Between 2006 and 2017, according to the Justice Department, Walgreens Boots Alliance, Inc., billed Medicare, Medicaid and other government healthcare programs for hundreds of thousands of insulin pens that it knowingly dispensed to people who did not need them. The nationwide pharmacy has agreed to pay $209.2 million to settle the government's claims.
The federal government intervened in eight False Claims Act lawsuits and brought criminal charges against Health Management Associates, LLC (HMA), a hospital chain that has since been sold. According to the Justice Department, HMA engaged in a scheme to defraud the U.S. The allegations include:
"When hospices increase their bottom lines by billing taxpayers for unneeded services, they are diverting money from vulnerable, terminally-ill individuals," said a spokesperson for the U.S. Department of Health and Human Services Office of the Inspector General. "Worse yet, these patients may not be receiving care for medical needs that would otherwise be covered in a non-hospice setting."
Livingston Regional Hospital, LLC, of Tennessee has agreed to settle a False Claims Act case brought against it in federal court. It will resolve the allegations for $784,000. The hospital is owned by LifePoint Health, Inc., which operates hospitals across the U.S.
The Justice Department and six U.S. states have joined a whistleblower's lawsuit against Insys Therapeutics, Inc. In the lawsuit, the drug maker is accused of trying to make more profit on Subsys, a spray form of the opioid fentanyl, by paying kickbacks to induce doctors to prescribe the drug. It is also accused of knowingly having insurers and federal healthcare programs to pay for Subsys when it was not medically necessary.
"Improper financial arrangements between government officials and private contractors corrupt taxpayer-funded contracts," says the acting assistant attorney general of the Justice Department's Civil Division.
Respiratory equipment supplier Rotech Healthcare, Inc., has agreed to settle False Claims Act Allegations for $9.68 million. Moreover, as part of the settlement agreement, the company admits that it knowingly billed Medicare for portable oxygen tanks (contents) that patients didn't need or use -- and regardless of whether the tanks were actually delivered.
When we think of fraud we often think of fraud and enforcement, we often think of federal laws and agencies. However, a new health care fraud whistleblower case that is making headlines in New York City is being pursued under state law. What does the case entail and how is state law working in this case?