National Chain Pharmacy Over-Bills Medicare and Medicaid for Insulin Pens

Walgreens, the nation’s second largest pharmacy chain, paid $209 million in January 2019 to settle allegations by two VSG clients that the pharmacy knowingly billed government health programs for medically unnecessary quantities of insulin pens. The whistleblowers, both of whom worked for Walgreens, claimed that Walgreens programmed its dispensing and billing software program so that pharmacists could not dispense less than 5 insulin pens at a time – the amount in a carton of pens, understated the dispensed “days’ supply”  on claims to payers, and then refilled prescriptions prematurely.

Navy Billing Fraud

Inchcape Shipping Services, one of the world’s largest providers of marine support services, agreed to pay $20 million to settle a VSG whistleblower lawsuit accusing Inchcape of overbilling the Navy for services provided to Navy ships in ports around the world. VSG’s clients were awarded $4.4 million, 22% of the settlement proceeds.

Kickbacks to Induce Unnecessary Hospital Admissions

EmCare, Inc. paid more than $30 million to settle qui tam claims brought by VSG clients and another set of relators, alleging that EmCare received kickbacks from a major hospital chain in exchange for pressuring hospital emergency room (ER) doctors to increase the rate of ER-to-hospital admissions. EmCare also entered into a confidential settlement with VSG’s client on her unlawful retaliation claim.

Multiple Award Schedule False Claims

CA Inc., a major supplier of software to federal agencies, paid $45 million to settle a False Claims Act lawsuit by a VSG client who alleged that the company misrepresented to the Government the nature and extent of the pricing discounts that the company was providing to its commercial customers.

Drug Manufacturer Kickback on Specialty Medications

Novartis Pharmaceuticals Corporation paid $390 million to settle a False Claims Act lawsuit brought by a VSG client who alleged the company paid kickbacks to specialty pharmacies so they would recommend to doctors and patients six of Novartis’ specialty medications. The $465 million aggregate recovery in the case was, at the time, the largest recovery ever in a qui tam suit based solely on a kickback theory.

Drug Manufacturer Kickbacks to Specialty Pharmacies

Accredo Health Group, Inc. and Bioscrip, Inc. two specialty pharmacy chains, paid a combined total of $75 million to settle qui tam whistleblower claims in a False Claims Act lawsuit that also named as a defendant the Swiss drug manufacturer, Novartis Pharmaceuticals Corp. The case alleged the companies participated in a kickback scheme involving the iron-chelating drug Exjade, a specialty drug that costs government health programs thousands of dollars per month to cover a single prescription.

Off-Label Marketing

Pfizer Inc. paid $491 million to settle allegations raised by a firm client that Wyeth Inc., a pharmaceutical manufacturer acquired by Pfizer, had illegally marketed the kidney transplant drug Rapamune for uses that had not been approved by the Food & Drug Administration. The firm’s client shared the relator share award with whistleblowers in another case with partially overlapping allegations.

Kickbacks to Long Term Care Pharmacy

Johnson & Johnson, Inc., paid $149 million to settle allegations in cases filed by two qui tam whistleblowers, including a firm client, that the pharmaceutical giant paid kickbacks to long term care pharmacy chain Omnicare to induce Omnicare to recommend the atypical antipsychotic Risperdal for residents of nursing homes serviced by Omnicare.

Grant Fraud

New York State paid $27 million to resolve allegations in a whistleblower lawsuit that it submitted false claims for federal funds meant for the training of social service workers.

Buy American Act Fraud

A government contractor paid over $5 million to settle allegations in a qui tam lawsuit that it sold supplies to the United States in violation of its contractual obligations to adhere to the Buy American Act and the Small Business Act.

Billing Fraud by Medical Device Manufacturer

Becton Dickinson & Co., a medical device manufacturer, paid $3.3 million to settle a qui tam whistleblower case alleging that the contractor overcharged the Department of Veterans Affairs for devices after failing to disclose more favorable prices provided to commercial customers.

GSA Fraud

Motorola, Inc., in what was at the time the largest civil recovery ever by the General Services Administration (GSA), paid $15 million to settle GSA’s claims that the company had submitted false claims for goods sold pursuant to the Multiple Award Schedule.