Tenet Healthcare, Inc., operator of the nation’s second largest health care chain at the time, paid more than $900 million to settle claims in multiple qui tam whistleblower lawsuits that it had over-billed Medicare through use of an overstated “cost-to-charge” ratio that inflated “outlier” and other cost-based payments sought by this hospital chain.
VSG’s qui tam lawyers, while in private practice and previously with the Department of Justice, have successfully represented whistleblowers and the government, winning many significant False Claims Act recoveries and qui tam awards. Our whistleblower lawsuits have received national coverage in the media, including The New York Times, Wall Street Journal, Washington Post, Los Angeles Times, Boston Globe, and 60 Minutes.
The following are summaries of some of our cases.
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.
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.
Fresenius Medical Care North America, a health care company, paid $385 million to settle civil claims in multiple qui tam whistleblower lawsuits that a predecessor company, National Medical Care, Inc., paid unlawful kickbacks to induce physicians and nurses to provide unnecessary intravenous nutrition to dialysis patients covered by Medicare.
HCA, Inc., the nation’s largest hospital chain at the time, paid $225.5 million to resolve claims by multiple qui tam whistleblowers that HCA unlawfully paid kickbacks to physicians, and violated the federal “Stark” law, to induce physicians to refer patients whose care would be billed to federal health programs.
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.
Omnicare, Inc. paid $98 million to settle allegations that drug manufacturers paid kickbacks to Omnicare so that the pharmacy chain would prefer their products over competing products when recommending products to nursing home patients, and that Omnicare paid kickbacks to nursing homes to secure their business. The settlements were based on allegations by four qui tam whistleblowers, including a firm client.
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.
Omnicare, Inc. the nation’s largest long term care pharmacy chain, paid $49.5 million to settle allegations made by two qui tam whistleblowers, including a firm client, that it switched the form of patient medications (e.g., tablets to capsules) without physician approval in order to maximize Medicaid reimbursement.
LifeScan, Inc., a medical device manufacturer, paid $30.6 million to settle allegations in a qui tam lawsuit that it sold defective blood glucose monitors to Medicare patients and failed to report adverse events to the FDA.
Emergency Physicians Billing Service paid over $28.8 million to resolve whistleblower claims in a qui tam lawsuit that it systematically overcharged Medicare for emergency physician services. The settlement followed a trial conducted by qui tam attorney Mr. Vogel, co-counsel, and government counsel that established the defendant’s liability under the False Claims Act.
BlueCross/Blue Shield of Michigan, the fiscal intermediary for Medicare in Michigan, paid more than $27.6 million to settle qui tam whistleblower claims alleging that it cheated on quality control tests in order to misrepresent the quality of the auditing services it was providing for the Medicare program.