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. Read Press Release

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. Read Press Release

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. Read Press Release

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. Read Press Release

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. Read Press Release

Pharmacy Kickbacks to Nursing Homes

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.

Violating Usual & Customary Charge Requirments

Omnicare, Inc. paid more than $20 million to resolve allegations made by a firm qui tam whistleblower client that the pharmacy chain knowingly overbilled the Medicaid programs of Massachusetts and Michigan as a result of its failure to comply with the “usual and customary charge” billing rule. Read Press Release

Drug Manufacturer Kickbacks on Generic Drugs

Ivax Pharmaceuticals a manufacturer of generic medications, paid $14 million to resolve qui tam whistleblower claims by a firm client that it paid kickbacks to become Omnicare’s exclusive supplier of certain generic medications.

Drug Switching to Inflate Medicaid Reimbursement

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.

Evading Caps on Reimbursement for Services

NIPSI, a pharmacy company, paid over $7 million to resolve allegations in a qui tam whistleblower case alleging that it overstated the cost of intravenous drugs.