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»  Posts By   July 2016 

Qui Tam Lawsuits Are Becoming an Increasingly Popular Tool to Combat False Claims Act Violations

A New Jersey federal court has ordered Nita K. Patel, Kirtish N. Patel and their two diagnostic testing companies, Biosound Medical Services, Inc. and Heart Solution P.C., to pay more than $7.75 million for knowingly submitting claims to the United States Government for falsified diagnostic testing reports. In its Complaint, the Government accused the defendants of developing a fraudulent scheme to create falsified diagnostic testing reports, forge physician signatures on...

Audit Trend Alert: Will Your Pharmacy Be Prepared to Demonstrate Proof of Delivery?

In the course of routine PBM audits, pharmacies have always been called on to provide documentation demonstrating that prescriptions delivered by third party couriers to patients were in fact delivered. However, recent audit trends and PBM alerts indicate that there has been an increased focus on verifying proof of delivery during audits and also a shift in the type of documentation that PBMs will accept as adequate proof of delivery....

CVS and AIG Jointly Settle an Insurance Misrepresentation Dispute for $310 MM

CVS Caremark is in the news arising out of contract entered into more than twenty-five (25) years ago. In 1990, MedPartners Inc. (now Caremark) reached a $56 million settlement on a pending securities and derivative litigation after a failed merger with Nashville, Tennessee-based PhyCor Inc. Plaintiffs in the new litigation matter alleged that during the negotiations leading to a settlement in 1990, MedPartners and its insurance company, American Insurance Group...

Hidden Dangers in Selling Your Pharmacy

With the continuing turmoil in the compound and specialty pharmacy industry, many stakeholders are looking for a quick exit. A pharmacy owner may be presented with a stock purchase agreement, which at first, would seem to solve his problems: an all cash offer for all of the shares of the pharmacy, minimal, if any representations and warranties from the Seller, and the assumption by the Buyer of the liabilities of...

Unprecedented Department of Justice Health Care Fraud Takedown Results in 301 Individuals Charged Over More than $900 Million in False Billing

On June 22, 2016, Federal officials from the Justice Department, along with the FBI, HHS, and the Medicare Fraud Strike Force, announced civil and criminal charges against 301 individuals and medical professionals who allegedly charged Medicare and other government programs over $900 million in allegedly fraudulent billing. Many of the charges involve relationships and arrangements among various providers, marketers and marketing companies. The claims include conspiracy to commit health care...