Archive for 2019

Endo Pharma Faces Suit for Opioid False Claims

TN Attorney General sues opioid maker Endo Pharmaceuticals (photo courtesy Times News)

Endo Pharmaceuticals, the same company which was at the center of a $193 million settlement with one of James Hoyer’s whistleblower clients, is now facing another major legal battle. The Tennessee Attorney General is suing Endo for making unlawful and false claims about the safety and benefits of its opioid products.

The AG’s office says Endo violated the Tennessee Consumer Protection Act and contributed to a devastating health crisis in Tennessee. Here are details from the news release by Attorney General Herbert Slatery’s office:

Attorney General Herbert H. Slatery III today sued Endo Pharmaceuticals and Endo Health Solutions Inc. (Endo) for making unlawful and false claims about the safety and benefits of its opioid products.

The State’s lawsuit, filed in Knoxville, alleges Endo violated the Tennessee Consumer Protection Act and contributed to a devastating public health crisis in Tennessee.

“Our Office has conducted an extensive investigation into Endo’s unlawful marketing practices which included targeting vulnerable populations like the elderly,” said Tennessee Attorney General Herbert H. Slatery III. “Endo has repeatedly refused to take responsibility for its unconscionable conduct, which is why we are taking this action.”

The allegations in the State’s 180-page complaint detail how Endo deceptively marketed its opioid products as being less addictive and more effective than others on the market. It did this despite evidence to the contrary, including the FDA’s explicit rejection of Endo’s claim that Opana ER was resistant to abuse as well as overwhelming evidence that Opana ER was being abused throughout Tennessee.

The Complaint alleges that Endo also knew the dangers of its opioid products, including increased risks of respiratory depression and death in elderly patients, and failed to clearly disclose those risks while it specifically targeted patients in that age group.

The State also has reason to believe Endo used the recommendations and educational materials of third-party groups like the American Pain Foundation without disclosing that Endo was by far the biggest donor to the Foundation and provided more than half of its total funding. Endo provided significant funding to other third-party groups and subsequently relied on material generated by those groups without disclosing the financial relationship.

The Attorney General requested the complaint be filed under a temporary seal because Endo claims the information produced during the State’s investigation is confidential. The order sealed by the judge allows the seal to expire in 10 days unless Endo acts to extend it.

The Attorney General believes the complaint should be made available to the public in its entirety and efforts to keep it confidential will only prolong and diminish Endo’s accountability for its conduct.

 

Generic Drug Price Fixing


Connecticut Attorney General William Tong interviewed on 60 Minutes

If you ever wondered why the price of generic drugs is getting so expensive, 60 Minutes gave us an inside look at the problem on its Sunday broadcast. The CBS program profiled the on-going battle of Connecticut Attorney General William Tong to hold big pharma accountable.

Connecticut and more than 40 other states filed a sweeping lawsuit accusing the biggest generic drug makers of engaging in an “industry-wide conspiracy” to fix the prices of generic drugs. They allege there is a massive, systematic scheme to bilk consumers and the government out of billions of dollars.

Based on evidence like text messages, emails, phone records, and documents, the prosecutors say sudden, dramatic, price spikes can be tied to drug makers colluding to profiteer, not a shortage of drugs. In a word “greed.”

The price hikes have affected 100’s of different, everyday prescriptions, driving up the costs for health insurance, Medicare and Medicaid. With 90-percent of all prescriptions filled with generic drugs, the impact on everyday American lives has been overwhelming.

Drug makers deny any wrong-doing and insist they will fight the lawsuits vigorously. Click here to watch the 60 Minutes report.

 

California legislators looking to expand False Claims Act to tax fraud

California Assembly Bill 1270 was introduced on February 21, 2019. If it becomes law, it would amend the state’s False Claims Act to remove the bar against tax-related false claims.

Read More…
 

Former CEO of Hospital Chain to Pay $3.46 Million to Resolve False Billing and Kickback Allegations

Gary D. Newsome, former CEO of Health Management Associates LLC (HMA),  a hospital chain that was headquartered in Naples, Florida, has agreed to pay the United States $3.46 million to settle allegations that he caused HMA to knowingly submit false claims to government health care programs by admitting patients who could have been treated on a less costly, outpatient basis, the Department of Justice announced. The settlement also resolves allegations that Newsome caused HMA to pay remuneration to Emergency Department (ED) physicians in return for referrals.  

“Those who bill federal health care programs for unnecessary hospital stays will be held accountable for wasting federal dollars,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Patients deserve the unfettered, independent judgment of their health care professionals. We will pursue those who cause hospitals to offer financial incentives to physicians in return for improper patient referrals that undermine the integrity of our health care system.”

“A physician’s health care decisions should be driven by what is in the patient’s best interest, not by what helps line a provider’s pockets,” said Barbara Bowens, the Acting U.S. Attorney for South Carolina for purposes of this case. “The U.S. Attorney’s Office will not tolerate false claims based on unnecessary hospital admissions, which drive up health care costs and can harm patients.”

“Providers are expected to closely follow rules and bill properly. Further, in this case, the government contended that Newsome directed illegal payments for referrals,” said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services. “Taxpayer money wasted is money stolen from vital government health programs.”

Read the entire press release from the Department of Justice by clicking here.

 

Pharmaceutical Company To Pay $17.5M To Resolve Allegations Of Kickbacks

US WorldMeds LLC founder and CEO Breckenridge Jones
US WORLDMEDS LLC

The Justice Department announced today that US WorldMeds LLC (USWM) has agreed to pay $17.5 million to resolve allegations that it violated the False Claims Act, 31 U.S.C. §§ 3729 et seq., by paying kickbacks to patients and physicians to improperly induce prescriptions of its drugs, Apokyn® and Myobloc®. USWM is a pharmaceutical manufacturer headquartered in Louisville, Kentucky. 

“The Department of Justice is committed to ensuring that physicians’ and patients’ selection of medications is not influenced by improper financial considerations,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “The nation’s health care programs and taxpayers deserve health care companies that play by the rules, including the Anti-Kickback Statute.”

When a Medicare beneficiary obtains a prescription drug covered by Medicare Part D, the beneficiary may be required to make a partial payment, which may take the form of a copayment, coinsurance, or a deductible (collectively “copays”). Congress included copay requirements in the Medicare program, in part, to encourage market forces to serve as a check on health care costs, including the prices that pharmaceutical manufacturers can demand for their drugs. Under the Anti-Kickback Statute, a pharmaceutical company is prohibited from offering, directly or indirectly, any remuneration — which includes paying patients’ copay obligations — to induce Medicare patients to purchase the company’s drugs. 

Read the entire press release from the Department of Justice by clicking here.

 

Supreme Court Deals Worker Rights Another Blow

The fight for worker rights took another blow today.  The Supreme Court ruled employees at a California company could not band together in an effort to get compensation from their employer for a breach of their data.  The 5-4 decision put yet another limitation on the ability to use class arbitration and class actions against bigger, more powerful opponents.

Attorney Dave Scher, head of the James Hoyer Employment Law Division, says the decision is disappointing but “really not surprising, given the conservative shift on the Court.”  Recent rulings have chipped away at employee rights and, unfortunately, this will make it even more difficult for employees to tackle joint grievances in the workplace.

“It impacts any issue where employees band together to fight unfair circumstances in their workplace—not paying overtime, underpaying tips, break times, not getting benefits they’re entitled to—things like that,” Scher explained.

Forcing Individual Arbitration

The ruling helps allow companies to ban class action lawsuits and class arbitration proceedings to address disputes; instead, forcing employees to bring their cases on an individual basis.  It essentially creates a divide and conquer scenario for companies to take away the “strength in numbers” individuals can get by working together.

Attorney Dave Scher

“It allows corporations to take advantage of low-income employees and prevents them from being held accountable for improper practices,” Scher said.  “They do what they want, because they know there’s really nothing these employees can do about it.”

It’s cost prohibitive in most cases for employees to bring individual cases for claims that don’t amount to large sums, even if the collective damage to all employees is large.  Class actions and class arbitrations are supposed to help even the playing field for employees and consumers by spreading out the costs, but that gets harder now with this ruling.

“Companies can afford to fight, but an individual with a $1,000 or $5,000 claim can’t afford it.  They can’t pay a lawyer to help them, and the way it’s now structured, many lawyers can’t afford to bring the case, because they won’t recoup their costs.”

According to the Economic Policy Institute, nearly 54-percent of non-union, private sector employers require mandatory arbitration clauses and 65-percent of large companies with more than 1,000 employees have them.  These arbitration agreements require workers to give up their rights to have disputes settled in a court of law. They are often a take-it-or-leave-it deal, where if you don’t sign, you don’t get the job. Unfortunately, many don’t even realize the rights they are giving up and that it puts them at a significant disadvantage should a dispute arise.

What can you do about it?

Some employment attorneys are developing a head-on approach to tackle “class” bans by filing large numbers of arbitration cases, one by one.

“Creative employment lawyers are saying—‘Fine, instead of having a class, I’ll find a thousand workers who fit into this category, and I’ll represent each of them. And I’ll bring a separate arbitration claim for each of them, and you’re going to have to pay for the cost of each of those arbitrations.’ And that is having some degree of effect,” Scher explained.

In other words, in the world of unintended consequences, class bans could end up backfiring on some employers.

“Essentially employers are coming back and saying, ‘Well, wait a minute, that’s completely inefficient. It’s all the same issue’—which is the whole point of having a class action,” Scher explained. “So ultimately, we can put them all together in a class or you can oppose class actions. Which do you want? You’re making me do this.”

If you find yourself facing an unfair workplace issue, click here to contact attorney Dave Scher for an evaluation.

 

Attorney Jesse Hoyer Fights Fraud, carrying on firm legacy

James Hoyer law firm Shareholder & Partner Jesse Hoyer

Attorney Jesse Hoyer is a partner and shareholder of the James Hoyer law firm. She carries on the legacy of her parents, former prosecutors who founded the firm. Watch the video below to learn more about her.

Attorney Jesse Hoyer explains how she helps clients.

Jesse’s main area of practice is False Claims Act – Whistleblower litigation, which is essentially fighting fraud against the government. Her area of specialty is education fraud, specifically cases involving for-profit colleges that abuse government financial aid funding. She also handles cases involving healthcare, big pharma, and defense contractor fraud, among others.

If you are a potential whistleblower with information that your company is improperly billing the U.S. government, you can request a confidential evaluation here: http://www.jameshoyer.com/contact-us/

**Be sure to let us know that you learned more about Jesse and the firm by watching this video.

 

Rare Case of Patient Whistleblower leads to Successful Settlement

AgeVital agrees to pay $775,000 to settle kickback claims

[*See video below on coverage of the settlement on WFLA channel 8 in Tampa. James Hoyer Attorney Jesse Hoyer is interviewed*]

SARASOTA, FL – The action of one patient who recognized possible fraud against Medicare led to this settlement which returns nearly one million dollars to taxpayers.  Vital Life Institute LLC, known as AgeVital Pharmacy LLC, along with owners Jenny and William Wilkins, have agreed to pay at least $775,000 to resolve claims that they violated the False Claims Act by engaging in an illegal kickback scheme.

“The importance of this settlement goes far beyond the amount recovered. It demonstrates the value and impact of everyday citizens who come forward to expose fraud,” said attorney Jesse Hoyer, local counsel for the whistleblower case. “Medicare, Medicaid and Tricare beneficiaries who carefully review their Explanation of Benefits statements can make a difference.”

The settlement resolves allegations that Sarasota-based AgeVital paid kickbacks to a third-party marketing company to solicit patients for compounded drug prescriptions, regardless of patient need. The marketing company allegedly arranged for prescribers to sign those prescriptions, which were then referred to AgeVital to be filled in exchange for a substantial share of Tricare and Medicare reimbursements.

Details of case

The case was filed in federal court in Tampa in 2015, after Manfred Knopf, a patient in New Jersey who received prescriptions he did not need or want, recognized that Medicare was billed for the products. AgeVital solicited Mr. Knopf to purchase the expensive compounded pharmaceuticals after he suffered a slip and fall accident that required treatment for his injuries.

Despite never agreeing to receive these medications, AgeVital began sending containers of expensive compounding creams to his doorstep. The healthcare prescriber listed on the packages delivered was Dr. Jean Wilson, a provider Knopf had never heard of or been treated by. Medicare paid approximately $37,377 for these medically unnecessary compounded pharmaceuticals sent to Knopf. After recognizing what he believed was fraud, Knopf decided to report his concerns to the government.

With the assistance of attorney David Williams of Kline & Specter, P.C. (along with Jesse Hoyer and Elaine Stromgren of James Hoyer, P.A.), the lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act. The Act allows private citizens who suspect

fraud against the government to bring a lawsuit on behalf of the United States for false claims and to share in any recovery. 

“The False Claims Act gives us a powerful tool with which to expose fraud and recover money on behalf of taxpayers. We thank Mr. Knopf for recognizing the fraud and having the courage to bring it to the Government’s attention,” said attorney Hoyer.

Anti-Kickback Statute

The Anti-Kickback Statute prohibits the knowing and willful payment of compensation to induce the referral of services or items that are paid for by a federal health care program. Individuals and entities can be subject to liability under the False Claims Act for submitting claims to federal health care programs in violation of the Anti-Kickback Statute.

“Kickback schemes undermine public trust in our health care system and lead to unnecessary health care costs at taxpayers’ expense,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division.

“We will not tolerate those who profit at the expense of taxpayers by entering into illegal kickback arrangements,” says U.S. Attorney for the Middle District of Florida Maria Chapa Lopez. “Our office is committed to holding individuals accountable for corporate malfeasance.”

Mr. Williams, Ms. Hoyer and Ms. Stromgren sincerely appreciate the efforts of the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Middle District of Florida, the FBI, the Defense Criminal Investigative Service and the U.S. Department of Health and Human Services Office of Inspector General that contributed to the resolution of this case.

Kline & Specter P.C. is a nationwide personal injury and medical malpractice law firm with offices in Pennsylvania, New Jersey, Delaware, and New York.

James Hoyer, P.A. is a nationwide whistleblower and employment law firm with offices in Florida, Washington D.C., and Michigan.

 

What to do when work related issues threaten your job

When you’re facing issues at work, it can be scary and confusing. Wrongful termination. Discrimination. Retaliation. Witnessing fraud. James Hoyer Employment Lawyer Dave Scher explains what to do and how to get help.

Dave Scher leads the James Hoyer Employment law division. Click here to learn more about Dave and to contact him directly for a consultation.

 

Employment Lawyer Dave Scher explains how he helps clients

Attorney Dave Scher leads the James Hoyer Employment Law division. His philosophy stems from the simple belief that it’s a privilege to help people. Watch the video below to hear from Dave personally on why he practices employment law and how he helps his clients.

Click here to learn more about Dave and to contact him directly for a consultation.