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In this Issue
OIG Activity CMS Developments Trailblazer Fraud Alert Reveals Provider Identity Theft Long Term Care Pharma Hospitals Nonphysician Practitioners Compliance OIG's Supplemental Hospital CPG Looks at Hospital-based Physicians OIG/AHLA Release Second Compliance Resource Reimbursement Correct Minor Errors and Omissions Without Appeals Self-referral FCA Lack of Pharmaceutical Recycling Guidance Precludes FCA Liability Questionable Incentive Program Raises FCA Liability Enforcement Tax Antitrust Physican Focus Employment |
TAP Pharmaceuticals Settles with Lupron Consumers
When TAP Pharmaceuticals paid $875 million in 2001 to settle criminal and civil charges of fraudulent drug pricing and marketing of its cancer drug, Lupron, it was one of the largest amounts ever paid in a health care fraud prosecution. Even so, the amount paid did not include compensation for the health insurers and consumers who alleged they had been overcharged for the drug. The civil claims brought against TAP Pharmaceuticals by a nationwide class of insurers and consumers were resolved November 24, 2004, when TAP agreed to pay Lupron purchasers $150 million as compensation for the allegedly inflated prices they paid for the cancer drug. Lupron is an injectible drug used primarily to treat prostate cancer, endometriosis, uterine fibroids, and precocious puberty. The class action claimed that consumer prices for Lupron were inflated as a result of TAP Pharmaceutical's sales, pricing, and marketing practices, which allegedly included artificially inflating the Average Wholesale Price of the drug; giving doctors free samples for which the company knew the doctors would charge patients and insurers; and giving doctors incentives for prescribing Lupron. The settlement did not include an admission of wrongdoing by TAP Pharmaceuticals. The settlement involved two separate classes of plaintiffs: one a group of health insurance companies and health plans (Settling Health Plans (SHP) Group); the other a Lupron Purchaser Class comprised of third-party payors and individual consumers. Under the terms of the settlement, $55 million of the $150 million settlement amount would be paid to the SHP Group. The remaining $95 million would be paid to the Lupron Purchaser Class, with $40 million allocated to consumers and $55 million to third-party payors. s Class members can access documents related to the Lupron settlement, including claim forms, through the official court website for the Lupron class action settlement at www.lupronclaims.com. Copyright© 2005, Ober, Kaler, Grimes & Shriver | ||