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- In 2003, Bayer Corporation paid $257
million to settle civil and criminal charges that
it defrauded Medicaid by overcharging for two popular
drugs through a complex drug labeling scheme. The
settlement arose from a qui tam suit in which Getnick
& Getnick represented the relator, a director
of corporate marketing at Bayer who had reported the
scheme internally following a compliance lecture at
Bayer, receiving no response.
- A qui tam suit filed by a divisional reimbursement
supervisor for the Columbia/HCA national hospital
chain against his employer and an accounting firm
that helped prepare Medicare cost reports resulted
in a $9 million settlement with the accounting firm
in 2001, and formed part of an $881 million settlement
with the hospital chain in 2003.
- In 2004, Gambro Healthcare, one of the nation's
largest renal dialysis providers, paid a total of
$350 in a civil settlement and criminal fines following
a quit tam case filed by its Chief Medical Officer
alleging that Gambro billed for unnecessary tests
and services.
- In 2001, TAP, a multinational pharmaceutical
joint venture, agreed to pay $875 million to the federal
government in the largest health care fraud settlement
ever. The settlement arose from two qui tam cases,
one filed by TAP's former Vice President of Sales,
who alleged that the company gave kickbacks to doctors
and encouraged them to defraud Medicare by billing
for free samples of the drug Lupron. The other case
was filed by the Medical Director of an HMO with which
TAP did business, and who said he was offered a kickback
by TAP salespeople to put Lupron on the HMO's formulary.
- In 1998, the CFO of a Florida hospital in the Columbia/HCA
chain turned in his employers after they responded
inadequately to his reports that certain management
fees submitted to Medicare for reimbursement were
inflated. His qui tam case against the hospital chain
and an affiliated would care company, Curative Health
Services, recouped $16.5 million from Curative, and
formed part of an $881 million settlement with the
hospital chain in 2003.
- A former Vice President of a home health care company
filed a qui tam case in 1997 against his employer
and a national hospital chain alleging that they made
claims to Medicare for non-reimbursable marketing
activities. In 1999 the home health company agreed
to a $51 million settlement and $10 million in criminal
fines. In 2000, the hospital chain settled this and
a number of other qui tam cases for $745 million.
- A qui tam lawsuit filed in 1993 by the former CFO
of a Montana hospital against his employers alleging
Medicare cost reporting fraud resulted in an $85 million
settlement in 2001.
- In 1989, a sales manager for one of the country's
major clinical testing laboratories, National Health
Labs, filed a qui tam case against his employers and
other laboratories after they listened to his complaints
alleging corrupt practices by a competitor -- and
copied them. His lawsuit resulted in criminal charges,
and civil recoveries totaling $149 million..
- The National Health Laboratories settlement was
followed by a number of additional qui tam cases against
most of the nation's major clinical testing laboratories,
ultimately recovering in excess of $1 billion. The
single largest settlement in these cases -- $325 million
-- arose from three qui tam cases, one filed by a
senior billings system analyst for the laboratory,
and another filed by a laboratory medical director.
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