The government and whistle-blowers have shifted their focus from drug manufacturers to parties that regularly contract with manufacturers, including Medicare Part D plan sponsors, as a target for False Claims Act investigations and lawsuits, according to a National Law Review report.
The Medicare Part D program receives a significant amount of taxpayer and beneficiary money, and there is a plethora of regulations that each party to a Part D transaction must comply with, which makes the program an attractive option for applying the FCA, according to the report.
The complexities of the Part D rules have caused companies, even those familiar with the rules, to become the subject of government FCA investigations. For example, in 2012, Walgreens agreed to pay nearly $8 million to settle an FCA lawsuit that was filed based on employees accepting Walgreens' gift cards from Medicare beneficiaries, even though the cards specifically stated those individuals were not permitted to use them.
Due to the complexities of the Part D rules and recent successful FCA lawsuits concerning Part D transactions, moving forward, parties involved in Part D transactions should expect increased scrutiny under a variety of laws, including the FCA, according to the report.
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