The False Claims Act ("FCA") requires a materiality to establish a claim for liability, and defines "material" as a natural tendency or capability to influence a bribe. Earlier this year, the Third Circuit applied a stricter materiality standard in United States ex rel. Petratos v. Genentech Inc. ("Petratos"), 855 F.3d 481 (3d Cir. 2017). The Third Circuit ruled that plaintiffs failed to show that the defendant's alleged noncompliance with the Food and Drug Act ("FDA") regulations had an impact on the government's payment decisions, and thus, the alleged conduct was not materially noncompliant. The Court noted that, after the plaintiffs disclosed the defendant's alleged "campaign of disinformation" toward the FDA, the FDA still maintained its approval of the defendant's drug, Avastin, which was at the center of the dispute. Additionally, the government did not stop reimbursement payments for prescriptions of the drug.
U.S. District Judge Mary S. Scriven dismissed a suit brought against HealthMarkets Inc. ("HealthMarkets" or the "Company") by an anonymous whistleblower ("John Doe" or "Doe") on May 23, 2017, after the federal government declined to intervene and John Doe dropped the suit.
Novartis Pharmaceuticals Corporation ("Novartis") currently faces several False Claims Act ("FCA") charges for its alleged kickback schemes. Recently, Novartis has agreed to pay out $390 million to settle one of its major cases, which claimed it incentivized specialty pharmacies to increase sales of Exjade, an iron-reducing drug, and Myfortic, an immunosuppressant.
Medicare is a federally-funded program that "provides subsidized medical insurance for the elderly and certain disabled people." According to 2013 estimates by the National Committee to Preserve Social Security, some 52.3 million Americans currently rely upon Medicare for their primary health and medical needs.
When an employee blows the whistle on an employer and files a qui tam lawsuit on behalf of the government, the government can choose whether or not to join the lawsuit. If the government investigates the case and decides not to join, the whistleblower can still go ahead with the lawsuit and, if successful, receive a percentage of any amount that is recovered.
Government customers of United Parcel Service Co. (UPS) overpaid the company because it falsified delivery records over a 10-year period, according to a lawsuit UPS recently settled. The whistleblower suit was filed by a former driver and manager for UPS. Now he is expected to receive $3.75 million for bringing the allegedly false claims to the attention of the federal government.
According to a recently unsealed whistleblower lawsuit, two health care providers in Indiana put the health of mothers and newborns at risk in a Medicaid fraud scheme that placed the care of low-income, pregnant mothers in the hands of lower-cost midwives rather than doctors. The suit alleges that the health care providers -- IU Health and HealthNet Inc. -- then falsely billed Medicaid for doctor-provided services.
According to current figures from the U.S. Department of Justice, since 2009, legal claims brought under the federal False Claims Act have led to the recovery of more than $23.9 billion. About 63 percent of that -- more than $15.2 billion -- has been recovered from cases involving fraud against health care programs, including Medicaid and Medicare.
Since the mid-1980s, the federal False Claims Act has been the government's primary tool for fighting fraud against government programs, including Medicare and Medicaid. The law's qui tam provisions allow whistleblowers to bring lawsuits against companies and individuals that defraud the government, and whistleblowers have collectively received billions of dollars in rewards for blowing the whistle on fraud.
The federal False Claims Act allows individuals, called relators, to bring lawsuits -- qui tam claims -- on behalf of the government, and the relators may collect a portion of any amount of money the government recovers. Since the mid-1980s, the United States government has recovered more than $15 billion through qui tam claims, and that figure continues to rise.