On September 9, 2020, the Justice Department (DOJ) announced a 77-year old and 65-year old were sentenced to 28-months and 24-months, respectively, for their part in a compounded medication scheme that cost the TRICARE program $65 million in actual... Read More
Express Scripts, Inc. (“ESI”), following a period of stay in its April 7, 2020 recoupment action, has resumed its efforts to recover funds from certain pharmacies who submitted claims to TRICARE in 2015, this time, with no indication of slowing... Read More
At the request of the Defense Health Agency (“DHA”), Express Scripts, Inc. (“ESI”) has begun sending letters to some of the pharmacies within its network recouping on claims that had been submitted to TRICARE. This recent batch of letters is... Read More
On January 15, 2020, L.M.G., Inc., d/b/a TMJ & Orofacial Pain Treatment Centers of Wisconsin ("LMG") agreed to a $1 million settlement to resolve allegations that it violated the False Claims Act. LMG operates four clinics that specialize in... Read More
On November 15, 2019, the Department of Justice (DOJ) announced a settlement in excess of $46 million with a number of California hospitals and affiliated medical practices. The basis for the action by the DOJ related to a variety of financial... Read More
This week, the state of New Jersey joined the long list of States to file suit against the principle members of the Sackler Family, owners of Purdue Pharma. While Purdue Pharma and the Sackler Family may have become poster children for greed in the... Read More
One cannot move in legal circles without hearing at least some discussion of the SCOTUS' position on the administrative state. With a now-entrenched conservative majority and at least two or three of those justices expressing doggedly... Read More
When dealing with white collar crime and fraud, federal sentencing guidelines largely reflect the amount of loss sustained. When it comes to the federal Anti-Kickback Statute (AKS)- which makes it a crime to seek, offer, give or receive any... Read More
Earlier this week, the California Insurance Commissioner filed a wide-ranging lawsuit against AbbVie, alleging classic illegal kickbacks to physicians as well as an intricate network of "nurse ambassadors" designed to improperly boost prescriptions... Read More
PBMs have increasingly begun targeting the usage of manufacturer sponsored coupon programs and copayment assistance programs in both desktop and on-site audits of pharmacies. As a result of these audits, PBMs are alleging discrepancy findings, and... Read More
