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Breaking News: Virginia Attorney General Bob McDonnell resigns to focus on his gubernatorial race



Attorney General Bob McDonnell announced his resignation this morning in an email to OAG staffers.  No big surprise there–for the last thirty years, no Virginia Attorney General has served more than three years in office.  Julian Walker at the PilotOnline  has the story.

IMHO, Bob McDonnell has done a fine job as AG, and he has been a big improvement over his predecessors in many ways.  It appears that Bill Mims, McDonnell’s chief deputy, is poised to take the reins.  Because the General Assembly is in session, the decision will be confirmed by them, and Mims is expected to sail through. 


 

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Just One Example of Why the Office of the Attorney General is so Important




Given that the last few posts have concerned the OxyContin prosecutions led by Attorney General Bob McDonnell and former U.S. Attorney John Brownlee, today’s OAG press release was perfect timing.

Today, Virginia Attorney General Bob McDonnell awarded a small slice of the money Virginia recovered from Purdue Pharma.  A little over $650,000 of the $634 million recovered in the OxyContin prosecutions was awarded to three worthy causes in rural Virginia.

Click here to read the OAG press release. 

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Eli Lilly May Spend $2 Billion More for Fraud on State Governments–But Again, Where is Virginia’s Share?


Eli Lilly & Co., after agreeing to pay more than $2.6 billion to settle claims by the federal government and an assortment of state governments over the marketing of its anti-psychotic drug Zyprexa, still faces lawsuits that might cost the company an additional $2 billion.

That is because only certain states settled in the original settlement agreement, announced last week.  There are currently 12 state suits pending, and additional states, such as Virginia, could bring suit any time to reclaim the money fraudulently obtained from our Medicaid coffers. 

The states claim Lilly withheld information about the side effects of Zyprexa, such as diabetes, and encouraged sales of the drug for unapproved, or off-label, purposes. The states who have brought claims have asked for damages and fines for violations of their state false claims acts.

I suppose I will leave it to Attorney General Bob McDonnell to explain why Virginia has not filed its own lawsuit to claim its share–General McDonnell has done a very good job of making sure Virginia reclaims its money for the most part, so I hope it is just a matter of time.

Perhaps the biggest flaw in McDonnell’s administration of the OAG has been his failure to see the importance of hiring outside counsel to prosecute claims his office is too overwhelmed to handle. 

Like some politicians in both parties, McDonnell brings to the table an inherent bias against trial lawyers, and especially a bias against hiring outside counsel on a contingency-fee basis.  In some cases, he is quite correct that a state would be better off paying for its outside lawyers on an hourly basis. 

Given the Commonwealth’s current budget crisis, however, I doubt very much that Virginia has the funds to pay outside counsel by the hour to pursue its share of the Zyprexa settlement.  In this current climate, McDonnell would do well to reconsider his ban on hiring outside counsel on a contingency fee basis.   


The take away message is this–big pharmaceutical companies have been gorging themselves on our state and federal tax dollars for many years, and they are just now starting to pay the piper.  The battleground is shifting to state governments–specifically, to the various state Attorney Generals who have the authority to prosecute false claims made to the Medicaid programs of each state.  

And THAT, ladies and gentlemen, is why this blog sometimes discusses politics and specifically the 2009 Virginia Attorney General race.  In order to maximize our state expenditures, we need our next Attorney General to get tough with everyone gorging themselves on our state tax dollars.  That includes “big pharma”–i.e., the big pharmaceutical manufacturers–but it also includes everyone else that does business with the Commonwealth, from Fortune 500 companies to the Wall Street traders that handle our bond sales to the mom and pop operations that provide mulch on our interstates. 

Virginia has one of the lowest tax burdens in the entire country, and Virginia’s government does much with a little, but we could do so much more.


 

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How The Mighty Have Fallen: Restrictions Are Upheld for Executives in Purdue Pharma OxyContin Case



An administrative law judge has upheld a decision barring three former Purdue Pharma executives from participating in federal health care programs for 15 years, the Department of Health and Human Services announced last Friday, according to the New York Times.  

The three executives are former CEO Michael Friedman, Howard Udell, the company’s former top lawyer, and Dr. Paul Goldenheim, who was once the chief medical officer of the company.  In a nutshell, they pled guilty to intentionally misbranding OxyContin as a safe, non-addictive pain reliever, when in fact they knew those things be untrue.   

In 2007, as part of a /files/116785-109034/Plea_Agreement_Friedman.pdf”>Friedman, /files/116785-109034/Plea_Agreement_Udell.pdf”>Udell, each pleaded guilty to criminal charges.  As a result, each was banned for 15 years from doing business with federal health care programs. 

Notwithstanding the logistics and the sheer size and  Mixx Delicious Digg Facebook Twitter

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Eli Lilly Agrees to Pay $1.4 Billion to Settle Qui Tam Claims Brought by the United States and 26 States–Unfortunately, Virginia is Not Among Them



For the first time, a qui tam settlement has topped the $1 billion mark.  Late last week, Eli Lilly announced that it had agreed to pay a total of $1.4 billion to the United States and to a collection of participating state governments for off-label marketing violations and other violations related to the drug Zyprexa.  

Before going any further, a few words about pharmaceutical fraud and off-label marketing will be helpful.  Off-label use of a drug occurs whenever the drug is prescribed by a doctor to treat a condition or illness other than the condition or illness for which it is approved by the United States Food and Drug Administration. 

When a physician writes a prescription for a drug to treat a condition other than the one for which the drug is approved by the FDA, that is known as an “off-label” prescription.  Physicians prescribe drugs for off-label purposes all the time–it is considered well within the discretion of the treating physician.

For Medicare or Medicaid patients, however, it is a different story.  Both programs refuse to pay for any drug that is prescribed for an off-label purpose (i.e., any purpose other than one approved by the FDA.)
 
The states recovering money include Washington state, which will receive $7 million, Texas, which will receive $30 million; Michigan, which will receive $26.4 million, and others.  No word yet on Virginia’s share.
 
     

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SCOTUS Blog Selects Several False Claims Act Cases in “Petitions to Watch”



This week the renowned SCOTUS blog highlighted Petitions for Certiorari filed in several False Claims Act cases.  This is important for many reasons, not the least of which is that the folks at the SCOTUS blog have an uncanny ability to predict which petitions will be granted by the United States Supreme Court.  

SCOTUS, for those of you who may be wondering, is an acronym for Supreme Court of the United States.  I confess to having no idea where this acronym comes from, but I assume it comes from the same source as the acronym “POTUS” for President of the United States.  The SCOTUS blog was started by Supreme Court practitioner Tom Goldstein. 

In federal courts, certiorari is the writ that an appellate court issues to a lower court in order to review its judgment when there is no right to an appeal.  Any given petition faces incredible odds–of the more than 7,000 petitions that are filed in an average year, the Supreme Court will generally grant somewhere between 75 and 150.     

The SCOTUS blog has correctly predicted certiorari grants in the last three FCA-related Supreme Court cases.

The two cases highlighted this week are: 

Docket: 08-511
Title: U.S., ex rel. Feingold v. Palmetto Gov’t Benefits Adm’rs
Issue: Whether the Eleventh Circuit correctly decided that a provision granting immunity to Medicare carriers for any payment that is processed on behalf of the government barred a qui tam suit.


Docket: 08-660
Title: U.S. ex rel. Eisenstein v. City of New York
Issue: Whether the 30-day time limit in Federal Rule of Appellate Procedure 4(a)(1)(A) for filing a notice of appeal, or the 60-day time limit in Rule 4(a)(1)(B), applies to a qui tam action under the False Claims Act.





 

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A New Year, A New President, and Lots of New Money–How We Can Prevent the Same Old Fraud?


The year 2009 will bring a new President to the White House who has promised lots and lots of new federal money to fund various state and federal projects.  Some have gone so far as to say that President-elect Obama will supervise the largest spending program since the Eisenhower Administration built the federal interstate system.  


With great opportunity comes great risk, however.  This blog has previously argued that the Federal False Claims Act and state false claims acts such as the Virginia Fraud Against Taxpayers Act have their own role to play in protecting this large expenditure of federal funds.  Furthermore, because anyone with knowledge of fraud on the federal government or a state government can come forward under the qui tam provisions of such statutes, each individual has their own role to play. 


As one example of the sort of mischief that follows large federal expenditures, today we will look at fraud in the E-rate Program.  I selected this example because we have all heard a great deal recently about federal funding to extend broadband Internet access to remote areas of the United States.


E-Rate, a program authorized by Congress in the Telecommunications Act of 1996, was designed to ensure that all eligible schools and libraries have affordable access to modern telecommunications and information services. Up to $2.25 billion annually is available to provide eligible schools and libraries with discounts under the E-rate program for authorized services.  

Under the E-Rate program, schools can receive money for cabling, Internet infrastructure items (i.e., servers, PBX switches and so forth), and the reimbursement of monthly Internet and telephone service fees.  E-rate operates under the auspices of the Federal Communications Commission (FCC).

In a nutshell, eligible institutions can file a federal FCC Form 471 with the FCC listing the services and other items desired.  Privater vendors can access these postings, and then directly contact the entity to bid on providing the work.  E-rate is only available to institutions that have certain qualifying characteristics.  If the entity seeking funding is a school, for example, a certain percentage of the school’s students must qualify for the National School Lunch Program.  There is also a preference for rural schools and libraries.

As we see in other contexts such as healthcare, a cottage industry has sprouted up around defrauding the E-rate Program.  Such fraudfeasors normally call themselves “Education Consultants” or some such title, and they promise to obtain E-rate funding for anyone who hires them.   One such individual is former “Education Consultant” Judy N. Green, who was sentenced to 7.5 years in prison for participating in E-rate fraud in Arkansas, California, Michigan, New York, Pennsylvania, South Carolina, and Wisconsin. 

Green was convicted of orchestrating schemes to defraud the E-Rate Program of funds by inflating the cost of eligible equipment and services in order to pay for ineligible equipment and services, and by misrepresenting schools’ ability and willingness to pay their portions of the projects’ costs.  She also conspired to rig bids in favor of companies and individuals that had business relationships with her. 

Anyone with first-hand knowledge of fraud on the E-rate program has the ability to step forward and take action to stop it utilizing the qui tam provisions of the Federal False Claims Act.  Last year, the United States recovered more than $1 billion as a result of whistleblowers who decided enough was enough.  Those who come forward are eligible to receive an award of between 15 and 30 % of the recovered funds. 

To learn more about becoming a whistleblower under either the Federal False Claims Act or the Virginia Fraud Against Taxpayers Act, please click here.    


 

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Ohio Auditor Misses the Mark: Ohio’s Plan to Reduce Medicaid Fraud Includes Everything BUT a State False Claims Act



The state of Ohio–which, like every other state, is facing a record budget deficit–is searching for ways to cut costs and stretch its budget a little.  Amazingly, in a new report released this week by Mary Taylor (who currently serves as the state’s Auditor), the passage of a state false claims act is not one of the suggestions made to stretch the state’s dollars further and eliminate fraud, waste, and abuse from the program. 

To put things in perspective, Ohio spends over $13 billion each year on the Medicaid program.  This amount represents nearly a quarter of the total state budget.  Assuring that these funds are spent appropriately and that fraud, waste and abuse are identified and addressed is one of Ms. Taylor’s priorities.

You can view Auditor Mary Taylor’s web page, as well as some of some of the blog discussion from Ohio and you will find no mention of a state false claims act.  I suspect the reason is a simple failure to understand the concept of the false claims act.  

As a member of the House of Representatives in 2005, Auditor Taylor worked with the Ohio General Assembly to include legislative language giving the Auditor of State the authority to undertake a performance audit of the Medicaid program, as well as the ability to audit Medicaid providers.  According to her website, this legislation has resulted in a number of policy changes that address efficiencies that can be achieved in the Medicaid program and protect and saved significant taxpayer dollars.

That is all fine and well–however, if Ms. Taylor really wants to save the good people of Ohio some money, she will simply request that a state false claims act that complies with the Deficit Reduction Act of 2005 be enacted.  Simply by having such a law in place, the state will receive an additional 10% of all monies recovered–even without taking any further actions.    In other words, there is no need to hire additional prosecutors, or do anything else, in order to start reaping the benefits.

This Cook & Kitts, PLLC        

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Breaking News: Amendments to the Michigan False Claims Act



Yesterday, the Michigan False Claims Act was amended to add two important–but optional–elements of a state false claims act.  Previously, this blog has not addressed elements of a state false claims act over and above compliance with Deficit Reduction Act of 2005, so this seems like as good a time as any.


You can read the Michigan changes /files/116785-109034/OIG_statepolicymakers.pdf”>similar enough to the Federal False Claims Act that it was approved by the Office of the Inspector General of the Department of Health and Human Services.  After its approval, Michigan began to receive an additional 10% of all monies recovered by Medicaid fraud prosecutions. 

However, just because a state false claims act complies with the wishes of the federal government does not mean it is doing all that such a statute can do for the state.  One drastic error that some states make is passing a state false claims act that applies only to Medicaid fraud, which is exactly what Michigan had until yesterday.      

In other words, Michigan’s previous statute was not a general false claims act that outlawed any false claim made to the state of Michigan for payment, or to avoid payment to the state of Michigan. 

As a result, the state was leaving tens of millions or hundreds of millions of dollars on the table–or more accurately, in the pockets of fraudfeasors–every year by only penalizing Medicaid fraud.  With the exception of Medicaid fraud, until yesterday it was open season on the Michigan treasury by unethical actors of all stripes.  As just one example, banks and federal credit unions were free to not escheat unclaimed money to Michigan, without fear of substantial penalties.

No longer.  Now, Michigan has a statute penalizing the same conduct as the Federal False Claims Act.  Just to bring things full circle, our own Virginia Fraud Against Taxpayers Act has been, since it became law on January 1, 2003, a general false claims act that provided remedies for any false claim made to the Commonwealth. 

The second major change made yesterday is one that our Virginia statute does not have.  I am referring to a “retroactive clause” which would make false claims made prior to the enactment of the statute subject to suit.  Now that our statute is almost six years old, retroactivity is not such a problem. 

At any rate, I should mention that Michigan qui tam lawyer Dave Haron is largely responsible for moving the changes thought the Michigan legislature–congratulations Dave!      



  

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Starting today, Federal Contractors Must Focus on Ethics and Disclose “Credible Evidence” of False Claims Act Violations



Effective today, federal contractors are required by the Federal Acquisition Regulations (“FAR”) to take certain proactive steps regarding the Federal False Claims Act. 

The Federal Register’s publication, which includes the comments made by the industry, and the responses to such comments, can be seen Mixx Delicious Digg Facebook Twitter