The US DOJ announced on November 20, 2019 that Jewish Hospital & St. Mary’s Healthcare Inc., doing business as Pharmacy Plus and Pharmacy Plus Specialty (collectively, Jewish Hospital), of Louisville, Kentucky, agreed to settle allegations that they submitted false claims to Medicare – for the sum of $10,101,132.
The allegations against Jewish Hospital asserted that the hospital knowingly submitted claims for prescription drugs to Medicare knowing that the claims didn’t meet Medicare’s coverage requirements. The requirements included:
- The need for the treating doctor to sign an order showing medical necessity for the prescriptions
- The need to confirm that refills were reasonable and necessary
- The need to document that the medications were indeed delivered
Additional allegations asserted that Jewish Hospital submitted Medicare claims in violation of the Anti-Kickback Statute (AKS) because it gave the Medicare beneficiaries free blood glucose testing supplies and waived their co-payments and deductibles for insulin. The AKS prohibits “offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally-funded programs.” The Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services said that when Medicare pays for medically unnecessary drugs – then vital government health programs are robbed or essential resources.
The DOJ settlement was due, in large part, to a pharmacist who brought a lawsuit under the whistleblower or qui tam provision of the False Claims Act. The whistleblower was awarded $1.85 million for his efforts. Whistleblowers in False Claims Act cases are generally awarded between 10 and 30% of any recovery including any treble damages and statutory penalties.
The Jewish Hospital did not admit liability as part of the settlement.
Whistleblowers often are employees who people who work for the defendants.
At the California Law Offices of Stephen Danz and Associates, we have been helping whistleblowers file claims and seek awards for more than 30 years with numerous substantial results. For help filing your whistleblower case, call us at online contact form to make an appointment.or use our