Texas Heart Hospital to Pay $48 million to Resolve Allegations of False Claims

The DOJ has announced that Texas Heart Hospital of the Southwest LLP and its subsidiary THHBP Management Company, LLC have agreed to pay the US $48 million to settle allegations that the hospital submitted claims to Medicare that were in violation of the Physician Self-Referral Law and the Anti-kickback Statute of the False Claims Act. The allegations of misconduct rest on the hospitals requirement that it’s owners, who are physicians, satisfy a yearly quota of 48 patient contacts in order to maintain ownership. Under the Physician Self-Referral Law, commonly known as the Stark Law, hospitals may not bill Medicare for services furnished by a doctor with which the hospital has a financial relationship, barring certain regulatory exceptions. The law is intended to ensure physicians operate in the best interest of their patients and not under the influence of improper financial inducements.

The settlement is the result of a qui tam complaint brought by two former Texas Heart Hospital physician owners. They will collectively receive almost $14 million as their share in the recovery.

Read the DOJ press release here: https://www.justice.gov/opa/pr/texas-heart-hospital-and-wholly-owned-subsidiary-thhbp-management-company-llc-pay-48-million

FIRST PERSON: Don’t Muzzle the Whistleblowers

RIPPING OFF THE U.S. government has reached epidemic proportions. The Department of Justice estimates that fraud costs the Medicare system alone between $30-$60 billion annually. But instead of fines and jail time, fraudsters are frequently rewarded with more government business. And if the U.S. Chamber of Commerce and its allies have their way, these fraudsters will gain enhanced legal protection. The U.S. Supreme Court recently heard oral arguments in a critical case testing the right of citizens to bring suit in the name of the United States in order to recover damages from corporations or individuals that have cheated the government. By taking up the case known as Schindler Elevator, the high court is looking into whether a private citizen can secure information from a Freedom of Information Act request and use that information to form the basis of a qui tam or False Claims Act whistleblower lawsuit…

Read the complete article here: https://www.law.com/corpcounsel/almID/1202489937878/

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

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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