Advanced Search

Medicare Compliance & Reimbursement

ENFORCEMENT WATCH:

DOJ Chips Away At 'Double Dipping' Schemes

Published on Fri Sep 09, 2005

Best advice: Dip once and end it.

Providers beware: The Department of Justice is paying even closer attention to the accuracy of providers' drug prices that impact Medicare and Medicaid payments.

Reason: Pharmaceutical manufacturing giant GlaxoSmithKline has agreed to pay $150 million to settle allegations of fraudulent and inflated drug prices, the DOJ announced on Sept. 20.
 
The company allegedly hatched a scheme to inflate its prices for Zofran and Kytril, causing federal healthcare programs to base their reimbursement rates on the incorrect prices, and thus, cause providers to submit false claims to Medicare and Medicaid.

GlaxoSmithKline also purportedly engaged in a "double dipping" scheme in which the company encouraged customers "to pool leftover vials of Kytril to create an extra dose, which then would be administered to a patient and re-billed to Medicare and other federal healthcare programs," the DOJ says.

Ven-A-Care of the Florida Keys, Inc., a home infusion company, filed a whistleblower lawsuit against GlaxoSmithKline, which spurred the investigation. Ven-A-Care will receive approximately $26 million of the settlement. The federal government will receive $140 million of the settlement and the states will receive a full $10 million.

GlaxoSmithKline has also agreed to an addendum to its existing Corporate Integrity Agreement with the HHS Office of Inspector General that would require the company "to report accurate average sales prices and average manufacturer's prices for its drugs" that Medicare and Medicaid cover, the DOJ notes.

Find it online: To read the press release, go to http://www.usdoj.gov/opa/pr/2005/September/05_civ_489.htm.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All