Advanced Care Scripts Consents to Pay $1,400,000 to Settle Accusations of Conspiring with Biogen Inc. to Reimburse Kickbacks via the Two Foundations.
Boston – Biogen Inc., a pharmaceutical company in Cambridge, Massachusetts, agreed to reimburse 22 million U.S. dollars to settle accusations that it breached the False Claims Act by unlawfully utilizing two foundations, The Assistance Fund and Chronic Disease Fund, as conduits to reimburse the Medicare co-payments for patients taking Biogen’s multiple sclerosis medications, Tysabri, and Avonex.
Advanced Care Scripts, a specialty chemist that conducted services for Biogen Inc., agreed to reimburse 1.4 million U.S. dollars to settle accusations that it schemed with Biogen to allow Biogen to utilize The Assistance Fund and Chronic Disease Fund as conduits for Biogen Inc. to reimburse Medicare co-payments for Tysabri and Avonex patients.
In other settlement agreements in late 2019, Chronic Disease Fund reimbursed 2 million U.S. dollars, and The Assistance Fund reimbursed 4 million U.S. dollars to settle accusations about their respective roles in allowing specific pharmaceutical firms to reimburse kickback to Medicare patients.
Once a Medicare beneficiary received a drug prescription insured by Medicare Part D, the beneficiary might be needed to make a partial reimbursement, which might take the form of co-insurance, co-payment, or deductible (collectively, copays). Congress added the copay requirements in these programs, partly to motivate market forces to act as a check on health care expenses, such as the prices that pharmaceutical makers can demand for their medications. The Anti-Kickback Act does not permit pharmaceutical firms to offer or pay, directly or indirectly, any kickback or bribes, which entails money or any other material of value, to persuade Medicare beneficiaries to procure the firms’ drugs.
As per the 17th December 2020 settlement agreement, the United States purported that Biogen Inc., acting with Advanced Care Scripts’ assistance, utilized The Assistance Fund and Chronic Disease Fund, each of which avouched to be a non-profit organization for tax purposes, as channels to reimburse the copay obligations of numerous (thousands) Medicare beneficiaries taking Tysabri and Avonex. According to the government’s accusations, Biogen Inc. utilized The Assistance Fund and Chronic Disease Fund, which Biogen Inc. reimbursed, to cover Tysabri and Avonex patients’ copays to persuade those Medicare-reimbursed patients to purchase the drugs.
The United States clearly purported that in 2011, Biogen Inc. identified the Medicare program-eligible Avonex patients in Biogen Inc.’s free medication program, and organized for Advanced Care Scripts to move those patients from the Biogen free medication program to Chronic Disease Fund, so that Chronic Disease Fund could cover the Medicare copays for those patients and the purchases of Avonex by these patients would make Medicare revenue for Biogen Inc. afterward reimbursed Chronic Disease Fund, and Advanced Care Scripts instantly sent a batch of copay assistance applications files to Chronic Disease Fund for Medicare-qualified Avonex patients who had been obtaining the free medication from Biogen Inc. Chronic Disease Fund after that approved majority of those applications and covered the expenses of those patients’ Medicare copays for Avonex.
The United States also purported that in 2012, Biogen Inc. identified the Medicare program-eligible Tysabri patients in Biogen Inc.’s free medication program, and organized for Advanced Care Scripts to move those patients from the Biogen free medication program to The Assistance Fund, so that to The Assistance Fund could cover the Medicare copays for those patients and the purchases of Tysabri by these patients would make Medicare revenue for Biogen Inc. made reimbursements to The Assistance Fund in the third and second quarters of 2012, each time Advanced Care Scripts afterward sent a batch of copay assistance applications files to The Assistance Fund for Medicare-qualified Tysabri patients who had been obtaining the free medication from Biogen Inc. The Assistance Fund, after that, reimburse the majority of or all those patients’ Medicare copays for Tysabri. Besides, the federal government purported that in 2013 and in the same manner, Biogen Inc. worked again with Advanced Care Scripts to move Medicare-qualified patients from the Biogen free medication program to Chronic Disease Fund, which Biogen Inc. reimbursed so that Chronic Disease Fund would offset those patient’s Medicare copays for Tysabri and Biogen Inc. would obtain the resulting Medicare payment income.
The First United States Assistant Attorney Nathaniel Mendell stated that Biogen Inc. collaborated with Advanced Care Scripts to play the system, time its reimbursements, and direct its cash to offset copay expenses for patients taking its drugs. Through utilizing copay foundations this manner, as a channel to reimburse for copays for Biogen Patients, Biogen Inc. breached the Anti-Kickback Act and compromised the copay structure for Medicare, which Congress created to protect against inflated drug prices. First, U.S. Assistant Attorney Mendell further noted that they commend Advanced Care Scripts for settling this case expeditiously and Biogen Inc for settling this issue on a cooperative basis.
Jeffrey Bossert Clark, Acting Assistant Attorney of the Justice Department – Civil Division, stated that the settlement agreement reported on 17th December 202, like previous resolutions about similar criminal behavior, shows the federal government dedication and commitment to hold answerable firms that reimburse kickbacks to compromise crucial constraints on inflating drug prices. Jeffrey Clark further assured they would hold accountable drug firms that unlawfully influence charitable patient assistance programs to finance copays for their products.
Special Agent Phillip Coyne in Charge, Office of the Inspector General of the Health and Human Service Department – Boston Regional Office stated that kickback conspiracies could compromise the nation’s health care system and result in higher expenses for the Medicare program. Coyne assured that they would persistently hold accountable pharmaceutical firms and specialty chemists if they collaborate to subvert the charitable donation process and breach the Anti-Kickback Statute’s provisions on kickbacks reimbursement.
Special Agent Joseph R. Bonavolonta in Charge of the Boston FBI Division stated that Biogen Inc. attempted to unethically boost its bottom line by collaborating with Advanced Care Scripts to charge the Medicare program for those patients who were already acquiring their medication for free, compromising Medicare’s copay structure which was designed by the Congress to protect against inflated medication prices. Bonavolonta further added that kickback conspiracies, including this scheme, compromise the nation’s health care system, corrupt medical decisions, and waste taxpayer funds. Special Agent Bonavolonta assured that the FBI would persistently collaborate with its enforcement partners to hold responsible those scheming to disguise kickbacks as charitable donations, at the cost of the Medicare program.
From 2017 the Office of the United States Attorney has collected more than 1 billion U.S. dollars from 11 pharmaceutical firms that purportedly utilized 3rd-party foundations as channels to reimburse kickbacks. The Department further has reached a settlement agreement with 4 foundations and Advanced Care Scripts regarding its relationship with a different pharmaceutical firm.
The False Claims Statute resolutions settle accusations initially submitted in cases filed by whistleblowers under the qui tam provisions of the False Claims Statute, which permits private entities or individuals to submit and file cases on the government’s behalf and share in any recovery. Regarding the 17th December 2020 settlement, the whistleblower will obtain about 3.96 million U.S. dollars of the recovery.
First U.S. Assistant Attorney Mendell, HHS-OIG SAC Coyne, Acting Assistant Attorney General Clark, and Boston FBI SAC Bonavolonta reported the settlement on 17th December 2020. U.S. Assistant Attorneys Evan Panich, Abraham R. George, and Gregg Shapiro of Lelling’s Affirmative Civil Enforcement Unit investigated the case with help from Trial Attorneys Sarah Arni and Augie Ripa of the Department of Justice – Civil Division.
You risk a severe imprisonment sentence and hefty fines if found guilty of breaching the False Claim Statute, Anti-Kickback Statute, or the Controlled Substance Act. Plotting to commit health care fraud by swindling state-sponsored programs such as TRICARE or Medicaid could also have you locked up in the big house as fast. Individuals accused of committing the above crimes are treated as lawbreakers, and they can face severe punishment when and if found guilty. When charged with any health care fraud-related offenses, seeking the services of an excellent and experienced legal team is a matter of when not if.
Seek our highly qualified team; if you are looking to make your money count when it comes to the best legal representation and advice- a positive ending is assured. Our highly professional lawyers at the Health Care Fraud Group are at a wizard level when it comes to putting an end to all Health Care Fraud issues linked to the Federal Health Care Program. Their knowledge about civil cases runs deep, mainly due to the many years of practice and exposure. Their work ethic is also unmatched, and their excellent track record when dealing with health care fraud issues and investigations has made them a household name all across the United States. Additionally, they are well-versed in Health Care fraud defense, all legal matters, and medical matters.
We welcome you with open arms; our team is prepared to hit the ground running when it comes to your defense. Now, we are the best in the game for several reasons, top on the list being our team’s ability to act quickly on your case without you needing frequent legal consultations. Our evaluation of your case is faultless and quick, with us being extremely thorough with the collection, acquisition, and assembling of key details tied to the government’s investigation of your case. If hired, our team will liaise with yours to devise the best and most appropriate decisions. Our skilled attorneys will work round the clock to guide and train you on ways to aid your legal defense and advice you on some of the mistakes that will warrant a Health Care fraud investigation.
Additionally, we offer legal assistance and advice for cases and investigations under the jurisdiction of the IRS, FBI, DEA, CMS, DHHS, and the OIG. To keep your career off the mud, we also offer to investigate health care fraud potentials, and if already indicted in health care fraud, we make sure to prove your innocence beyond a shadow of a doubt. Reach us at 888-402-4054 for the best legal representation, advice, or help with all your Health Care Fraud related charges.