Pharmaceutical Firm Agrees to Reimburse $12,600,000 to Settle Accusations it Breached the False Claims Act

Pharmaceutical Firm Agrees to Reimburse $12,600,000 to Settle Accusations it Breached the False Claims Act

Philadelphia, Pennsylvania – Jennifer Arbittier Williams, Acting United States Attorney, on 4th May 2021, reported that Incyte Corporation, with headquarters in Delaware, had consented to reimburse 12.6 million U.S. dollars to resolve claims that it breached the False Claims Statute by utilizing a foundation as a channel to reimburse the copayments of the Medicare and TRICARE programs patients using Incyte’s medicine Jakafi. The TRICARE program is a federal health care program for disciplined service members, veterans, and their kin.

When a recipient of the Medicare or TRICARE programs receives a prescription medication covered by a federally-funded health care program, the recipient may be obligated to make a partial reimbursement, in the form of a coinsurance, copayment, or a deductible (“copays”). The copays were included in the programs by Congress, in part, to act as a check on healthcare expenses, including the costs that pharmaceutical firms can demand for their medications.

According to the Anti-Kickback Act, a pharmaceutical firm cannot give or reimburse, indirectly or directly, any inducements, such as money or any additional thing of value, to persuade the Medicare or TRICARE programs patients to buy the firm’s drugs. This ban includes the reimbursement of patients’ copay requirements. Reimbursement of those prescriptions in breach of the Anti-Kickback Act results in submission of fraudulent claims to the Medicare program and TRICARE program and the False Claims Act violations.

Incyte Corporation trades Jakafi, a drug sanctioned in 2011 to treat myelofibrosis and sanctioned for the treatment of other disorders after 2014. Incyte Corporation purportedly was the only donor to a fund that was incepted in November 2011 by a nonprofit foundation to help myelofibrosis patients only. Following the inception of the fund, the U.S. contents that between Nov. 2011 and Dec. 2014, Incyte Corporation used its effect as the only donor of the fund to have the nonprofit foundation reimburse the copays of the Medicare and TRICARE programs patients using Jakafi that never had myelofibrosis, and therefore were ineligible for support from the fund. Incyte Corporation managers purportedly influenced the nonprofit foundation via emails and phone calls to give economic aid to these unentitled patients, and Incyte Corporation’s contractor assisted ineligible recipients in filing their applications that were presented to the fund for aid. The U.S. purports that through this behavior, Incyte Corporation caused fraudulent Jakafi claims to be submitted to the Medicare and TRICARE programs.

Jennifer Arbittier Williams, Acting United States Attorney, stated that Pharmaceutical firms should not violate the anti-kickback Act by concealing their incentives to government-insured patients as generous donations. Acting U.S. Attorney Williams further added that this settlement shows their office’s persistent commitment to holding answerable drug firms for this conduct.

Northeast Field Office DCIS Special Agent in Charge Patrick J. Hegarty stated that safeguarding the TRICARE program is the Defense Criminal Investigative Service’s top priority.  Special Agent Hegarty added that Incyte Corporation’s fraudulent claims for unqualified patients undermined the TRICARE program integrity. Special Agent Hegarty further said that the 4th May 2021 resolution resulted from a collaborative effort with the Justice Department – Civil Frauds, U.S. Attorney’s Office, and Health and Human Service Department -Office of Inspector General, and proves their ongoing dedication to collaborate with its law enforcement partners to inquire those who take part in health care fraud.

The civil resolution comprises the settlement of accusations submitted under the False Claims Act’s qui tam provisions by Justin Dillon, a previous compliance manager at Incyte Corporation.  According to these provisions, a private individual or entity can file a case on behalf of the government and get a percentage of any recovery. The qui tam suit was lodged by Brian McCormick from Ross Feller Casey LLP, based in Philadelphia, Pennsylvania.

Acting U.S. Attorney Williams thanked the whistleblower and relator’s counsel for their help to this matter. Williams said that without information from Americans like the whistleblower in this case, discovering fraud and protecting government program funds would be very difficult.

The Defense Department – Office of Inspector General, together with the U.S. Health & Human Services Department – Office of Inspector General, carried out the matter’s investigations. The investigation and settlement obtained in this suit were handled by Deputy Chief Charlene Keller Fullmer, Assistant United States Attorneys Matthew E.K. Howatt and Paul J. Koob, and Auditor George Niedzwicki.  This case was handled in collaboration with Fraud Section’s Senior Trial Counsel Jennifer Cihon of the Justice Department – Civil Division, Commercial Litigation Branch.

The claims settled by the resolution are merely allegations, and there has been no liability determination.

Breaching the Controlled Substance Statute, the False Claim Act, and the Anti-Kickback Statute is harshly punished by the law. Besides, conspiracy to commit health care fraud like stealing taxpayer-funded health care programs, like the Medicare, TRICARE, or Medicaid programs, is a serious crime. Any person who executes these crimes violates the law and is sternly fined or punished if found liable of or pleads guilty to the accusations. When charged for these offenses, one must look for the best legal assistance or representation to defend, fight, and pursue their rights. You should hire our competent team of the best defense and criminal attorneys if you require the most exceptional legal assistance and representation, which guarantees positive result for your case. Health Care Fraud Group consists of a highly qualified team of lawyers with tremendous skills in handling Health Care Fraud-linked matters concerning Federal Health Care programs; they are highly informed about civil and federal matters. The attorneys are well-known across the nation due to their remarkable work and proficiency when tackling health care fraud investigations and cases. Our experienced attorneys are fully fitted out with prior knowledge of each phase of Health Care fraud protection, medical, and legal issues.

Our offices are functional 24/7, and we are fully prepared and set to begin your protection instantly. We conduct a brief and safe assessment of your issue and work fast to collect, acquire, and bring together the necessary and vital particulars regarding your case in the government’s inquiries. Once you employ us, we will assist you and your colleagues to come up with the correct and best verdict.

Besides, we will offer you and your team with full legal assistance and defense in matters and investigations that you are indicted with and even those in other firms or institutions that cover the Internal Revenue Service and the Federal Bureau of Investigation, and inquiries and cases that are under the jurisdiction of the CMS, DOJ, DHHS, OIG, and DEA. Also, we will inquire about potential health care fraud and assist in keeping you and your career safe. Our highly qualified attorneys at the HCFG are conversant and clearly understand the need to prove innocence after the accusation of any crime. For any legal representation, advice, or support you may need, contact us at 888-402-4054.

Schedule a Confidential Initial Compliance Assessment with Our Federal Health Care Group