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Advanced Care Scripts Inc., $1.4 million

United States of America ex rel. Paul Nee v. Biogen, Inc., et. al. District of Massachusetts.

GBB attorneys settled this qui tam suit against Advanced Care Scripts and Biogen, one of the worlds’ largest pharmaceutical companies. The complaint, filed by a whistleblower under the False Claims Act, alleged that Defendants used charitable organizations in a kickback scheme to pay the Medicare copays for multiple sclerosis drugs Avonex and Tysabri. Medicare subsequently paid the claims for these drugs, which can cost as much $80,000 per patient per year. 

Read more: https://www.prnewswire.com/news-releases/pharma-giant-and-speciality-pharmacy-settle-case-alleging-false-claims-violations-301195541.html?tc=eml_cleartime

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Biogen Inc., $22 million

United States of America ex rel. Paul Nee v. Biogen, Inc., et. al. District of Massachusetts.

GBB attorneys settled this qui tam suit against Advanced Care Scripts and Biogen, one of the worlds’ largest pharmaceutical companies. The complaint, filed by a whistleblower under the False Claims Act, alleged that Defendants used charitable organizations in a kickback scheme to pay the Medicare copays for multiple sclerosis drugs Avonex and Tysabri. Medicare subsequently paid the claims for these drugs, which can cost as much $80,000 per patient per year. 

Read more: https://www.prnewswire.com/news-releases/pharma-giant-and-speciality-pharmacy-settle-case-alleging-false-claims-violations-301195541.html?tc=eml_cleartime

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Biogen Inc. and Advanced Care Scripts Inc. to Pay $23.4 Million in False Claims Settlement

One of the world’s largest pharmaceutical companies, Biogen, Inc., and a large specialty pharmacy, Advanced Care Scripts, Inc. (ACS), will pay a combined $23.4 million to settle allegations under the Federal False Claims Act that kickbacks were used to induce the sale of drugs used to treat multiple sclerosis. Biogen will pay $22 million and ACS will pay $1.4 million.

The settlement was reached in United States of America ex rel. Paul Nee v. Biogen, Inc., et. al., 17-CV-10192-MLW, pending in the United States District Court for the District of Massachusetts. The complaint – filed by a whistleblower under the False Claims Act – alleged that Defendants profited from “engaging in a kickback scheme that uses it free drug program and so called financial assistance to charities as conduits to induce and steer” patients to the drugs Avonex and Tysabri, which are drugs reimbursed under the federal Medicare program….

Read the full press release here:

https://www.prnewswire.com/news-releases/pharma-giant-and-speciality-pharmacy-settle-case-alleging-false-claims-violations-301195541.html?tc=eml_cleartime

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Home Healthcare Agency Settles Whistleblower Suit for $5.8m

Doctor’s Choice Home Care, Inc. and former executives have agreed to pay $5.8 million to settle allegations that the home health agency engaged in a variety of conduct in violation of the False Claims Act, including providing illegal remunerations or bonuses for referring physicians. Doctor’s Choice, which provides medical services to Medicare patients in their homes, was also accused of pressuring clinicians to increase the number of visits to Medicare patients to avoid triggering protocols that reduce Medicare payments for low-visit patients. This settlement specifically contends that Doctor’s Choice acted in violation of both the Stark Law and the Anti-kickback Statute of the False Claims Act.

The suit was brought by four whistleblowers, all former employees of Doctor’s Choice.

Read the full press release here: https://www.justice.gov/opa/pr/home-health-agency-and-former-owner-pay-58-million-settle-false-claims-act-allegations

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Kaiser Foundation Health Plan to Settle False Claims Act Allegations

Oakland, CA based Kaiser Foundation Health Plan has agreed to pay $6.3 million to settle allegations that it submitted false Medicare Advantage patient diagnoses in order to receive inflated payments from Medicare.

Under the Medicare Advantage program, Medicare pays private insurers based on the cost of providing care for all recipients enrolled in their plans. Generally, patients with worse or more numerous diagnoses result in larger payments while healthier patients result in smaller payments.

The suit was brought by a former employee of Kaiser Health foundation. She will receive $1.5 million for her role in the settlement.

Read the full press release here: https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-63-million-settle-false-claims-act-allegations

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