Koleen S. Kirkwood will speak on “ERISA Compliance & Enforcement Issues in 2017 & Beyond” during a live webcast sponsored by The Knowledge Group. Read More
In 2014, the federal government reported that government auditors had recovered only $10 million of an estimated $1.9 billion in annual improper payments in the Medicare Part D prescription drug benefit program.
One reason for the low recovery rate?
Insufficient investigative resources.
But help is on the way.
Conscientious employees inside the Part D program — at insurance companies, pharmacies and pharmacy benefit managers — are learning about the False Claims Act.
And that means an increased rate of recovery in the years to come.
Pamela Coyle Brecht is a partner at Pietragallo, Gordon, Alfano, Bosick & Raspanti in Philadelphia.
Her focus — pharmacy benefit managers. The big three are — Express Scripts, CVS Caremark, and United Health.
In a pathbreaking case, Brecht represents industry insider Anthony Spay who alleged that one of the big three pharmacy benefit managers – CVS Caremark – engaged in a nationwide scheme to defraud the Part D program. Spay survived a motion to dismiss, but Caremark was granted summary judgment. The case is now on appeal to the Third Circuit.
Spay is one of the first whistleblowers to allege Part D fraud against a pharmacy benefit manager.
The Spay case was filed in 2009. Spay’s company was hired to audit the Part D claims processed by Caremark on behalf of Medical Card System, a Puerto Rican health insurance company.
After a 2007 merger, CVS and Caremark have served as a Part D Sponsor, pharmacy benefit manager, and retail pharmacy in the Part D program.
In the course of his company’s audit, Spay alleged that he found that Caremark was improperly adjudicating and submitting claims for prescriptions that were not allowed under the Part D Program.
Spay alleged that Caremark improperly dispensed gender-specific drugs to the opposite gender, failed to apply “maximum allowable cost” pricing to prescription drugs, billed for drugs with expired and obsolete National Drug Code identifiers, billed for prescriptions that contained false physician identifiers, dispensed prescription drugs without prior authorization, and billed for quantities of supplies of drugs that exceeded approved limits. Read More
Brazilian conglomerate Odebrecht S.A., and its affiliated petrochemical company, Braskem S.A., agreed to pay at least $3.2 billion combined to resolve criminal charges that the companies conspired to violate the anti-bribery provisions of the Foreign Corrupt Practices Act. The scheme, as described by the government in documents filed in the U.S. District Court for the Eastern District of New York, ran from 2001 to 2015, during which time the companies employed “an elaborate, secret financial structure” to pay almost $800 million in bribes on three continents. Odebrecht kept Brazilian politicians on retainer, and the politicians favored the company with the passage of friendly tax legislation and contracts with the state-owned oil firm, Petrobras. Set forth below are the most interesting aspects of the largest anti-corruption settlement history:
The U.S. Sentencing Guidelines call for an even larger payout. The parties agreed that, under the Guidelines, Odebrecht’s base penalty is $3.336 billion and the appropriate multiplier is between 1.8 and 3.6, for a total range of between $6.0048 and $12.0096 billion. For Braskem, the Guidelines establish a base penalty of more than $465 million, a multiplier of between 1.6 and 3.2, and a total penalty of between $744 million and almost $1.5 billion.
The government agreed to a below-Guidelines fine based on cooperation and ability to pay. Because of Odebrecht and Braskem’s cooperation in ongoing investigations, the government agreed to recommend reductions for both companies. Odebrecht got a 25% reduction beyond the bottom end of the Guidelines range to $4.5 billion, while Braskem received a 15% discount to $632 million. The government agreed to further reduce Odebrecht’s penalty based on the company’s attestation that it cannot pay all $4.5 billion and stay afloat.
The exact amount of the fine will not be determined until sentencing. To secure the ability-to-pay settlement, Odebrecht has opened its books to the government, which could advocate for a larger amount at sentencing if it feels the company can pay more while remaining in business. Read More
Articles in This Issue:
Pennsylvania Mechanics’ Lien Law Amendments for Dummies
Tis the Season for the Holiday Party: How to Socialize Without Stress of Future Litigation
Be Aware of the Legal Principle of Accord and Satisfactoin Before Cashing a “Full and Final Payment” Check
Aggressive Bidding or False Claim?
Delay in Payment to Subcontractor May Prove Costly
Storage Tank and Spill Prevention Act Penalty Math or How I Learned to Stop Worrying by Contacting Counsel
Related Information:
construction_legal_edge,_winter_2016_edition.pdf Read More
Pamela Coyle Brecht will speak on “Medicare Part C & D Compliance” at the Health Care Compliance Association’s San Francisco Regional Conference at the Walnut Creek Marriott in Walnut Creek, CA. Read More
Marc Stephen Raspanti will speak at the Government Contractor False Claims Forum that takes place at the University Club of Washington DC. He will participate in the “Identifying how Plaintiffs Select High Value Cases” session. The event is hosted by the Financial Research Associates, LLC. Read More
PHILADELPHIA, PA – Marc Stephen Raspanti, a name partner with Pietragallo Gordon Alfano Bosick & Raspanti, LLP, will be recognized as the recipient of the 22nd Annual Beccaria Award for his contribution to the cause of justice and the advancement of legal education. The Justinian Society of Philadelphia and Philadelphia Bar Association’s Criminal Justice Section will present him with this prestigious award on Thursday, November 17th, at 5:00pm, at City Hall in Philadelphia, PA. He is a long-standing member of the Justinian Society of Philadelphia.
The Beccaria Award is presented annually to a legal jurist, scholar or practitioner for their outstanding contributions to the legal community. The award is named after Cesare Beccaria, an 18th Century Italian scholar, who was an early proponent of many of the tenets of modern criminal law. His visionary work is credited with aiding the subsequent European penal code reform and the eventual development of the American criminal justice system.
Mr. Raspanti is the founder of the firm’s White Collar Criminal Defense group and the Qui Tam Trial practice group. He has served as trial counsel in a number of complex, high-profile white collar and False Claims Act cases. He represents executives, corporations, physicians, health care providers, accountants, lawyers, politicians, and professionals in numerous federal and state investigations throughout the country.
Mr. Raspanti was selected by his peers as one of Pennsylvania’s Super Lawyers from 2004 through 2016 in the field of White Collar Criminal Defense. In addition, from 2007 through 2015, he was listed as one of the Top 100 Pennsylvania Super Lawyers as well as one of the Top 100 Philadelphia Super Lawyers from 2008 through 2015. He was elected as a Fellow of the American College of Trial Lawyers, an organization devoted to recognizing outstanding civil and criminal trial lawyers in the United States and Canada. Read More
Marc Stephen Raspanti will speak at the Pennsylvania Bar Institute’s program on False Claims Act Cases in Philadelphia. He will sit on a panel representing plaintiff’s interests. Read More
Pamela Coyle Brecht will speak at the 3rd Annual Qui Tam Conference at InterContinental Century City in Los Angeles, CA. She will participate in discussions on “Medicare Part D Fraud” and “Relator’s Counsel.” Read More
