Late last month, the United States Department of Justice announced that Walgreens Pharmacy had agreed to pay $7.9 million to settle allegations that Walgreens had violated the Federal False Claims Act. In a suit brought as a qui tam action by a pharmacy technician and an independent pharmacist, the government contended that Walgreens’ program of offering $25 gift cards to patients when they transferred a prescription from another pharmacy constituted a violation of the Federal False Claims Act. The government alleged that while the advertisements for the program and program documents stated that it did not apply to patients with Medicaid, Medicare or any other government health benefits, Walgreens employees were nonetheless providing gift cards to government health beneficiaries, and such actions constituted illegal inducements under the Federal anti-kickback statute.
The claim was brought as a qui tam action by two whistleblowers: a former Walgreens pharmacy technician and an independent pharmacist. A qui tam action involves a suit initiated by an individual, or “relator,” who with the help of the government, alleges that the defendant violated certain federal laws, including the Federal False Claims Act. Individuals who file under the False Claims Act are entitled to receive a portion of the monetary recovery from the defendant (normally between 15-25%).
Under the False Claims Act, a defendant can be liable if it knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval or knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim. In this case, because Walgreens was in violation of the Federal anti-kickback laws by providing these gift cards, it was viewed as submitting false claims to the government because it was otherwise certifying compliance with government requirements. For their role in filing the qui tam actions, the two relators were entitled to receive over $1.2 million from the settlement.
What Kinds of “Qui Tam” Claims Could I Possibly Have to Bring Against a Company?
If you are aware that a company is engaging in illegal activity, is submitting false or fraudulent claims to the government, or is not in compliance with certain government program requirements, you could be able to bring a qui tam action as a relator. Examples of these claims include:
- Knowledge of fraudulent billing to Medicare, Medicaid, or other government health benefits program, such as
- billing for services not rendered
- billing for unnecessary procedures or equipment
- billing using an inflated billing code
- billing for new equipment but providing used equipment
- Knowledge of kickbacks or remuneration being paid in exchange for referrals
- Knowledge of illegal self-referrals
- Knowledge of a provider’s routine waiver of copayments
- Knowledge of a provider’s noncompliance with certain government or CMS requirements, such as:
- participating with excluded providers
- practicing without a valid license and/or certification
Frier Levitt handles False Claims Act cases and qui tam suits on behalf of individuals in the healthcare sector. Contact us today for help evaluating whether you may have a claim.
