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Whistleblower Exposes Medicaid Fraud Using False Claims Act and Makes Huge Recovery

above-the-bar-logo.jpgThe Department of Justice recently settled allegations with pharmaceutical giant GE Healthcare Inc. that a company that it had acquired in 2004, Amersham Health, Inc. (“Amersham”), violated the False Claims Act by overcharging Medicare for a drug used to detect heart disease. GE Healthcare paid $30 million plus interest to resolve the qui tam whistleblower lawsuit. The whistleblower, James Wagel, will get $5.1 million from the government’s recovery.

The government had charged that Amersham had caused Medicare to overpay for Myoview, a radiopharmaceutical drug used in certain medical procedures to detect heart disease. Myoview, which comes in multi dose vials of powder, is mixed with radioactive agents to make individual doses which are then injected into patients for cardiac imaging procedures. Medicare payment rates for Myoview were partly based on the number of doses per vial of Myoview. The Department of Justice claimed that Amersham gave Medicare false information as to how many doses were available in each vial which caused Medicare to overpay.

The fraud against the government in this case would have continued if James Wagel, the whistleblower, had not brought it to the government’s attention. Wagel, who sold Cardiolite, which is a competing drug to Myoview, repeatedly heard from clients that they were purchasing Myoview because they were able to maximize the number of times each vial was used. Not only was this against the U.S. Food and Drug Administration guidelines but it also resulted in health care providers billing Medicare multiple times for the same product. Additionally, health care was being compromised as the drug was being diluted to get more use out of it.

Tony West, the Assistant Attorney General for the Justice Department’s Civil Division, stated that it’s “important for drug manufacturers to provide accurate pricing information to Medicare so that taxpayers aren’t overcharged for medicines purchased with their dollars.”

The qui tam provision of the False Claims Act allows an individual with knowledge of fraud being committed against the government to bring an action on behalf of the government. However, you must be represented by an attorney and you must be the first person to bring evidence of the fraud to the government’s attention. In other words, you cannot reveal your story on Eyewitness News and then expect to bring an action. You may be entitled to anywhere from 15% to 30% of the government’s recovery depending on whether the government intervenes and takes over your lawsuit.

Medicaid and Medicare fraud is a national problem affecting not just the government but also every taxpayer in this country. The qui tam whistleblower provision of the False Claims Act is a great tool to fight fraud against the government. Although it is a complex statute with strict requirements, the recovery can be quite substantial and worth the effort. However, it only works if you observe fraud and do something about it. If you have observed fraud being committed against the government at your workplace, call our experienced qui tam Whistleblower Attorneys at Villanueva & Sanchala at (800) 893-9645 to figure out if you have a case under the False Claims Act.

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