Healthcare and Pharma Cases


$784 Million Recovery in Whistleblower Exposed Pfizer Medicaid Billing Scheme

$784 Million Recovery in Whistleblower Exposed Pfizer Medicaid Billing Scheme

In one of the biggest settlements of its kind to date, U.S. drug giant Pfizer has entered a tentative agreement to pay $784.6 million to settle long-running allegations that drug manufacturer Wyeth overcharged Medicaid for its heartburn medication Protonix. The two whistleblowers who brought the initial claims under the False Claims Act stand to split a whistleblower award of nearly $59 million.

Tip of the Big Pharma Fraud Iceberg says Whistleblower Lawyer

“The conduct of Big Pharma is shocking,” said prominent U.S. fraud recovery and whistleblower attorney Brian Mahany, who has aided in the recovery of billions for the taxpayers through his representation of whistleblowers nationwide. “This case against Pfizer is not an isolated incident. The big drug companies have been fined billions of dollars in recent years, yet they still can’t clean up their act. Unfortunately, Pfizer looks at the $785 million fine as a small cost of doing business instead of a deterrent.”...


DOJ Off-Label Promotion Defeat & Harsher Responses to Pharma Schemes

A Report from the Conference on Fraud and Abuse in the Sale and Marketing of Prescription Drugs and Medical Devices As a dozen Department of Justice lawyers from several Northeastern states gathered in Boston to discuss fraud and abuse in the health and pharma sectors, the DOJ was settling an off-label promotion case with Amarin Pharma.
The First Amendment settlement has recognized the Dublin-based pharmaceutical company´s right to promote drugs for uses that are not approved by...

51 Hospitals Settle Medicare Fraud Allegations at $23M for Cardiac Device Implants

51 Hospitals Settle Medicare Fraud Allegations at $23M for Cardiac Device Implants

51 hospitals in 15 states have agreed to pay the Federal Government $23 million to resolve False Claims Act allegations by two whistleblowers, regarding the implantation of cardiac devices in Medicare patients without adhering to Medicare's coverage requirements.

This is the last resolution in a series of lawsuits that began a nationwide investigation into Medicare billings for unnecessary cardiac implants. Last October, nearly 457 hospitals in 47 states reached 70 settlements totaling a recovery of $250 million. At that time, whistleblowers Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a healthcare reimbursement consultant, received a reward of $38 million.

ICD Medicare Coverage Rules Ignored Per Leatrice Richards & Thomas Schuhmann Whistleblowers

Richards and Schuhmann filed the lawsuit after observing irregularities in the way hospitals established who was a suitable candidate for the implantation of a cardioverter defibrillator (ICD) covered by Medicare. Each ICD costs the Federal healthcare program $25,000. ICDs perform the same function as common handheld defibrillators, working to restore the heart's normal rhythm. The ICD detects abnormal cardiac rhythms and rapidly corrects them, by way of a delivering a shock to the heart....


Wrist Slaps & More Guilt Admissions Topics of Healthcare Fraud Conference

Conference on Fraud and Abuse in the Sales & Marketing of Prescription Drugs and Medical Devices It is common knowledge that the Department of Justice has recovered several billion dollars from health care providers through whistleblower lawsuits. The amounts recovered tend to be significantly lower than the unlawful profits made by the companies under scrutiny, but this is not the DOJ’s biggest problem today.
Arguably, the main focus of a recent Conference on Fraud and Abuse...

Naples Urology Doc Spellberg $1.5M Settlement on Medicare Billing Fraud Allegations

Naples Urology Doc Spellberg $1.5M Settlement on Medicare Billing Fraud Allegations

Florida based urologist David Spellberg recently agreed to repay the federal government $1.5 million dollars for allegedly unnecessary medical tests he ordered while working at Naples Urology Associates.
Whistleblower Mariela Barnes Racks up 2nd Cash Award This is the second settlement to benefit whistleblower Mariela Barnes whose False Claims Acts allegations prompted Naples Urology Associates parent company, 21st Century Oncology, to pay the federal government $19.75 million last...

2015 Year of the Whistleblower: Record $3.5 Billion False Claims Recoveries

2015 Year of the Whistleblower: Record $3.5 Billion False Claims Recoveries

The Civil Division of the U.S. Department of Justice (DOJ) collected over $3.5 billion in settlements and judgements from False Claims Act (FCA) civil cases in fiscal year 2015, with a whopping 81% of these recoveries driven by whistleblower (qui tam) lawsuits. The record annual whistleblower recovery amount was led by health care industry fraud FCA cases this year with a record high percentage of cases declined by the DOJ, subsequently pursued, and won by private attorneys.
FY2015...

21st Century Oncology to pay $19.75M in Unnecessary Tests Medicare Lawsuit

21st Century Oncology to pay $19.75M in Unnecessary Tests Medicare Lawsuit

21st Century Oncology of Fort Myers, Florida, has agreed to pay the Federal Government $19.75 million in a health care fraud settlement that resolves allegations that the company submitted false claims to both Medicare and Tricare for unnecessary medical tests.
Whistle blower Mariela Barnes, once a medical assistant for one of 21st Century Oncology’s urologists, received $3.2 million as a reward provided for in the qui tam (whistle blower) provision of the U.S. False Claims Act for...

Whistleblower Richard Forrest $1.13M Reward in Wisconsin Laboratory False Claims Act Settlement

Whistleblower Richard Forrest $1.13M Reward in Wisconsin Laboratory False Claims Act Settlement

Wisconsin-based Pharmasan Labs, Inc., NeuroScience, Inc., as well as two of their executives, have reached an $8.5 million settlement agreement with the federal government. As the Relator in the whistleblower case, former Pharmasan Labs employee Richard Forrest will receive $1.13 million as his portion of the settlement.

Pharmasan is a laboratory in Osceola, Wisconsin that performs medical lab testing in the areas of neurology, endocrinology, and immunology. NeuroScience is an associated corporation founded by Pharmasan that bills Medicare for Pharmasan’s services. This settlement resolves claims that the labs violated the False Claims Act and committed healthcare fraud by deliberately billing Medicare for ineligible lab tests. The settlement also resolves allegations that the labs submitted tests for reimbursement to Medicare that were not performed by approved physicians, and in fact were not performed by physicians at all.

According to Department of Justice information, the labs were accused of billing Medicare for millions of dollars’ worth of lab tests that did not meet federal reimbursement guidelines. Many of the tests were ineligible for reimbursement because they were medically unnecessary or experimental, most frequently involving testing for food sensitivities which is not a medical service covered by Medicare....


No Free Ride for Regent in $3M Ambulance Swapping Fraud Settlement

No Free Ride for Regent in $3M Ambulance Swapping Fraud Settlement

November 30 marks one the first U.S. False Claims Act settlements to hold a medical institution (rather than ambulance companies) responsible for an “ambulance swapping” arrangement. Texas-based Regent Management Services L.P. has agreed pay $3.199 million to resolve allegations it accepted kickbacks in exchange for patient transport (ambulance) referrals.
Regent Management a Legitimate Party in Kickback Scheme Case Galveston-based Regent Management Services operates 12...

Piedmont Pathology Settles Kickback Scheme Allegations at $500K

Piedmont Pathology Settles Kickback Scheme Allegations at $500K

The Department of Justice announced on Monday, November 30 that Piedmont Pathology Associates, Inc. and Piedmont Pathology, P.C. have agreed to pay the U.S. government $500,000 to resolve allegations of False Claims Act violations. The former Piedmont Pathology contract employee whose initial lawsuit prompted the investigation is set to collect a whistleblower award of $75,000, plus costs and attorney’s fees.
Diagnostics Group Offered Electronic Medical Record (EMR) Software For...