Healthcare Fraud / Kickbacks / Illegal Reimbursements

The news has been full of stories about healthcare companies, in particular drug companies, settling or losing lawsuits and paying millions in judgments. Some of these judgments were due to government programs such as Medicare and Medicaid being billed for unapproved drug applications (off-label prescribing) or other situations where a healthcare provider made a “false claim” for payment to the government.

In many of these cases, one or two employees or others close to the company “blew the whistle” on the fraudulent activity, allowing the government to collect damages. In turn, the person who came forward with the fraud was entitled to between 15 and 30 percent of any damages collected under the False Claims Act (FCA). Also known as the Whistleblower Act, Qui Tam Statute or Lincoln Law, the FCA gives any citizen the power to sue companies or individuals over financial fraud committed against the government. Whistleblowers in successful cases can receive substantial awards for their efforts.

Qui tam is the abbreviated Latin phrase that translates to whistleblowers speaking up about fraud. In May 2010, the New England Journal of Medicine reported that 90 percent of healthcare fraud cases were qui tam actions initiated by whistleblowers, known as “relators” under the FCA, on behalf of the government.

Questions About Reporting Possible Healthcare-Related Fraud Against the Government?

If you suspect your health-related employer is defrauding the federal government, contact the Louthian Law Firm today toll free at (803) 454-1200 or online for a free evaluation of your claim. We can confidentially review the facts in your case, advise you about whether your claim has merit and inform you about how the False Claims Act protects whistleblowers from retribution in the workplace — all for no charge.

Recent Healthcare Fraud Whistleblower Protection Lawsuits

Several high-profile qui tam lawsuits were settled recently, many related to pharmaceutical companies.

Physicians can prescribe drugs for off-label uses, but it is illegal for pharmaceutical companies to advertise or market the drugs for uses that have not been approved by the Food and Drug Administration (FDA). Federal laws also prohibit drug companies from paying kickbacks related to prescriptions to physicians. Generally, government-funded healthcare programs such as Medicare and Medicaid do not allow reimbursement for off-label prescriptions. When a pharmaceutical company’s illegal marketing practices cause off-label prescriptions to be written by doctors, and the government pays for those prescriptions, the payment becomes an actionable False Claims Act violation.

Recent qui tam whistleblower cases include:

  • In July 2012, GlaxoSmithKline agreed to plead guilty to several criminal misdemeanor charges and pay $3 billion to settle a series of False Claims Act cases. GSK was charged with illegally promoting nine different prescription drugs, including the antidepressants Wellbutrin and Paxil, the diabetes medication Avandia, the pulmonary drug Advair, and the anti-nausea medication Zofran, as well as five other drugs: Imitrex, Lamictal, Lotronex, Floven, and Valtrex. This is the largest pharmaceutical False Claims Act case so far.
  • Kidney dialysis giant DaVita Inc. settled a whistleblower lawsuit in July 2012. The company agreed to pay $55 million over allegations of drug overuse, while denying wrongdoing. The case settled fraud claims in a Texas lawsuit challenging the dialysis chain’s past use of anemia drug Epogen.
  • In May 2012, the Justice Department announced that Abbott Laboratories Inc. pled guilty and agreed to pay $1.5 billion to resolve four cases of criminal and civil liability arising from the company’s unlawful promotion of the prescription drug Depakote for uses not approved by the FDA. The settlement includes a criminal fine and forfeiture totaling $700 million and civil settlements with the federal government and the states totaling $800 million.
  • In April 2012, WellCare Health Plans agreed to pay $137.5 million to settle four False Claims Act cases related to price gouging and Medicare and Medicaid overpayments.
  • In February 2012, Johnson & Johnson agreed to pay Texas $158 million to settle a whistleblower lawsuit that charged the company with off-label marketing of antipsychotic medication Risperdal. The case is one of several whistleblower lawsuits against Johnson & Johnson and subsidiary Janssen Pharmaceuticals related to Risperdal. In April 2012, a judge in Arkansas ordered the companies to pay more than $1.2 billion in fines after a jury found they had minimized or concealed the dangers associated with the drug. In 2011, a South Carolina judge imposed civil penalties of $327 million against Janssen, and in 2010, a Louisiana jury awarded nearly $258 million in damages.
  • In November 2011, Merck & Co. (MRK), the second-largest U.S. drugmaker, agreed to pay $950 million to settle allegations the company sold painkiller Vioxx for unapproved uses and made false statements about its cardiovascular safety. A unit of the company, Merck Sharp & Dohme, agreed to plead guilty to one count of misbranding Vioxx. The settlement includes a $321.6 million criminal fine and $628.3 million to resolve civil claims.

If you have information about similar false claims made to government healthcare programs, you could be entitled to bring a qui tam action that could possibly result in your receiving a significant cash reward.

How Do I File a Claim Under the False Claims Act?

An experienced whistleblower attorney like the ones at the Louthian Law Firm can assess your case and help you file the necessary disclosure statement with the government if you have a valid case. In some instances, the government will “intervene” or take part in your lawsuit. A qualified attorney can help you structure your claims in such a way that the government will be persuaded to intervene in your case, possibly increasing the likelihood that you will recover reward money. However, even if the government doesn’t decide to intervene, it might still be advisable to pursue your case without government involvement.

For a free, confidential evaluation of your case, call the Louthian Law Firm today at (803) 454-1200 or fill out the online consultation form.