GE Healthcare has paid the U.S. $30 million, plus interest, to settle allegations that a company it acquired in 2004, Amersham Health, had violated the False Claims Act by causing Medicare to overpay for Myoview, a radiopharmaceutical used in certain cardiac diagnostic imaging procedures, according to the U.S. Department of Justice (DoJ).
Myoview is distributed in multi-dose vials of powder, which nuclear pharmacies mix with a radioactive agent to prepare individual doses that are injected into patients as part of the cardiac imaging procedures. Certain Medicare payment rates for Myoview were based, in part, on the number of doses available from vials of Myoview, according to the DoJ. The government alleged that Amersham provided false or misleading information to Medicare regarding the number of doses available from vials, causing Medicare to pay for Myoview at artificially inflated rates.
“It’s important for drug manufacturers to provide accurate pricing information to Medicare so that taxpayers aren't overcharged for medicines purchased with their dollars,” said Tony West, assistant attorney general for the DoJ’s civil division.
The allegations arose from a lawsuit that was brought under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the U.S. and to share in any recovery. The whistleblower in this suit, James Wagel, will receive $5.1 million from the government’s recovery.
This resolution is part of the government’s emphasis on combating healthcare fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services, in May 2009. One of the most successful tools in that effort is the False Claims Act, which the DoJ has used to recover more than $6.6 billion since January 2009 in cases involving fraud against federal healthcare programs.
The DoJ’s total recoveries in False Claims Act cases since January 2009 are more than $8.6 billion.