Things may be looking up for Tuomey Healthcare System. Back in 2013, this South Carolina-based healthcare provider was slapped with an initial whopping $276 million fine regarding accusations of physician kickbacks. In a surprising turn of events, the Department of Justice recently announced that it settled with Tuomey for a much lower price tag.
In a recent article published by the whistleblower advocacy organization Taxpayers Against Fraud (TAF), an unofficial tabulation of False Claims Act settlements shows a lucrative fiscal year with over $3 billion recovered on behalf of taxpayers, with $2 billion of that represented by whistleblower-initiated cases.
Following an intensive investigation into the practices of pharmaceutical giant Warner Chilcott U.S. Sales LLC, the company has agreed to settle criminal and civil allegations of healthcare fraud for $125 million as well as plead guilty to one felony count of healthcare fraud. In October 2015, the former president of the company, Carl Reichel, was arrested in a related matter pertaining to healthcare fraud and faces similar charges stemming from allegations of illegal kickbacks and other financial misdeeds.
When it comes to pharmaceutical marketing, it may seem like the options are virtually endless for a company seeking to boost sales and increase exposure of its product. However, despite the relentless television commercials and internet ads, there are a number of restrictions placed on the marketing practices of drug companies. Hefty fines and penalties await those that attempt to market their product for purposes other than those approved by the FDA.
With just one week before the start of a False Claims Act trial involving drug manufacturer Novartis Pharmaceuticals, the company decided to avoid the unpredictability of a jury in favor of a calculated $390 million settlement. The company is facing several False Claims Act lawsuits involving a number of different drugs.
In yet another case of defense contractor fraud, a company known as APL, Ltd. has agreed to pay $9.8 million to the federal government amid allegations of false billing. APL is a Scottsdale, Arizona-based subsidiary of Singapore’s Neptune Orient Lines Limited, a global shipping company engaged in the transcontinental transport of shipping containers.
In some cases, a company facing possible liability under the False Claims Act may opt to self-report and self-disclose the potential violations, which typically results in a lesser fine and may help offset some of the statutory penalties awaiting violators of the Act. In today’s case, we review a recent settlement out of Louisiana arising after Westwood Mental Health, LLC and its parent company followed the self-disclosure protocol implemented by the Department of Health and Human Services to allow companies the opportunity to voluntarily reveal information that may involve violations of the FCA and other statutes. Accordingly, today’s case does not involve a whistleblower. However, the conduct alleged against Westwood is not unlike that seen in other cases involving healthcare fraud.
Under federal regulations, government healthcare programs like Medicare and Medicaid are only available to cover end-of-life services once a patient has reached a terminal point in their illness or injury. Unlike curative care, palliative care is only designed to make a patient more comfortable. Program regulations state that curative methods should not be used for patients receiving hospice services.
Ideally, False Claims Act lawsuits are resolved via a negotiated settlement between the whistleblower, the defendant, and the government. However, if a settlement agreement cannot be reached, the parties must press on toward a trial – an option that sets up both sides for a greater amount of unpredictability and risk.
A Kentucky-based company known as Nurses’ Registry and Home Health Corp. has agreed to pay $16 million to settle False Claims Act allegations that it defrauded the Medicare program. The case was originally filed by two whistleblowers – former employees of the company – who suspected it was exaggerating the home healthcare needs of the patients.