Blog

»  Posts By    

Pharmacy Alert: Recent Uptick in Federal Investigations Against Pharmacies

According to recent statistics released by the Department of Justice (DOJ), federal government enforcement actions targeting the health care and pharmaceutical industries have risen over the past year by about 5%. In 2019, the DOJ brought in over $3 billion in judgments and settlements under the False Claims Act (FCA), with $2.6 billion stemming from health care and life sciences companies such as hospitals, drug manufacturers and pharmacies. In addition,...

PHARMACY ALERT: New Year = New P&Ps for Pharmacies

Recently, a former Aegerion Pharmaceuticals Inc. salesman, Mark Moffett, was found guilty, by a federal jury, of conducting a drug fraud scheme that cost Medicare and other insurers more than $1.8 million. According to federal prosecutors, Moffett faked patient histories, diagnoses and certain test results, all in an effort to cause claims for Aegerion's cholesterol treatment, Juxtapid, to be approved by payors, including PBMs. While Moffett had argued that any...

Plan Sponsor ALERT: Ohio Continues Its Fight Against Abusive PBM Practices

The State of Ohio has become one of the many states that have fallen victim to PBMs' abusive revenue tactics, as detailed in an audit report finding that the state's PBMs — OptumRx and Caremark — charged the state a spread of 31% on generic drugs. As a result, the state was charged $224 million, at the expense of the taxpayers, more than what these PBMs paid pharmacy providers in...

PBMs Taking Hard Stance Over Use of Patient Assistance Programs

Recent enforcement actions over allegations regarding assisting pharmaceutical manufacturers to pay improper kickbacks to Medicare beneficiaries are not the only issues currently impacting Patient Assistance Programs (PAPs). PBMs are also taking an increasingly hard stance over the use of PAPs by specialty and retail pharmacies across the country. Some PBM Provider Manuals include explicit terms and conditions regarding the use of financial hardship policies, but many are silent with regard...

Second Circuit Dicta Concerning FCA “Alternate Remedy” Provision May Create Perverse Incentive for Government to Increase Criminal Prosecution

The Second Circuit's decision in U.S. v. L-3 Communications EOTech, Inc., included ominous dicta pertaining to the "alternate remedy" provision of the False Claims Act (FCA), which may lead to an increase in government determinations to prosecute FCA matters criminally, rather than joining or "intervening" in an ongoing civil suit. The "alternate remedy" provision reads, in pertinent part, that "the Government may elect to pursue its claim [under the FCA]...