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Draft:Ven-A-Care

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Ven-A-Care of the Florida Keys is one of the most financially successful whistleblowers in the history of the United States.[1][2] The four-person team[1] specialized in being relators for qui tam suits in healthcare overbilling, producing more than $2.2B in revenue for the government and $380M for themselves and their legal team.[3] During a study conducted on whistleblowing efforts between November 2010 and July 2012, they accounted for almost half of the money from whistleblower-prompted federal and state settlements.[4]

Ven-A-Care is additionally unusual for being what are termed outside relators, or people who investigate companies they have no other formal relationship with in order to find and report wrongdoing.[1][3] As a consequence of this, they also have filed whistleblower suits against an unusually large number of unique defendants.

Early history and first case

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Ven-A-Care was co-founded by Mark Jones and Luis Cobo[3] as a four-person[1] pharmacy in the 1987.[5] They specialized in to providing end-of-life care to HIV and cancer patients during the AIDS Crisis. This came primarily in the form of home infusions.[6]

In 1991 W. R. Grace and Company allegedly approached Ven-A-Care about partnering to open a new AIDS clinic, termed National Medical Care Inc. In lawsuits, Ven-A-Care alleged that National Medical Care Inc intended to choose the drugs that would make the clinic the most money, rather than selecting the drugs for medical reasons.[6]

The new clinic significantly negatively impacted Ven-A-Care's operations, and eventually lead to their first qui tam lawsuit in 1994.[6] The ensuing $500M settlement in 2000 against National Medical Care Inc broke Department of Justice records and included a $100M criminal penalty.[7]

Additional anti-fraud litigation work

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Much of Ven-A-Care's litigation was based on alleged manipulation of the calculation of average wholesale price for Medicare and Medicare billing.[8]

In 2001, a Ven-A-Care case with Bayer reached a settlement.[9]

In 2005, a Ven-A-Care case with GlaxoSmithKline Pharmaceuticals settled.[10]

In 2007, a Ven-A-Care case reached a settlement with Bristol Myers Squibb and its subsidiary Apothecon.[11] Another case, with Aventis Pharma also settled.[12][13]

In 2009, Ven-A-Care's cases with four pharmaceutical companies (Mylan, AstraZeneca, Ortho-McNeil Pharmaceutical, and UDL Laboratories) settled over a Medicaid Drug Rebate Program suit.[14] A case against Schering-Plough also settled that year,[15][16] as did an additional one with Teva Pharmaceuticals.[17]

In 2010, they secured settlements against Abbott Laboratories[3] B. Braun and Roxane Labs,[18][19] and the Dey family of companies.[5][20]

In 2011, after 18 cases handled by settlement, a Ven-A-Care secured its first trial victory over Actavis.[3] The verdict was appealed, and the eventual settlement was for far less.[21] A separate case against Par Pharmaceutical also settled.[22][2] Two additional cases against Watson Pharmaceuticals and a unit of Novartis also settled.[23]

In 2013, Ven-A-Care settled a price manipulation case against Pfizer.[24]

In 2017, Ven-A-Care settled a second case against Mylan,[25] this time with former defendant Sanofi (via Avantis) as a co-relator.[26]

References

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  1. ^ a b c d Javers, Eamon (February 10, 2011). "How Four Men Got Rich Exposing Pharma Fraud". CNBC.
  2. ^ a b Rockwell, Lilly (November 5, 2012). "Medicaid Fraud Fighters". Florida Trend.
  3. ^ a b c d e Zajac, Andrew (February 2, 2011). "Whistle-blower Ven-A-Care wins in Texas case against drug company". LA Times.
  4. ^ "State Settlements With Drug Companies Over Medicaid Fraud Are at Record Highs; Many States Recover More Than They Spent on Enforcement". Public Citizen. September 27, 2012.
  5. ^ a b "Ven-A-Care Whistleblowers Strike Again, Recover $280 million from Dey Pharma". Greene LLP. December 20, 2010.
  6. ^ a b c Voreacos, David (August 13, 2013). "Fla. pharmacists win $597M blowing whistle on Medicare scheme". Bloomberg News.
  7. ^ Vise, David; Lorraine, Adams (January 19, 2000). "Firm Settles Health Care Fraud Case for $500 Million". Washington Post.
  8. ^ Hergott, Daniel (June 29, 2015). "How a Pharmacist Becomes A Qui Tam Whistleblower". Behn & Wyetzne Chartered.
  9. ^ "Bayer to pay $14 million to settle claims for causing providers to submit fraudulent claims to 45 state medicaid programs". US Department of Justice. January 23, 2001.
  10. ^ "Glaxosmithkline pays $150 million to settle drug pricing fraud case". US Department of Justice.
  11. ^ "Bristol-Myers Squibb to Pay More Than $515 Million to Resolve Allegations of Illegal Drug Marketing and Pricing". US Department of Justice. September 28, 2007.
  12. ^ "Aventis Pays More Than $190 Million to Settle Drug Pricing Fraud Matters". US Department of Justice. September 10, 2007.
  13. ^ "Sanofi settles Anzemet drug-pricing fraud case in the USA". PharmaTimes. September 11, 2007.
  14. ^ "Four Pharmaceutical Companies Pay $124 Million for Submission of False Claims to Medicaid". Office of Public Affairs US Department of Justice. October 19, 2009.
  15. ^ "U.S., Calif. and Florida recover $69 million from Schering-Plough". Phillips and Cohen. December 22, 2009.
  16. ^ "Brown Settles $21.3 Million Medi-Cal Fraud Suit with Pharmaceutical Giant Schering-Plough". State of California Department of Justice Office of the Attorney General. December 17, 2009.
  17. ^ Bouley, Jeffrey (February 4, 2010). "Teva announces 'settlement in principle' regarding drug pricing lawsuits". Drug Discovery News.
  18. ^ "Pharmaceutical Manufacturers to Pay $421.2 Million to Settle False Claims Act Cases". Office of Public Affairs US Department of Justice. December 7, 2010.
  19. ^ "Three Major Drug Firms Pay $421 Million in Settlement with Justice Department". ABC News.
  20. ^ "Pharmaceutical Manufacturer to Pay $280 Million to Settle False Claims Act Case". Office of Public Affairs US Department of Justice. December 20, 2010.
  21. ^ "Actavis settles Medicaid fraud case for $84 million". Reuters. December 28, 2011.
  22. ^ "Par Pharmaceutical Companies Announces Settlement in Principle Regarding Certain Drug Pricing Lawsuits". PR Newswire. April 27, 2011.
  23. ^ Voreacos, David; Rosenblatt, Joel; Bennett, Simeon (September 15, 2011). "Watson, Sandoz Pay $145 Million to Settle Drug-Price Case". Bloomberg News. Archived from the original on March 20, 2015.
  24. ^ Aaronson, Becca (January 4, 2013). "Texas Getting $36 Million in Settlement Over Medicaid Fraud Cases". Texas Tribune.
  25. ^ Sullivan, Michael (August 18, 2017). "$465 Million Settlement in Our Client's Qui Tam Whistleblower Case Over Pharmaceutical Manufacturer's Underpaying Medicaid Rebates for New EpiPen Products". Finch McCranie, LLP.
  26. ^ "Settlement Agreement". Securities and Exchange Commission. August 16, 2017.
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