Insitu Inc. to Settle False Claims Allegations for $25 million

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Washington State company Insitu Inc., an unmanned aerial vehicle contractor, has agreed to pay $25 million to settle allegations that it submitted false cost and pricing data for determination of contract value with the U.S. Special Operations Command and Navy. The lawsuit was built upon evidence that between 2009 and 2017 Insitu entered into multiple federal contracts that were based on pricing data for new parts and materials while the company fully intended to, and in fact did, purchase and use less expensive recycled or refurbished parts. The settlement was the result of a whistleblower complaint filed by a whistleblower and former executive of Insitu. The whistleblower will receive over $4.6 million from the recovery.

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

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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

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

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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

Home Healthcare Agency Settles Whistleblower Suit for $5.8m

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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

Kaiser Foundation Health Plan to Settle False Claims Act Allegations

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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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