Enacted during the Civil War in 1863, the False Claims Act (FCA) is an American federal law. Also known as the “Lincoln Law”, it imposes liability on both individuals and companies that defraud governmental programs. The FCA is the federal government's primary litigation tool in combating fraud against the government. It has been very effective in recovering substantial amounts of money for both the U.S. government and taxpayers.
The False Claims Act enables people to report and combat fraud against government programs and contracts. It is often used in cases involving healthcare fraud and defense contractor fraud as well as fraud related to government contracts, grants and subsidies. Violations of the FCA often result in significant financial penalties and legal consequences, not to mention reputational damage for those found guilty of defrauding the government.
Tampa doctor agrees to pay $1.5 million to settle FCA liability.
As reported last Friday by the Middle District of Florida branch of the U.S. Attorney’s Office, Dr. Edward Lubin will be coughing up no less than $1.5 million. The Tampa-based pain management physician has agreed to resolve allegations that he violated the False Claims Act. Lubin is accused of causing the submission of claims for fentanyl prescriptions that were written in exchange for kickback payments and that were medically unnecessary.
“The agreement resolves the United States’ claims against Dr. Lubin under the FCA,” informs the report, “The claims resolved by the settlement are allegations only, and there has been no admission or determination of liability.”
The allegations in the complaint involve the drug, Subsys.
Subsys is a fentanyl-spray medication. Manufactured by Insys Therapeutics, Inc. (Insys), the medication is used to help relieve sudden cancer pain. It is often prescribed to people who regularly take moderate to large amounts of opioid pain medication. Fentanyl is part of a group of drugs known as opioid analgesics. It works in the brain to change how the body feels and responds to pain.
The complaint from the United States alleges that Dr. Lubin knowingly and willfully accepted approximately $159,580 in kickback payments from Insys in return for prescribing Subsys. The settlement figure of $1.5 million is nearly 10 times the amount that Dr. Lubin received in kickbacks, the U.S. Attorney’s Office report points out.
Dr. Lubin disguised his kickback payments.
The United States alleges that once Dr. Lubin became involved with Insys, he immediately began prescribing Subsys in exchange for kickbacks. Medical necessity did not play a factor in his decision to write the prescriptions. The complaint against the doctor contends that the kickbacks paid to him were disguised as payments for speaking at sham “events”. These engagements either lasted a few minutes or never occurred.
In some cases, the sham “events” apparently had repeat attendees despite the lack of any reason to present the same information multiple times to the same individuals. The report reveals that court documents allege that Dr. Lubin caused more than 400 false claims for Subsys to be submitted to the Medicare and TRICARE programs. They were all in violation of the federal Anti-Kickback Statute (AKS) and the FCA, which paid in excess of $4 million for these claims.
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