Health Care

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Client Alert – Guilty Pleas Continue to Amass in New Jersey State Health Benefits Fraud Investigation

October 12, 2017 - In late summer we issued a client alert describing a healthcare fraud scheme that had hit two New Jersey state health benefits programs for over $25 million by submitting fraudulent prescriptions for compounded medications. At the time of the initial alert, five conspirators had submitted guilty pleas to an assortment of [...]

Client Alert – Insys Therapeutics Runs Afoul of Attorneys General in Two States

October 10, 2017 - Arizona-based pharmaceutical company Insys Therapeutics Inc. (Insys) has found itself under investigation in both Massachusetts and New Jersey over the aggressive marketing of its opioid-fentanyl drug Subsys. Subsys has been approved by the FDA for use with breakthrough pain in cancer patients who have developed tolerance to other opioid-based drugs. The [...]

Client Alert – Diagnostic Test Maker Alere Faces Whistleblower FCA Suit

October 9, 2017 - A recently unsealed suit against Alere Inc., initially filed by two whistleblowers in a Florida federal court in 2015, reveals multiple allegations of False Claims Act (FCA) and Anti-Kickback Statute violations against the diagnostic test-maker. The whistleblowers, former Alere vice president of business development Michael Nolan and Jacob Whitfield, a former [...]

Client Alert – AmerisourceBergen Agrees to Pay $260 Million for Mislabling Oncology Drugs

October 3, 2017 - Late last week drug wholesaler AmerisourceBergen Corp (ASBG) pleaded guilty in federal court in Brooklyn to violations of the federal Food, Drug and Cosmetic Act. ASBG disclosed in a stipulated statement of facts at the hearing that a former ASBG business unit, the Alabama-based company Medical Initiatives Inc., (MII) had sold [...]

CVS Health Named in Insulin Price Fixing Investigations; Class Action Suits also Pending

October 2, 2017 - In a recent SEC filing, CVS Health (CVS) has disclosed just how embroiled its PBM division has become in a number of insulin price fixing investigations and lawsuits nationwide. Two putative class action suits have been filed against CVS, along with a number of other PBMs and drug manufacturers, in the [...]

Feds Unravel Multimillion Dollar Health Care Fraud Scheme Targeting New Jersey State Health Benefits Programs

August 21, 2017 - Thus far, five men, including an Atlantic City firefighter and four pharmaceutical sales representatives, have admitted to defrauding two New Jersey state health benefits programs of over $25 million by submitting fraudulent claims for compounded medications. More indictments may follow as the government continues its investigation into the conspiracy. The alleged [...]

Client Alert – Attorney General Sessions Announces Formation of Opioid Fraud and Abuse Detection Unit

August 8, 2017 - While speaking at the Columbus, Ohio, Police Academy last week, U.S. Attorney General Jeff Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit. The Unit is a pilot program, staffed by 12 U.S. Attorneys in select federal districts, that is designed to utilize sophisticated data tracking to detect and [...]

Client Alert – United Healthcare Named in Whistleblower Suit – Accused of False Reporting to CMS

August 7, 2017 - United Healthcare Services Inc., which operates the country’s largest private Medicare Advantage insurance plan (covering about 3.6 million people), has been accused by some of its own sales agents of concealing hundreds of complaints of enrollment fraud and other misconduct. The company is currently embroiled in an earlier lawsuit, filed in May, [...]

Client Alert – PBMs are Targets in Nevada’s Diabetes Drug-Pricing Transparency Bill

July 31, 2017 - In the absence of federal action, Nevada, along with a number of other states, is enacting legislation to combat skyrocketing drug prices and create transparency regarding the pricing activities of drug manufacturers and Pharmacy Benefit Managers (PBMs). Nevada’s Senate Bill 539 places new reporting requirements on pharmaceutical manufacturers and PBMs for [...]

Three Ohio Healthcare Companies Hit with $19.5 Million Price Tag for Medicare False Claims

July 19, 2017 - Three Ohio-based companies, Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia), along with two company executives, Brian Colleran (Colleran) and Daniel Parker (Parker), will pay nearly $19.5 million to settle allegations that the companies submitted false claims for medically unnecessary rehabilitation therapy and hospice [...]