Practice Area: False Claims Act, Qui Tam, & Whistleblower

Case Status: Settled

Settlement Amount: $124 million

Court: United States District Court for the District of New Jersey

Berger Montague represented the whistleblower in this qui tam action resulting in a $124 million settlement. The case was litigated in the United States District Court for the District of New Jersey.

The whistleblower alleged that the Pharmacy Defendants created a kickback scheme that involved a practice known as “swapping.” Specifically, it was alleged that the Pharmacy Defendants underpriced Medicare Part A drugs to nursing homes in exchange for the opportunity to provide the same drugs, at a higher cost, to the nursing home’s Medicaid, Medicare Part D, and privately insured patients. The Pharmacy Defendants allegedly knew it was practically impossible for a nursing home to have more than one institutional pharmacy because of the complex administrative burden. From a business viewpoint, to compensate for the profit they were losing when they charged nursing homes low prices for drugs to the Medicare Part A patients, the Pharmacy Defendants relied on the higher paying business generated from Medicaid and Medicare Part D patients in order to operate at a profit.

The whistleblower alleged this kickback arrangement violated the Anti-Kickback Statute (“AKS”), and was not protected by the “discount safe harbor.” In addition to violating the AKS, the kickback arrangement allegedly violated the drug pricing rules of the California State Medicaid Program, known as Medi-Cal, by charging Medi-Cal higher prices for prescription drugs than other comparable payers.

If you are a whistleblower seeking representation concerning a potential qui tam / whistleblower / False Claims Act case, please contact Berger Montague.

About Berger Montague

Berger Montague is a national law firm focusing on complex civil litigation in federal and state courts throughout the United States. For over half a century, Berger Montague has played lead roles in consequential, precedent-setting cases and has recovered over $60 billion for its clients and the classes they have represented. Berger Montague is headquartered in Philadelphia and has offices in Chicago, Minneapolis, San Diego, San Francisco, Toronto, Wilmington, Del., and Washington, D.C.

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