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In anticipation of the upcoming U.S. presidential election, the news cycle is heating up with discussions about federal and state budget deficits and funding for Medicare/Medicaid programs. Both the Republican and Democratic Parties are lining up and getting ready to pitch their proposals to the public, complete with confusing and contradictory statistics. The parties will be taking sides on issues relating to costs, necessity, and waste within government sponsored "entitlement programs." These are the topics that will play out in the presidential and other political races, and opinions will be disseminated across the news, Twitter and other social media.
Almost under the radar and with virtually no fanfare, however, state and federal government programs continue diligent efforts to recover money that had been improperly paid to medical providers. The untold story in the current debate is that of the qui tam plaintiffs, their private counsel, and the public sector attorneys who work to root out and correct fraud within the current system. By intervening in qui tam actions and by filing their own False Claims Act suits, a number of state attorney generals and federal prosecutors are aggressively pursuing claims against medical providers who have engaged in fraudulent billing practices and other fraudulent activity.
In early July, the largest health care fraud settlement in U.S. history took place as pharmaceutical giant GlaxoSmithKline reached a $3 Billion settlement in a Massachusetts federal consolidated action. United States, ex rel. Greg Thorpe, et al. v. GlaxoSmithKline (U.S. D.C. Mass. 11-10398-RWZ; 11-10741-NG; 03-10641-NG; 11-10931-NG). The suit, which was covered by the LexisNexis Jury Verdict and Settlements Team at 2012 Jury Verdicts LEXIS 8028, had been brought to redress alleged unlawful promotion of drugs, failure to report safety data and false price reporting practices. The government claimed, inter alia, that GlaxoSmithKline had violated 31 U.S.C.S. § 3729(a) of the False Claims Act by making false and fraudulent statements regarding the safety, efficacy, superiority and medical necessity and appropriateness of its drugs to the public, to patients, to physicians and to Medicaid and other federal health care programs.
But that suit was only one of several other notable medical provider fraud suits that have been settled in the past several months. In May, Abbott Laboratories reached its own $1.5 billion settlement in an action that included federal and state claims for False Claims Act violations involving off-label promotion of medication, 2012 Jury Verdicts LEXIS 5186. In early August, the State of California and the U.S. Government entered into a $322 million settlement with long term care provider SCAN Health Plan in an action arising from questionable Medi-Cal billings. 2012 Jury Verdicts LEXIS 11807. In late July, drug wholesaler Express Scripts, Inc. agreed to pay $151 million in a New Jersey federal court action brought by 29 States and the District of Columbia. 2012 Jury Verdicts LEXIS 9675. In June, dialysis company DaVita, Inc. agreed to repay $55 million in a Texas federal suit relating to claims it had overfilled and over-administered the drug Epogen without regarding to medical necessity or patient need. 2012 Jury Verdicts LEXIS 8694. Medical provider NextCare agreed to repay $10 million in a North Carolina federal action relating to claims it had billed for medically unnecessary tests. 2012 Jury Verdicts LEXIS 8890.
In 2012 alone, the LexisNexis Jury Verdicts and Settlements Team members have authored nearly 40 summaries of Medicaid/Medicare fraud cases, with nearly each one involving recoveries in the millions of dollars. Clearly, in all the political bluster about the costs of the government medical programs, there has to be room for discussion about the hard facts and concrete numbers relating to these fraud recovery efforts. As that 90's television show, "The X-Files," used to tell us . . . The truth is out there.
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