A James Hoyer case tops the list of the 10 largest False Claims, Stark Law, and Anti-Kickback settlements of 2014, as compiled by Becker’s Hospital Review. Endo Pharmaceuticals $193-million settlement with the federal government for off-label marketing of its Lidoderm pain patch comes in at number one. James Hoyer client Peggy Ryan is the whistleblower who first exposed the massive fraud.
Coming in at number four on the list is another James Hoyer case in which we served as co-counsel, the $85 million Halifax Hospital settlement.
Becker’s reports this year is on track to be a record-breaking one for government recoveries in the healthcare industry. These two James Hoyer cases and several others settled this year have contributed substantially to the return of taxpayer dollars. The False Claims Act allows private citizens to bring civil actions on behalf of the federal government to recover money when fraud is suspected.
Here are the top four settlement recoveries so far in 2014, as compiled by Becker’s Hospital Review:
1. (James Hoyer Case) Endo Health Solutions — a pharmaceutical company — and its subsidiary, Endo Pharmaceuticals, agreed to pay $192.7 million to resolve criminal and civil claims stemming from Endo’s marketing of Liboderm for uses not approved by the Food and Drug Administration. The settlement included a deferred prosecution agreement and forfeiture totaling $20.8 million and $171.9 million to be paid to the federal government, the states and the District of Columbia.
2. Baton Rouge, La.-based Amedisys, one of the country’s largest providers of home health services, and its affiliates agreed to pay $150 million to resolve allegations brought under the False Claims Act, Stark Law and the Anti-Kickback Statute. The lawsuit filed against Amedisys was brought under the qui tam, or whistle-blower, provision of the False Claims Act by former employees of the company. The lawsuit alleged Amedisys submitted improper claims to Medicare for reimbursement from 2008 to 2010 for therapy and nursing services that were medically unnecessary or provided to patients who were not homebound. The lawsuit also alleged the company engaged in improper financial relationships with referring physicians.
3. Cincinnati, Ohio-based Omnicare — the nation’s largest provider of pharmaceuticals and pharmacy services to nursing homes — agreed to pay $124.24 million to settle allegations that it violated the False Claims and Anti-Kickback Statute. The government alleged Omnicare offered improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid beneficiaries. The government also alleged the improper relationship resulted in Omnicare and the facilities submitting fraudulent claims for reimbursement to Medicare and Medicaid.
4. (James Hoyer Case) Daytona, Fla.-based Halifax Hospital Medical Center and Halifax Staffing agreed to pay $85 million to resolve allegations they violated the False Claims Act and the Stark Law. The government alleged Halifax knowingly violated the Stark Law by executing contracts with six medical oncologists that included an incentive bonus that improperly included the value of prescription drugs and tests the oncologists ordered and Halifax billed to Medicare. The government also alleged Halifax knowingly violated the Stark Law by paying three neurosurgeons more than fair market value for their work, and the hospital admitted patients who did not need to be admitted, then billed Medicare for their care.