Narcotic medications can be a critical part of a pain-management regime. While these drugs can be miraculous for those in medical need, misuse has reached epidemic levels. Sadly, sometimes this abuse is fueled by the very medical practitioners who should be on the front lines of prevention. These wayward practitioners are often motivated by financial gain, with some taking part in pharmaceutical fraud schemes that endanger public health twice — First by improperly distributing powerful drugs and Second by defrauding the health care system generally and diverting money from legitimate health needs. Our Oakland health care fraud lawyer is committed to fighting these schemes with the help of the brave whistleblowers who call our office. Ending these fraudulent prescription schemes returns money to already-strapped government programs, provides an award to the whistleblowers for reporting and prosecuting the scheme, and helps restore public faith in our medical system by bringing the errant practitioners to justice.
“And a Side Order of Percocet…”
Last week, according to the Contra Costa Times, a federal grand jury returned an indictment, formally charging an East Bay doctor with health care fraud and counts related to improper distribution of controlled substances. On Thursday, officers arrested 62 year-old Dr. Toni Daniels of Berkeley who appeared in court the following morning. In the indictment, prosecutors (including U.S. Attorney Melinda Haag) allege that from October 2010 through April 2011, Daniels met clients at an odd assortment of Oakland-area locations including Burger King, Starbucks, and Dick’s Donuts. At these meetings, she allegedly sold prescriptions for controlled substances, providing strong medications such as oxycodone and hydrocodone in return for cash. Allegedly Daniels also knew that many of these customers relied on Medicare, Medi-Cal, or private insurance to cover the cost of the prescribed substances.
As a result of this scheme, Medicare and Medi-Cal paid more than $64,000 in fraudulent, false claims for medicines that Daniels prescribed between October 2010 and April 2011. Daniels reportedly earned about $144,000 in 2010, although the indictment states that she failed to file an income tax return that year. She is slated to appear in court again this week and could face up to 20 years in prison plus a $1 million fine on the controlled substances claims alone.
Types & Extent of Pharmaceutical Fraud
In 2013, per a press release, the Justice Department secured a total of $3.8 billion in False Claims Act settlements and verdicts. This included $2.6 billion in recoveries tied to federal health care fraud, which in turn included $1.8 billion related to alleged false claims for medications and medical devices pursuant to federally insured health programs (ex. Medicare, Medicaid, TRICARE). An added $443 million was recovered for state Medicaid programs. There were several types of pharmaceutical fraud cases including claims for off-label marketing (when manufacturers improperly promote drugs for uses that have not been approved by the FDA) and the manufacture/distribution of adulterated drugs. While it may account for a smaller portion of total recoveries, physicians improperly prescribing medicines is still an important pharmaceutical fraud issue and also a major public health concern.
The Critical Role of Whistleblowers & Qui Tam Actions
As with all forms of health care fraud and, in fact, all forms of False Claims Acts prosecutions, whistleblowers are essential to the recognition and prosecution of pharmaceutical fraud matters. Qui tam cases, the legal term for cases brought by private parties on behalf of the government, accounted for $2.9 billion of the $3.8 billion in False Claims Act recoveries for 2013. The individuals who bring these claims are entitled to a substantial financial award for their time, effort, and (even in light of whistleblower protections) bravery.
If you have observed health care fraud in California, including physicians selling prescriptions, we can help you pursue a qui tam action. Call to arrange a free meeting with our Oakland prescription fraud attorney to learn more.
(Photo by Kathea Pinto)