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Pharmacy Discount Programs Can Lead to a Violation of the False Claims Act

Retail pharmacies that offer a discount drug pricing program to consumers must charge Medicare the same prices for drugs that they charge consumers who participate in those programs. To do otherwise violates the False Claims Act (“FCA”). The specific question is whether a pharmacy that offers a discount drug pricing […]

Common Challenges With the Qui Tam Seal Requirement: What Whistleblowers Can Expect

One of the various procedural requirements imposed on whistleblowers is that they file their cases “under seal.”  Not much is explained in the False Claims Act (“FCA”) as to what that means, other than the general understanding that no notification of the filing to the defendant takes place, what is […]

District Court Rejects the Industry-Wide Public Disclosure Bar, Part II

In Part I of this blog series, we discussed the False Claims Act (“FCA”)’s public disclosure bar and the so called industry-wide public disclosure bar. In this blog post, we will examine a 2017 qui tam case that discusses and rejects the industry-wide public disclosure bar. An industry-wide public disclosure bar […]

District Court Rejects the Industry-Wide Public Disclosure Bar, Part I

The False Claims Act (“FCA”) permits private individuals, known as relators, to sue on the Government’s behalf to recover funds that were fraudulently or falsely obtained from the Government.  If a relator successfully recovers money for the Government, the FCA provides that the relator is entitled to a substantial percentage […]

The Unwritten Nexus Requirement: Requiring a Connection Between Federal Funds and False Claims Under the False Claims Act

The federal government provides funding to an incredible number of non-government entities through direct spending and grants. The False Claims Act (“FCA”) provides that anyone who presents “false or fraudulent claims” or who commits other similar offenses is subject to substantial penalties. “Claim” is defined as including any request for […]

Fraud in Connection With Contract Preferences or Set-Asides for Small Businesses or Businesses Owned by Veterans, Service-Disabled Veterans, Women or Disadvantaged Minorities, Part II

In Part I of this blog series, we identified various government programs that are often the target of fraud. In this blog post, we will examine the types of fraud that are committed against these programs, as well as recent case examples of fraud. Types of Fraud Cases alleging violations […]

Fraud in Connection With Contract Preferences or Set-Asides for Small Businesses or Businesses Owned by Veterans, Service-Disabled Veterans, Women or Disadvantaged Minorities, Part I

For decades now, the federal government has had various programs in place to provide preferences to businesses owned by groups to which the government wants to provide special opportunities. We wrote about this in a previous post and write now to expand on and update that post. In Part I […]

Are There “Special” Frauds Involving Specialty Drugs? Part II

In Part I of this blog series, we defined the term “specialty drugs” and addressed whether fraud is common in the specialty drugs arena. In this blog post, we will examine how the federal Anti-Kickback Statute impacts specialty drug fraud, whether there are special frauds involving specialty drugs, and what […]

Are There “Special” Frauds Involving Specialty Drugs? Part I

If you work in an industry involving pharmaceuticals, whether as a drug sales rep, a PBM employee or a direct healthcare provider, you’ve probably heard a lot about specialty drugs.  But what exactly are they?  Is fraud common in this area?  How do you know if your employer is playing […]

Third Circuit Decides Important Medical Necessity False Claims Act Case Brought By Qui Tam Whistleblower

On May 1, 2017, the United States Court of Appeals for the Third Circuit decided U.S. ex rel. Petratos v. Genentech, Inc. et al., C.A. No. 15-3805 (3rd Cir. 2017), a qui tam lawsuit filed pursuant to the federal False Claims Act (“FCA”) and the False Claims Acts of the […]

Misclassification of Employees May Form the Basis of an IRS Whistleblower Complaint, Part II

In Part I of this blog series, we discussed which taxes employers must withhold from employees, as well as the Internal Revenue Code’s definition of “employee.” In this blog post, we will review the factors that determine whether an individual is an employee or independent contractor and discuss the consequences […]

Misclassification of Employees May Form the Basis of an IRS Whistleblower Complaint, Part I

Under the Internal Revenue Code, employers must withhold federal income tax as well as social security tax from the wages they pay to employees. In addition, employers must pay social security and unemployment taxes on behalf of their employees.[1] “These taxes are known collectively as ’employment taxes.'” Greco v. IRS, 380 F. […]