| Below is a list of the top 10 or largest False Claims | | | | included unallowable cost in its annual cost reports. |
| Act cases in the United States. Under the federal | | | | Combined with the December 2000 settlement, the |
| False Claims Act, whistleblowers receive a reward of | | | | government has recovered $1.7 billion from HCA. In |
| between 15% and 30% of what the government | | | | this case, the whistleblowers received over $115 |
| collects for reporting fraud committed against the | | | | million. |
| government, such as fraud against the military, | | | | 6. Serono: $567,000,000 |
| Medicare, or one of 20 federal agencies and | | | | In October of 2005, Serono paid $704 million to |
| programs. In each of these cases, the whistleblowers | | | | settle a False Claims Act case involving Serostim, a |
| received rewards of over $50 million! | | | | human growth hormone product used to fight |
| 1. Tenet Heathcare: $900,000,000 | | | | AIDS?related wasting. The fraud allegations included |
| In July 2006, Tenet Healthcare, a large chain of | | | | paying kickbacks to doctors and off label marketing |
| hospitals, paid $900 million to settle False Claims Act | | | | of the drug. The whistleblower received over $50 |
| allegations that it committed fraud by manipulating of | | | | million. |
| “outlier” payments to Medicare, paid | | | | 7. TAP [Taketa?Abbott Pharmaceutical] |
| kickbacks, upcoded DRG codes, and engaged in bill | | | | Pharmaceutical Products Inc.: $559,483,560 |
| padding. The whistleblowers received rewards | | | | In October 2001, TAP Pharmaceutical Products Inc. |
| exceeding $150 million. | | | | paid $559 million to resolve False Claims Act |
| 2. Eli Lilly: $800,000,000 | | | | allegations that it illegally gave kickbacks to doctors. |
| In January 2009, Eli Lilly, a large pharmaceutical | | | | It was alleged to have provided free samples with |
| company, paid $800 million to settle allegations that it | | | | the understanding that doctors would bill Medicare |
| violated the False Claims Act and defrauded Medicare | | | | and Medicaid $500 per dose. The whistleblower |
| and Medicaid by “off label” marketing of a | | | | received $95 million. |
| popular drug Zyprexa. The government alleged that | | | | 8. Bristol?Myers Squibb Company (BMS): $515,000,000 |
| Eli Lilly widely promoted the use of this drug to | | | | In September 2007, Bristol?Myers Squibb (BMS) and |
| nursing homes patients to treat dementia, which is | | | | its wholly owned subsidiary, Apothecon, Inc., paid |
| not an approved use by the FDA. The whistleblowers | | | | over $515 million to settle False Claims Act allegations |
| are eligible for up to 25% of the $800 million civil | | | | that it paid kickbacks, promoted off label use drugs, |
| recovery or up to $200 million. The company also | | | | and violated Medicaid’s best price statute. The |
| paid criminal fines of $615 million. | | | | whistleblowers received $50 million. |
| 3. HCA The Healthcare Company: $731,400,000 | | | | 9. Cephalon: $425,000,000 |
| In December 2000, after changing its name to | | | | In November 2007, Cephalon, a biotech company, |
| “HCA The Healthcare Company” (formerly | | | | paid $425 million to settle False Claims Act allegations |
| known as Columbia HCA), the largest for?profit | | | | that it engaged in “off label” marketing of |
| hospital chain in the United States, settled its second | | | | three FDA approve drugs: Actiq (a narcotic lollipop |
| False Claims Act case by paying $731,400,000 to | | | | designed for pain control in cancer patients), Gabitril |
| resolve allegations of billing for lab tests that were | | | | (an epilepsy medication), and Provigil (a narcolepsy |
| not medically necessary or not ordered by physicians, | | | | medication). The company also paid a criminal fine of |
| upcoding, billing the government for advertising under | | | | $50 million. The whistleblowers received rewards |
| the guise of “community education,” and | | | | exceeding $55 million. |
| billing for non?reimbursable costs incurred in the | | | | 10. Abbott Labs: $400,000,000 |
| purchase of home health agencies around the | | | | In July 2003, Abbott Laboratories, Inc. paid $400 |
| country. The whistleblowers received $150 million. The | | | | million to resolve False Claims Act allegations relating |
| company also paid more than $100 million in criminal | | | | to the sale of “enteral” products, which |
| fines. | | | | pump food into the stomach of patients who cannot |
| 4. Merck: $671,000,000 | | | | digest meals. The whistleblower received |
| In February 2008, Merck & Company (a | | | | approximately $70 million. |
| pharmaceutical company) has paid $671 million to | | | | Footnotes: |
| resolve False Claims Act allegations that it failed to | | | | Outlier payments are an increased fee paid to |
| pay proper “rebates” to Medicaid under the | | | | hospitals over and above the normal DRG fee when |
| Best Price statute and that it paid kickbacks to | | | | they can show that their procedures are particularly |
| doctors. Under the Medicaid best price statute or | | | | difficult or complex. |
| rebate program, a pharmaceutical company is | | | | Off label marketing occurs when a pharmaceutical |
| required to give Medicaid the same discount it gives | | | | company obtains FDA approval for a specific use of |
| its best customers. The three drugs involved were | | | | a new drug, but then asks doctors to prescribe it for |
| Zocor, Vioxx, and Pepcid. The whistleblowers are | | | | other uses which it did not seek or obtain FDA |
| eligible for over $115 million. | | | | approval. It is illegal for pharmaceutical companies to |
| 5. HCA: $641,000,000 | | | | suggest to treating physician that they prescribe |
| In June 2003, HCA Inc. (formerly known as Columbia | | | | drugs for uses other than that which the FDA has |
| HCA The Healthcare Company) paid the United | | | | approved. |
| States $641 million to settle False Claims Act | | | | The government has paid over $3 billion in rewards |
| allegations that it paid kickbacks to physicians and | | | | to whistleblowers for reporting fraud. |