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Did You Know? An Overview of the False Claims Act (FCA) & “Qui Tam” lawsuits
One of the government’s most potent weapons in the fight against fraud is the False Claims Act (FCA), also called the “Lincoln Law”.
According to the Department of Justice website: Any person who knowingly submits false claims to the government is liable for double the government’s damages plus a penalty of $2,000 for each false claim—the most recent version of the FCA now charges violators for treble damages plus an inflationary penalty.
In addition to government actions, those private citizens who file successful “qui tam” suits on behalf of the government against FCA violators may receive a percentage of the government’s recovery.
And those who have brought successful “qui tam” suits have certainly cashed in on settlements and judgments along with the federal government.
Some of the largest healthcare False Claims Act recoveries have come from the pharmaceutical industry—fraud in the marketing of prescription medications has become a special focus of government enforcement authorities.
Some common types of pharmaceutical company false claims include:
- Average sales price fraud
- Clinical trial fraud
- Good manufacturing practices (GMP) fraud
- Kickbacks, including for illegitimate drug studies, grants, investigator and advisory board meetings, preceptorships, and speaking engagements
- Pricing fraud
The Department of Justice obtained more than $5.6 billion in settlements and judgments from fraud and false claims cases in the fiscal year 2021—over $5 billion of that amount involving the healthcare industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.
Typically receiving between 15% and 30% of the recovery, whistleblowers filed 598 qui tam suits in the fiscal year 2021 and reported settlements and judgments exceeding $1.6 billion.
To consult with us about a potential case of pharmaceutical fraud perpetrated by CVS' SilverScripts® Part D subsidiary, its Caremark® pharmacy benefit manager (PBM), or a retail pharmacy, click the button below to find out more.
Patients Who Were Forced to Miss, Skip, or Split Medication May be Due Compensation
A recent Pennsylvania lawsuit accuses SilverScript®, CVS® Caremark, and CVS® retail stores of scheming together to prevent coverage of cheaper, multi-source generics for at least 15 critical needs medications—including drugs used to treat multiple sclerosis, dementia, and even opioid addiction.
Victims who suffered a wide variety of dangerous and deadly effects as a result of the alleged collusion—from withdrawal symptoms that required medical care to suicidal ideation and even death—are bringing claims against the pharmaceutical giant.
This isn’t the first set of claims for damage brought against CVS® Caremark—in fact, CVS® has taken heat for its discount programs for years.
Six insurers—Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield of Minnesota, Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield of North Dakota, and Blue Cross and Blue Shield of Kansas City—sued CVS Health® in 2020 with allegations that the healthcare pharmacy chain overcharged them for generic drugs while hiding the true cash prices for those medications.
In 2015, a class-action lawsuit was filed against the company's health savings plan (HSP), which led to the program’s termination in 2016.
In the program, members could pay a monthly fee to obtain discounts on hundreds of generics.
CVS® can allegedly overcharge unknowing customers by collecting co-pays that exceed the pharmacists' price and then giving the excess payment back to the PBMs in what's known as “clawback” payments.
At least 16 other lawsuits have been filed against various drugstore chains accused of engaging in clawback practices.
We specialize in whistleblower and qui tam representation in healthcare fraud cases nationwide—click the button below to schedule a free, private case evaluation.
Patients Denied Critical Meds After the CVS®-Drugmaker Profiteering Collusion Can Submit a Case for Injuries
CVS® is alleged to have broken the barrier between its SilverScript® prescription drug plan, CVS® Caremark—its pharmacy middleman—and its vast chain of retail stores in a scheme intended to block seniors’ access to cheaper generic drugs in exchange for big rebates from the manufacturers of covered brand names.
For example, the fraudulent scheme is believed to disproportionately affected elderly patients with end-stage renal failure, while forcing many beneficiaries of the SilverScript® Part D program to go without critical treatment because they were unable to access generic versions of necessary drugs at affordable costs. But privately insured patients were also allegedly impacted by the CVS-Drugmaker pricing scheme.
Some prescription medicines involved in the fraudulent pricing scheme include:
- Advair Diskus—Asthma and chronic obstructive pulmonary disease
- Asacol HD—Inflammatory bowel disease, including ulcerative colitis and Crohn's disease
- Canasa Rectal Suppository—Active ulcerative proctitis (ulcerative rectal colitis)
- Copaxone—Multiple sclerosis
- Epclusa—Treatment of hepatitis C
- Exelon—Alzheimer’s Disease
- Harvoni—Treatment of hepatitis C
- Istalol—Ocular hypertension and glaucoma
- Renvela Packets—Chronic kidney disease on dialysis
- Renvela Tablets—Chronic kidney disease on dialysis
- Ventolin HFA—Bronchospasm
- Voltaren Gel—Arthritis Pain
- Xopenex HFA—Asthma and chronic obstructive pulmonary disease
Consumers who became victims of the alleged scheme—those forced to split doses, skip doses, or stop taking vital medications altogether—are encouraged to submit a case evaluation form for injuries, some of which may include:
- Withdrawal symptoms that required medical care;
- New illness or injury caused by under-treatment of primary disease;
- Loss or reduction of mobility;
- Worsening or prolonging the medical condition for which the drug was prescribed;
- Suicide or inpatient treatment for suicidal ideation; and,
We provide experienced, trusted representation starting with a free, private case evaluation—to discuss a potential case of pharmaceutical fraud with an experienced attorney, click the button below to find out how.
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