetary value is modest in comparison with the first two.   In the third settlement, Walgreens agreed to pay $3.5 million to the U.S. and the State of Wisconsin to settle allegations that, from 2011 to 2014, Walgreens violated Wisconsin Medicaid rules by dispensing routinely stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for a medically appropriate treatment.   More

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The Public Disclosure Bar

The False Claims Act qui tam provision allows private citizens to act as whistleblowers, and file a lawsuit on behalf of the government if they are aware of fraud taking place. These whistleblowers, or relators, are eligible to receive a portion of the money the government recovers if the lawsuit is successful.

It is important to note that the False Claims Act is designed to encourage people to report fraud that might otherwise go undetected; it is not designed to reward people who repeat allegations that have already been publicized. To that end, the False Claims Act includes language stipulating that the court will dismiss a case if substantially the same allegations contained therein were already publicly disclosed and the relator bringing the action is not an original source of the information. This section of the Act is commonly referred to as the "public disclosure bar". More

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An Overview of Nursing Home Fraud: False Claims Act Cases from the Last Three Years

The last three years have seen several FCA cases related to nursing home fraud achieve success. Two cases of note—one against a skilled nursing facility chain and one against a rehabilitation therapy provider—settled for over $100 million, and a recent Third Circuit decision revived a dismissed case against a pharmaceutical company and narrowed the public disclosure bar. Still other cases involving similar allegations of inflating reimbursement levels and engaging in illegal kickback schemes have settled for millions or involved criminal prosecution of the individuals responsible. More

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