Senior Department of Justice (“DOJ”) officials recently outlined the areas on which they intend to focus their affirmative enforcement efforts in the coming year. DOJ’s enforcement activities reflect the versatility of the False Claims Act and importance of whistleblowers to combat fraud and ensure the safety of the public.
One of the DOJ’s main priorities is combatting the opioid epidemic. DOJ has already prosecuted companies like Reckitt Benckiser and Indivior to the tune of $2 billion for their criminal and civil liability in connection with the marketing of the opioid addiction treatment drug Suboxone. These companies were brought to justice with help from whistleblowers represented by Baron and Budd. Despite successes in this area so far, DOJ remains focused on using the “False Claims Act to pursue individuals and entities that contributed to the epidemic by facilitating the diversion and abuse of prescription opioids.”
Another timely priority for the government is combatting fraud related to the COVID-19 pandemic. The federal government has allotted billions of dollars to numerous programs to offset the impact of the pandemic. COVID-19 fraud takes many forms, from individuals fraudulently getting stimulus payments to businesses applying for PPP relief funds for which they are not eligible. Sadly, whenever the government spends a great deal of money, fraud follows.
Another priority for the DOJ is combating fraudulent schemes contributing to rising drug prices. These fraudulent schemes range from failures to report accurate drug rebate and pricing information to the Medicaid program to improperly using foundations as conduits for the payment of patient copays.
DOJ is also focusing on investigating and litigating matters related to Medicare Part C, which is Medicare’s managed care program. One common scheme DOJ has uncovered is the attempt by Part C plants to manipulate the risk-adjustment process by auditing patient medical records to identify additional, unsupported codes that increase their Medicare reimbursement.
DOJ has also prioritized using the False Claims Act to combat companies taking advantage of the elderly by providing them poor or unnecessary health care. For example, DOJ has brought cases against skilled nursing facility (“SNF”) chains and rehabilitation contractors for putting profits over patients by providing patients medically unnecessary rehabilitation therapy services. DOJ also recently settled a case against Avanir Pharmaceuticals for $95 million for providing kickbacks and false advertising over its drug Nuedexta. These illegal promotional activities actions allegedly led to over-medicating nursing home residents. Due to the continuing evidence of deficient care being provided to seniors, the DOJ has launched a National Nursing Home Initiative.
DOJ is also focused on clinical trial fraud. According to Deputy Assistant Attorney General Daniel Feith, who leads DOJ’s Consumer Protection Branch: “Disturbingly, one published study found that one in six researchers involved in clinical drug trials reported that they were personally aware of fabrication in research.” Federal prosecutors have recently brought cases against researchers who fabricated data about a clinical trial for asthma medications in children.
DOJ’s enforcement priorities overlap with many investigations Baron and Budd is currently pursuing. Only with the help of whistleblowers can the DOJ be successful in prosecuting those who defraud the government and wrongfully obtain taxpayer dollars.
Whistleblowers are essential in the investigation and prosecution of fraud. If you have information about any type of fraud being committed against the federal government, you should seek the guidance of a whistleblower attorney.
With more than 30 years of experience, the attorneys on Baron & Budd’s whistleblower representation team have represented dozens of clients in government fraud cases returning over $5.4 billion to federal and state agencies, with whistleblower recovery shares as high as 49%. They are ready to help if you feel you have the evidence needed to file a whistleblower complaint.
Please call (866) 401-5971 or complete our contact form if you would like more information. For more information, see What You Need to Know About Becoming a Whistleblower. Please understand that contacting us does not mean that you have established an attorney-client relationship with Baron & Budd, P.C.