Articles Tagged with False Claims Act attorney

andres-de-armas-103880-copy-300x200The Department of Justice (DOJ) for the Eastern District of California announced on July 7 that Wal-Mart Stores, Inc. (Walmart) paid $1.65 million to resolve accusations related to unlawful medical claims. This is an important suit as it demonstrates that the federal and state governments will go after large retailers for false claims. Pursuing whistleblower suits and securing government funds that were unlawfully obtained remains a top property for the DOJ.

Walmart’s False Claims

Through a qui tam suit brought by a former Walmart pharmacist in the Sacramento area, the California government learned that Walmart was allegedly submitting false claims to the state’s Medi-Cal program in order to increase reimbursements. Supposedly, Walmart would knowingly submit claims that were not supported by a proper and relevant diagnosis or documentation. More specifically, Walmart would submit reimbursement claims for Code 1 drugs that were not based on proper and pre-approved diagnoses. Medi-Cal only reimburses for Code 1 drugs if they were prescribed for approved diagnoses. If a Walmart pharmacy wanted reimbursement for a Code 1 drug for something else, it would need to submit a specific request with the reasoning for a non-approved use. Walmart pharmacists intentionally submitted claims without confirming the approved diagnosis and obtaining the necessary documentation or for non-approved uses.

daan-stevens-282446-copy-300x191The U.S. Department of Justice announced on June 28 that PAMC Ltd. and Pacific Alliance Medical Center Inc. have agreed to pay $42 million to settle allegations that they violated provisions of the False Claims Act. The two companies, which operate together as Pacific Alliance Medical Center in Los Angeles, allegedly had unlawful financial relationships with doctors.

Qui Tam Suit Against Pacific Alliance Medical Center

The qui tam lawsuit against the defendants was filed by Paul Chan, who was a manager with one of the defendant businesses. A qui tam suit is a civil lawsuit brought by a private citizen on behalf of the government. The private citizen, known as the relator during the suit, provides information regarding the claims that is not available to the public. If the government receives a settlement or jury award in relation to the relator’s allegations, then he receives part of the monetary recovery. In this case, Chan is set to receive more than $9.2 million.

Few dpharmacyecisions are as important as those regarding our health and the health of our loved ones.  Decisions about medications, like many other health-related issues, involves a weighing of risks and benefits.  With increased direct-to-consumer advertising and pressure on doctors from corporations, this calculus can be extremely hard.  Americans must be able to trust that information released by pharmaceutical companies is accurate.  In some cases, pharmaceutical company fraud can amount to a violation of the False Claims Act which means ordinary Americans have the power to fight back with the help of our health care fraud law firm.

Settlement in Suit Alleging Pharmaceutical Companies Misled Doctors and Others About Cancer Drug

On June 6, the Department of Justice (“DOJ”) announced that Genentech Inc. and OSI Pharmaceuticals LLC will collectively pay $67 million to settle allegations the companies made misleading statements about the drug Tarceva.  A lawsuit filed under the False Claims Act alleged that, from 2006 through 2011, the companies made misleading representations to medical care providers about Tarceva’s ability to treat certain non-small cell lung cancers.  In actuality, according to the DOJ, there was little evidence that Tarceva could treat these cancers unless a patient had never smoked or had a particular mutation in their epidermal growth factor receptor.

We talk a lot courthouseabout the False Claims Act (“FCA” or “the Act”)) on this blog.  We do that because it is a powerful tool that allows ordinary Americans to take a stand and fight fraud.  The frauds it fights are frauds perpetrated against the government and government programs, frauds that are ultimately crimes against the American people.  Our posts often look at specific cases involving alleged violations of the FCA, but from time to time our whistleblowers’ law firm likes to take a step back and look at the FCA more generally to help our readers understand exactly what kind of wrongs the FCA tackles.

“A False or Fraudulent Claim”

The FCA is actually several sections of the United States Code, with 31 U.S.C. §3729 containing the basic description of what actions violate the Act.  Although it is only one of a number of subsections that describe these actions, §3729(1)(a) explains the basic wrong the Act tackles “a false or fraudulent claim for payment or approval.”  Essentially, this means that a person or entity is liable under the Act if they ask the government to pay an obligation that is not actually due or ask for more money than they are actually due.

Recently, our firm reported on the problem of institutions of higher learning abusing the public’s trust and breaking the law in connection with federal student loans and federal laws on student recruitment.  Sadly, those are not the ways colleges and universities abuse and misuse federal taxpayer funds.  Our education fraud attorney is closely monitoring developments involving federal education grant fraud.  These frauds are a form of theft from the American taxpayers and they also divert money from important education and research programs.

School Agrees to Pay $4 Million to Settle Education Grant Fraud Claims

In March, a federal court sitting in Sacramento announced that Bard College agreed to pay $4 million to resolve claims initially raised by two former students who attended a Master of Arts program at Paramount Bard Academy in California via the False Claims Act’s (“FCA”) qui tam provisions.  The government later intervened in the case.  classroomThe lawsuit alleged that Bard, a nonprofit school based in New York state, received funds from the Department of Education’s Teacher Quality Partnership Grant Program but failed to comply with the grant’s conditions.  Additionally, the suit claimed that Bard abused Title IV student loan money by applying funds to campuses that had not yet received necessary accreditation.  Although Bard agreed to pay to settle the case, it is important to note the school did not admit to the allegations in the complaint.