The City of New York and a number of New York counties have won a significant ruling in their Medicaid fraud case in federal court against 13 drug companies. The Plaintiffs’ victory came on their motion for partial summary judgment on liability. All of the 13 drug companies had reported WACs and most had reported AWPs for Medicaid reimbursement purposes. The reported prices were not the actual prices paid for any of the companies’ drugs. Employees of the companies actually admitted that the WACs and AWPs reported were not the real prices paid to acquire their drugs. The court ruled as a matter of law that the Defendants reported false prices and had committed fraud.
The Defendants tried to convince the court that the Plaintiffs knew the reported prices were false, but the judge didn’t buy that defense. The court ruled that AWPs are by statute prohibited from being used for reimbursement and are to be kept as confidential by the federal government, Centers for Medicare and Medicaid Services (CMS). Thus CMS could not have given this information to Plaintiffs. The court pointed out further that the Medicaid Act required CMS to set its prices on the basis of the companies’ published prices.
The court ruled that the Defendants made false representations in the form of WACs and AWPs in order to be reimbursed for their drugs. The judge granted partial summary judgment on the liability issue in favor of the Plaintiffs and against each of the 13 drug companies.
The companies involved in the ruling were: Barr Laboratories; Dey; Ethex Corporation; Ivax Corporation; Mylan; UDL Laboratories; Par; Purepac Pharmaceuticals; Boehringer Ingelheim (formerly known as Roxane); Sandoz; Schering Corporation; Teva Pharmaceutical USA; Watson Pharmaceuticals; and Wyeth. It should be noted that Ethex subsequently settled with the Plaintiffs after the ruling.
Source: The Court’s Order
Contact us today for a free legal consultation with an experienced attorney.
Fields marked *may be required for submission.
If you would like to subscribe to the Jere Beasley Report digital edition, simply visit our Subscriptions page and provide the necessary information or call us at 800-898-2034.
Attorney Advertising - Prior results do not guarantee a similar outcome.