Two whistleblower cases unsealed this week reveal how aggressive pharmaceutical marketing programs can cross the line into Medicare fraud and kickbacks. Trips to the Kentucky Derby for doctors and huge bonuses for sales reps can lead to bribes, conflicts of interest and poor-quality care.

Illustration: Tinker ReadyIn one case, a drug maker was competing with a far less expensive, easier-to-administer alternative. Sales reps reportedly told doctors they could shorten a two-to-three week treatment with the Questcor’s expensive anti-seizure drug to one week. However, the Food and Drug Administration had not vetterd the efficacy of the one-week course, according to the case.

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In the settlement case, the company is charged with secretly covering co-pays for all Medicare patients –not just those in need — thus insulating them from a steep price hike. Good for the patients, whose co-pays could have reached $5,000, DOJ noted; bad for the rest of us, who have to pay the balance. That’s why the approach is considered a kickback.


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medical-stethoscope-blue-pen-paper-medicare-fraudIn a recent interview with the AARP, Attorney General Sessions took a strong stance against Medicare fraud and empowering Medicare whistleblowers. Sessions stated that it’s time to consider taking Medicare fraud as seriously as the war on drugs (certainly an issue Attorney General Sessions believes to be of paramount importance).

Medicare fraud is a serious issue. It is estimated that 10% of Medicare funds are lost to fraud and waste, totaling approximately $16.2 billion. This suggests that billions of dollars, which should be directed to funding health care for our seniors, are instead going to fraudsters taking advantage of American taxpayers and the elderly.


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The Department of Justice recently announced the settlements, listed below, in False Claims Act cases. The False Claims Act permits private parties to sue on behalf of the government those who falsely claim federal funds or avoid paying funds owed to the government.  The United States may intervene in and take over the lawsuit.  The False Claims Act also allows the whistleblower to receive a share of any funds recovered through the lawsuit. The False Claims Act is one of the most powerful tools to combat government contract fraud. 
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The Department of Justice announced today that Medical device manufacturer ev3 Inc., formerly known as Fox Hollow Technologies Inc., has agreed to pay the United States $1.25 million to resolve allegations under the False Claims Act that Fox Hollow caused certain hospitals to submit false claims to Medicare for unnecessary inpatient admissions related to minimally-invasive atherectomy procedures. 
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Yesterday, the Justice Department announced that Community Health Systems, Inc., the nation’s largest operator of acute care hospitals, has agreed to pay $98.15 to settle multiple lawsuits against it filed under the False Claims Act. Nine whistleblowers stepped forward to report “a deliberate corporate-driven scheme” to bilk the U.S. taxpayers of millions of dollars.

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