Qui Tam/Whistleblower Case Histories In The Healthcare Industry
Here are some examples of recent Qui Tam cases from all over the United States. Approximately one of every three dollars recovered through false claims cases relate to healthcare fraud.
Tenet Heathcare
$900,000,000 under the False Claims Act:
In July 2006, Tenet Healthcare (formerly known as NME) consented to pay $900 million to the federal government to atone for the company's manipulation of the Medicare system via bill padding, kickbacks, and upcoding.
HCA
$745,400,000 under the False Claims Act:
In December 2000, the Nashville-based corporation known as the Health Corporation of America (HCA), agreed to pay the government $745 million to settle charges of fraudulent billing to Medicare and other government agencies. The fines levied against HCA arose out of the company's systematic defrauding of the healthcare system-i.e. billing for unnecessary tests, upcoding, and charging the government for advertising, which was disguised beneath the blanket of "community education."
HCA
$631,000,000 under the False Claims Act:
In June 2003, the Nashville-based corporation known as HCA, (formerly known as Columbia/HCA) consented to pay the federal government $631 million in civil penalties and damages to address false claims that were submitted to Medicare and other federal health programs. HCA incurred these fines because of the company's participation in kickback schemes and egregious billing practices.
Serono
$567,000,000 under the False Claims Act:
In October 2005, the Swiss biotech company Serono entered into agreement to pay $704 million to the federal government. The fines extracted from the company settled a fraud case involving the company's AIDS drug, Serostim, a human growth hormone product used to treat AIDS-related wasting. Serono amassed these fines because of the company's participation in kickback schemes, off-label promotion, and use of non-FDA approved diagnostic equipment that was used generate more prescriptions than necessary.
AP [Taketa-Abbott Pharmaceutical] Pharmaceutical Products Inc.
$559,483,560 under the False Claims Act:
In October 2001, TAP Pharmaceutical Products Inc. consented to pay $875 million to settle civil liabilities and criminal charges. These charges flowed out of the disreputable practices that the company engaged in to promote its prostate cancer fighting drug, Lupron. Of the amount that the company agreed to pay, $559,483,560 was obtained under the False Claims Act. Furthermore, TAP agreed to pay $290 million to settle criminal charges, which stated that the company had conspired to subvert the Prescription Drug Marketing Act.
Abbott Labs
$400,000,000 under the False Claims Act:
In July 2003, a division of Abbott Laboratories, Inc. confessed to defrauding Medicare and Medicaid programs as well as participating in the obstruction of a criminal investigation. The company agreed to pay $400 million to settle civil claims. In addition, CG Nutritionals, Inc., a subsidiary of Abbott Labs, submitted to a criminal fine of $200 million.
Fresenius Medical Care of North America (National Medical Care)
$385,000,000 under the False Claims Act:
In January of 2000, Fresenius Medical Care of North America-the world's largest manufacturer of kidney dialysis products and services-consented to pay $486 million to settle allegations of health care fraud brought against the company's subsidiary organization, National Medical Care, Inc. Of the amount that the company agreed to pay, $385,000,00 was recovered under the False Claims Act.
SmithKline Beecham:
In March of 1997, SmithKline Beecham Clinical Laboratories, Inc. paid the government more than $325 million to settle allegations that its clinical laboratory division defrauded Medicare, Medicaid, and other federally funded health insurance programs related to its pharmaceutical sales and billing. This historic settlement was the result of a joint effort between the Government and "whistleblowers," including Robert J. Merena, a former employee of SmithKline's National Billing System. The SmithKline settlement is one of the largest whistleblower assisted recoveries in the history of the United States.
HealthSouth:
In December of 2004, the Untitled States' largest purveyor of rehabilitative medical services, the HealthSouth Corporation, consented to pay the federal government $325 million to address allegations that the company defrauded Medicare and other federally funded healthcare programs. Assistant Attorney General Peter Keisler noted that, "HealthSouth's fraud on Medicare was driven both by longstanding business practices in its outpatient physical therapy business and improprieties in its inpatient rehabilitation business."
Gambro Healthcare:
In December 2004, Gambro Healthcare consented to pay $310 million to settle charges of fraudulent billing to Medicaid. The fines levied against HCA arose out of the company's systematic defrauding of the healthcare system-i.e. billing for unnecessary tests, offering kickbacks to doctors, and submitting false statements to obtain payment for unnecessary services.