As we discussed in yesterday’s post, fiscal year 2014 was a historic one for the Department of Justice and the False Claims Act. With an overall recovery topping $5 billion – most of which is attributed to healthcare and mortgage fraud – the top ten healthcare fraud settlements involve astronomical amounts of money.
In most of the cases discussed below, a whistleblower or group of whistleblowers exposed the fraud – and were rewarded generously. Under the False Claims Act’s qui tam provisions, a whistleblower may receive up to 30 percent of the ultimate recovery.
The following are the top five healthcare fraud False Claims Act settlements of fiscal year 2014:
#5 – $40.9 Million from Kentucky’s King’s Daughters Medical Center: In an alarming set of facts, King’s Daughters Medical Center was alleged to have ordered and performed medically unnecessary invasive heart procedures in order to boost revenue from Medicare and Medicaid reimbursements. The doctors also agreed to perform unnecessary heart catheterizations and stent implantations in exchange for lucrative kickbacks. The government’s press release did not reveal whether a whistleblower was involved or if a qui tam reward was offered.
#4 – $85 Million from Daytona, Florida’s Halifax Health: In a stunning $20.8 million payout for the whistleblower, a healthcare fraud case involving Florida’s Halifax Health resulted in an $85 million settlement of allegations of improper financial relationships between the hospital and several oncologists. Moreover, several neurosurgeons and oncologists were paid fees well above fair market value in exchange for their willingness to exclusively refer patients to the Halifax Health centers.
#3 – $124.4 Million from Ohio’s Omnicare, Inc.: In a case upon which we have worked diligently and fervently, Omnicare, Inc. agreed to pay a whopping $124.4 million to settle allegations it unlawfully participated in prohibited financial relationships with long-term nursing facilities in exchange for the facilities’ promise to exclusively purchase prescription drugs. Omnicare is also alleged to have offered varied prices depending on a patient’s enrollment status in Medicare.
#2 – $150 Million from Baton Rouge-based Amedisys: In an area of growing fraud concern, home healthcare provider Amedisys settled allegations it unlawfully billed Medicare and Medicaid for medically unnecessary home healthcare – which requires certification from a doctor that the patient is homebound and unable to receive care at a facility. Likewise, Amedisys is alleged to have billed the government for palliative (end-of-life) care for patients who were not actually dying. The whistleblowers received $26 million from the settlement.
#1 – $192.7 Million from Pennsylvania-based Endo Pharmaceuticals: In the largest healthcare fraud settlement of 2014, Endo Pharmaceuticals agreed to pay $192.7 million to the federal government to settle civil and criminal allegations involving the off-label marketing tactics used to sell its Shingles drug Lipoderm, which they were caught marketing as a back pain patch. The whistleblowers were former sales representatives for the company, and their reward was not revealed.
Contact Berger Montague Today
If you are aware of costly healthcare fraud like what we described today, we encourage you to contact us right away to discuss your rights under the False Claims Act.