Examples of Qui Tam Whistleblower Healthcare Fraud Cases

The number of health care fraud cases under the False Claims Act (FCA) is increasing every year. A study conducted by Taxpayers Against Fraud (TAF), reported 62 cases of qui tam health care fraud in the years between 1987 and 1992, but that number spiked to 417 cases in 2011, 412 in 2012, and in 2016 there were 501 new qui tam health care fraud cases in Health and Human Services.

The number of qui tam cases represents only those fraudsters who were caught. Whistleblowers who report health care fraud have a significant incentive to report fraud as fraudsters must pay up to triple damages, and statutory penalties. Those triple damages recover the money the federal government lost, pay the cost of the investigations with interest, and cover the whistleblower awards which can amount to 15 to 25% of the amount recovered. The False Claims Act (FCA), also called, “Lincoln’s Law,” is based on the idea that if you incentivize integrity you will get results. Since 1987, the federal FCA has recovered more than $53 billion in civil recoveries to the federal government. More than 80% of the False Claims Act cases pursued by the U.S. Department of Justice were initiated by whistleblowers. (TAF)

The following is just a sampling of some of the larger FCA cases that involve health care fraud, which is one of the largest sectors of government fraud. As of 2012, the settlement of just 80 fraud cases involving drug manufacturers returned more than $19 billion to the U.S. government. (TAF)

• Cephalon Inc., settled a whistleblower False Claims Act lawsuit over the company’s alleged marketing of its narcolepsy drug, Provigil, for un-approved, off-label uses. The whistleblower alleged that the company rewarded physicians who prescribed Provigil and Nuvigil (another narcolepsy medication) for off-label uses. The terms of the settlement were not made public.
• Novo Nordisk is settling a whistleblower lawsuit alleging that the company engaged in a “white coat marketing scheme” to boost sales of its diabetes drugs by offering the services of diabetes educators to doctors. The alleged intent of the scheme was to boost sales of diabetes drugs, NovoLog, Victoza, and Levemir. The complaint reports that the three drugs earned Novo Nordisk $6 billion in sales in 2013. In 2009, the company paid a $18 million fine for $1.4 million in illegal kickback payments to foreign governments. (com)
• Celgene Corp. has agreed to pay $280 million to settle fraud allegations in a whistleblower lawsuit regarding the promotion of two cancer drugs which did not have approval by the U.S. Food and Drug Administration. (com)
• An Atlanta pain clinic agreed to pay $250,000 to settle alleged FCA violations for billing Medicare for the services of a physician who had been suspended from the Medicare program, and for the use of non-FDA approved drugs which are not eligible for reimbursement under Medicare. (DOJ)
• The Norman Parathyroid Center agreed to pay $4 million to resolve allegations of FCA violations for billing Medicare for pre-operative services for which he had already received payment. The allegations originated from a whistleblower qui tam lawsuit filed by a former patient of the practice, who will receive a whistleblower award of about $600,000. (DOJ)

Do you have evidence that your employer is committing fraud against the federal health care agencies Medicare or Medicaid? If so, you are encouraged to speak to one of our discreet qui tam lawyers so that you can get a clear understanding of your rights and your options for proceeding with your claim. At Plattner Verderame, P.C., our Phoenix qui tam lawyers have experience working with the DOJ, and we can brief you on what possible reward may be available given the facts of your case. Please phone us at 602-266-2002 to schedule a consultation. You can also reach us confidentially through our contact form.

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