Healthy Skepticism Library item: 18843

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Silverman E
Healthcare Fraud, Whistleblowers & US Treasury
Pharmalot 2010 Oct 25
http://www.pharmalot.com/2010/10/healthcare-fraud-whistleblowers-the-us-treasury/

Full text:

There have been numerous headlines lately about healthcare fraud and whistleblowers whose lawsuits eventually prompted huge settlements with the federal government. The latest tally, however, shows that the US Department of Justice recovered over $3.1 billion in fraudulent claims in the 2010 fiscal year that can be traced to lawsuits filed under the federal False Claims Act.
Specifically, there were 145 FCA cases settled in the 2010 fiscal year and the 10 largest settlements involved health care fraud, with eight involving drugmakers, according to Taxpayers Against Fraud, a non-profit that supports whistleblower lawsuits. The 10 largest cases accounted for $2.7 billion recovered. Although fiscal year 2009 actually recovered a larger pot of money – $5.6 billion. It also worth that health care does not have a monopoly – fraud also occurred among defense, education, transportation, and oil and gas companies.
Of course, the scrutiny has been eating away at pharma’s reputation and gradually forcing changes in business practices. But attorneys say many more lawsuits are in the pipeline and the willingness of the federal government to pursue them – selectively – remains unabated. That’s hardly surprising if the non-profit’s calculation is correct: the FCA settlements have returned more than $15 for for every dollar invested in health care investigations and prosecutions. And given that some recovered dollars are returned to states where Medicaid fraud occurred, 28 states have passed their own versions of the federal False Claims Act to increase recoveries.
So which were the big cases?
Allergan settled for $600 million over off-label marketing charges for Botox (back story); AstraZeneca paid $520 million for illlegally marketing its Seroquel anti-psychotic (background); Novartis paid $422.5 milllion to resolve civil allegations and a criminal fine for unapproved promotion of Trileptal (read this); Forest Laboratories settled for $313 million to resolve civil claims and a criminal penalty for unapproved marketing of several drugs (see here).
Elan paid $203.5 million for improperly marketing Zonegran; Teva Pharmaceuticals settled charges of reporting inflated prices to Medicaid by paying $169 million; WellCare Health paid $137.5 million for defrauding Medicare and Medicaid programs in several states; Mylan, AstraZeneca, and Ortho-McNeil
setteld for $124 million after charges of improperly classifying some drugs to avoid rebates; Omnicare and Ivax Pharmaceuticals paid $112 million over charges of kickbacks (see here); and the Health Alliance of Greater Cincinnati and Christ Hospital paid $108 million to settle charges of paying kickbacks to doctors.