In recent years, the federal government has markedly increased its efforts to target and combat health care fraud. One of the most powerful tools at the government’s disposal to effectuate this effort is the False Claims Act, a civil statute which carries harsh penalties for knowingly presenting, or causing to be presented, false or fraudulent claims to the federal government for payment. Earlier this month, the Department of Justice (“DOJ”) announced in a press release that a settlement had been reached resolving liability under the False Claims Act stemming from several pharmacies’ presentment of claims to federal payors, which claims had been tainted by the involvement of an employee who had previously been excluded from participating in federal health care programs.
In 2010, the employee, then an active pharmacist, was convicted of a felony controlled substance offense. As a result of the conviction, the employee’s pharmacy license was suspended and he was excluded from participation in federal health care programs. The Office of the Inspector General of the U.S. Department of Health and Human Services excludes people from participating in federal health care programs upon their conviction of certain crimes in an effort to protect program beneficiaries and the integrity of the programs.
Thereafter, despite his exclusion, the former pharmacist was hired to work at a number of interrelated pharmacies. Again, despite the owners’ knowledge of his exclusion, the employee was given broad administrative authority, management responsibilities, and even the ability to fill prescriptions as necessary. As a result, false or fraudulent claims for payments, tainted by the employee’s exclusion, were presented to federal programs in violation of the False Claims Act.
How Frier Levitt Can Help
This settlement makes clear the federal government’s ability and intention to use the False Claims Act to its fullest extent to target all persons who share involvement in knowingly submitting, or causing to be submitted, tainted claims, as well as the government’s distaste for those who knowingly disregard federal health care exclusions. It also solidifies, specifically, that owners of pharmacies who knowingly hire excluded providers may be liable for causing the submission of – as distinct from directly submitting – false claims, actionable under the False Claims Act. Frier Levitt is well versed in representing providers and pharmacies who find themselves subjects of a False Claims Act investigation. Contact us today to speak to an attorney.
