Archive for April, 2013

Feds: Lance ‘Unjustly Enriched’ By Money Earned While Doping

Tuesday, April 30th, 2013

The federal government accused cycling legend Lance Armstrong of defrauding the U.S. Postal Service when he doped to win the Tour de France.

In a complaint filed in federal court in the District of Columbia, the government asserted that Armstrong violated the federal False Claims Act and would be “unjustly enriched” if allowed to retain the money he received from the Postal Service.

The original complaint in the case was filed by Armstrong’s former teammate, Floyd Landis.  The government announced in February that it intended to intervene in the case.

Amgen Pays $25M In Kickback Case

Monday, April 22nd, 2013

A California biotech company will pay almost $25 million to settle claims that it paid illegal kickbacks to boost prescriptions of a drug for treating anemia, the Department of Justice announced this week.

Amgen, Inc. will pay $17.8 million to the federal government and $7.1 million to various state governments under the settlement, which resolves claims that the company paid kickbacks to long-term-care pharmacy providers to get them to switch patients to Aranesp, a drug that Amgen manufactures.

The False Claims Act case was brought by Frank Kurnik, a longtime Amgen employee.

IBC And Cooper Cozy Over Insurance Subsidiary: Insurers Shift To Hospital Collaboration

Monday, April 22nd, 2013

Independence Blue Cross (“IBC”) announced on April 10, 2013, that it agreed to sell 20% of IBC’s New Jersey health insurance subsidiary, AmeriHealth New Jersey, to Cooper University Health Care (“Cooper”) of Camden, NJ.  AmeriHealth New Jersey, which was started in 1994, employs 140 in its Cranbury headquarters and covers 200,000 in New Jersey, for a roughly 5 percent market share.  IBC declined to disclose the price Cooper agreed to pay.  The deal still requires regulatory approval.

The Cooper/IBC deal is part of a trend to integrated hospitals and insurers to prepare for a shift to a payment system for healthcare that pays providers lump sums for all care needed by an individual rather than for each discrete visit and treatment.  Catholic Health Initiatives, of Englewood, Colo., one of the nation’s largest systems, spent $24 million last month for a majority interest in a health insurer.  The development of new, lower-cost insurance offerings (15-20% below market), is central to the Cooper-IBC partnership.

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Cardiologist Outed By Hospital For Unnecessary Stents

Tuesday, April 9th, 2013

The University of Pennsylvania Health System announced yesterday that it had reported a cardiologist to federal authorities, state regulators, and patients for performing unnecessary stent procedures at a system hospital. The physician, Vidya Banka, 71, was an independent cardiologist with medical privileges at Pennsylvania Hospital (he has since given up those privileges).  Outside cardiovascular experts reviewed a sample of patients who received stents by by Dr. Banka over the last five years, and they concluded that medical tests did not reveal  significant blockages in the heart blood vessels for approximately 20 patients. Penn took extraordinary steps in response to the finding: it notified the U.S. Attorney’s Office in Philadelphia; it also notified the Pennsylvania Board of Medicine, which licenses and disciplines physicians; and it offered patients who may have received stents inappropriately the services of a Penn cardiologist at no cost, or have their records transferred to a physician of their choice.

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OIG Fraud Alert: Cautioning Physicians With Skin In The Game

Thursday, April 4th, 2013

On March 26, 2013, OIG issued a Special Fraud Alert regarding physician-owned distributorships (“PODs”) involved in the sale of implantable medical devices.  OIG noted that a joint venture is “inherently suspect” from an Anti-Kickback perspective when it involves physician-owners who are also in the position to purchase these medical devices for use in surgical procedures.  The questionable features of PODs for implantable medical devices included: selecting investors in a position to generate business; requiring investors to surrender their investment when they are no longer in a position to purchase devices from the POD (i.e., no longer practicing in the area); and returns on investment that are disproportionate to the level of risk assumed by the physician investors.  The OIG is concerned that the connection between the physicians’ financial interest and the ability to impact the POD by purchasing devices for use in surgery will result in: “corruption of medical judgment, overutilization, increased costs to the federal health care programs and beneficiaries, and unfair competition.”

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