The False Claims Act – An Aggressive Tool to Combat the Opioid Crisis

February 26, 2019

Two things have taken a toll on our overburdened healthcare system in recent years: Medicare Fraud and the Opioid Epidemic.  The False Claims Act (FCA) may serve as an antidote to both. 

Conceptually, the FCA is a tool that can be used to address the over prescription of opioids since inherently over prescription means it is unneeded and thereby fits squarely into the False Claims fabric to litigate and eliminate unneeded services.  The Federal Government has jurisdiction when the prescription of opioids leaps into the Medicare & Medicaid world then the taxpayers have been defrauded by paying for things that are worse than unneeded as they create a cycle of dependence for the user, and a cycle of billing for the medical provider.

The United States Department of Justice took a super-aggressive step with the their ironically named Prescription Interdiction & Litigation (“PIL”) Task Force, by filing a complaint under seal pursuant to the FCA against pharmacies for allegedly violating the Controlled Substances Act and the False Claims Act.  The violations allegedly are so perverse that at least two people have died as a result of these over prescriptions emanating from these facilities.

But the DOJ and the PIL team went further then usual and also asked for emergent injunctive relief to prevent the Defendants from prescribing any further opiates.  The Court signing off on this pushes the envelope a bit arguably, since the Defendant is not even given notice of the restraining order until after it’s served with it, since the motion to obtain one was under seal and thus, the Defendant did not have an opportunity to challenge the validity of this request.  Presumably, after being served with it, they would have some remedy to address it, albeit if the Defendant is guilty of all the items complained of, they will be hard pressed to upend such an order.

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A casual review of the docket does not reveal whether there’s an opioid whistleblower, but under the Federal False Claims Act a whistleblower stands to receive up to 30% of what the government’s economic recovery is in the fraud as whistleblower award for revelations regarding the over prescription of opioids under the Medicare program or Medicaid Program.   Similarly, the State of California has the California Insurance Claims Fraud Prevention Act which may permit up to 50% of the governments recovery for a California state whistleblower laws or under the State of Illinois, Illinois Insurance Claims Fraud Prevention Act the Illinois whistleblower can receive up to 40% of the amount recovered.  While the False Claims Act addressed the federal programs, California and Illinois state allow a whistleblower to bring an action to recoup for private insurance.

Opioid whistleblowers can come in different shapes and fashions.  Generally, a whistleblower is thought of as an insider, and the strongest cases are brought by people from within the scheme since they may have the detailed information needed to properly file the False Claims Act lawsuit.  However, there’s all sorts of scams that are run with opioid drug pushing that include the use of illegal runners, and even the unfortunate drug dependent user may be eligible to file an action if he or she knows enough of the plan. 

If you have information regarding the illegal prescription of opioids or the over-prescription of opioids, you should call our whistleblower law firm at (877) 561-0000 to discuss what your rights are. With the Federal Government aggressively tackling this problem, if you are on the inside and you’re not part of the solution the government may think you’re part of the problem, so the sooner you call, the sooner you can educate yourself about your rights. We offer free whistleblower consultations and can advice you confidentially of your options.