Category:

Fraud & Abuse

SEC Whistleblower Program Surpasses $1 Billion in Award Payouts

The U.S. Securities and Exchange Commission (SEC) reached a rather auspicious milestone in September when it announced that, with the addition of two recent awards totaling $114 million, the aggregate amount of monies paid out under the SEC’s whistleblower program since its implementation in 2011 has exceeded $1 billion. In fiscal year 2021 alone, the SEC has awarded a record $500 million. The SEC also reported that award payments have been made to a total of 207 whistleblowers. In a statement, SEC Chairman Gary Gensler said, “[This] announcement underscores the important role that whistleblowers play in helping the SEC detect, investigate and prosecute potential violations of the securities laws.” The two most recent awards included a payment of $110 million to an individual who, according to the SEC, provided the SEC and another regulatory agency with “independent analysis that substantially advanced the SEC’s and the other agency’s investigation” and culminated in successful enforcement actions. Another whistleblower also provided original information to the SEC and received an award of approximately $4 million, although the smaller amount reflects the fact that the information passed on was significantly more limited in scope. As is its standard policy, the SEC declined to specifically name either of the whistleblowers involved or the cases and companies to which they were connected.

Talk Kickback to Me: Healthcare Provider Remuneration by Big Pharma

Recently, pharmaceutical companies are gaining increased notoriety for violations of the False Claims Act, the Anti-Kickback Statute, and general fraudulent practices directed toward physicians and medical care providers with the intent to increase profits. In 2019, Avanir Pharmaceuticals settled with the Department of Justice to pay more than $108 million of criminal penalties and civil damages for engaging in kickbacks with physicians, and misleading marketing of their drug Nudexta for unapproved purposes. Then, in May of 2021, Incyte Corp., a Delaware-based pharmaceutical manufacturer agreed to pay $12.6 million for unspecified damages arising under a violation of the Federal False Claims Act for improperly using an independent foundation to cover copays of individuals consuming Incyte’s cancer drug, Jakafi. Despite widespread prosecutions against pharmaceutical drug manufacturers, and the fraud deterrent provisions of the False Claims Act, the risk of fraud and remuneration still runs high in relationships between healthcare professionals and pharmaceutical companies.

The Explosion of Remote Patient Monitoring in the Wake of COVID-19

The COVID-19 pandemic has fundamentally changed many aspects of healthcare delivery. Most notably, the pandemic increased the demand for digital health services. Telemedicine saw ten years’ worth of expansion in one year, but it was not the only digital health service that exploded as a result of the pandemic. Telehealth has evolved from merely meeting with a provider via a video conference to include more sophisticated technologies. Remote Patient Monitoring (“RPM”) allows for providers to collect patient data without the patient having to go to a healthcare facility for monitoring. RPM can improve the quality of healthcare delivery by more closely monitoring a patient while also reducing patient volumes within a healthcare setting. In addition, because RPM allows patients to get more care at home, it can largely reduce costs to the patient and the payor while increasing access. Despite the many benefits associated with RPM, there are considerable risks and compliance issues.

Reining in Tax Havens

Shortly after Bristol Myers Squibb filed to create an offshore subsidiary in Ireland, the IRS took notice. The large drug manufacturer’s actions would now allow them to attribute some of its patent rights and medications to the subsidiary, and therefore subject to a twelve and a half percent Irish corporate tax rate, which is far less than the current twenty one percent rate in the United States. Additionally, while Bristol Myers had maximized the write offs and deductions for their products in the United States, the Irish deductions would now offset the U.S. taxes.

Lawmakers and Regulators Call for Action After Archegos Meltdown

Last week, the finance industry watched one of the biggest implosions of an investment firm since the 2008 financial crisis. Archegos Capital Management rocked the industry when it was forced to liquidate huge positions in blue-chip companies after some risky investment strategies went south. The financial instruments used in this risky investment strategy are called total return swaps. The Archegos meltdown has lead lawmakers and regulators to call for increased scrutiny of the swaps.

The “Particularity” With Which Relators Need to Plead Under The False Claims Act

The False Claims Act (“FCA”) is one of the United States Government’s most powerful tools for fighting fraud. In fact, the Department of Justice recovered nearly $1.8 billion under the FCA for health care fraud and $1.6 billion in FCA qui tam relator cases in the 2020 fiscal year. Keeping the enforcement of fraud in mind, underlying all FCA qui tam suits is successfully pleading with particularity under Federal Rule of Civil Procedure 9(b). This requirement has led many U.S. District Courts to dismiss qui tam cases at the pleading stage and U.S. Courts of Appeals to affirm those decisions. The upshot is that amid changes to the Stark Law and Anti-Kickback law, the continuation of COVID-19 related fraud, and the continuing splits in the Federal Circuit regarding pleading standards, the ground may begin to shift for compliance officers, attorneys, and general counsels in health care organizations.

McKinsey Reveals Management Issues in Rejecting Top Partner’s Bid for Reelection

In February 2021, McKinsey and Company’s 650 global partners turned down Kevin Sneader’s bid for a second three-year term as the firm’s lead partner. The rejection marked the first time in 40 years the storied consulting firm has opted not to offer its leader a second term. The vote came as McKinsey struggles to reconcile its lucrative business model with a series of ethical lapses that have been widely reported in the press, litigated in the courts, and questioned by some of the firm’s next generation of leaders.

Let It Ring

A full year of quarantine, and a whole lot of spam. You wouldn’t be alone in noticing that telemarketer and spam calls have proliferated in the past year of lockdown. The Federal Trade Commission (“FTC”) has noticed, too: the tail end of 2020 saw the agency file its first ever complaint against a VoIP service provider for enabling scammers to make robocalls. Just weeks later, they filed their second. The agency is making clear that this new method of enforcement will help combat the issue—but is it?

In the Aftermath of Identity Theft: What You Need to Know About the Fair Credit Reporting Act

For me, it started with a phone call. Normally I do not answer calls from unknown numbers. But that day I did. The woman on the other end of the line informed me that she was calling on behalf of a debt collection agency. Sensing my confusion, she explained, “We’ve been trying to reach you regarding your outstanding balance with Sprint.” That did not make sense, I insisted. I had never been a Sprint customer in my life. After a brief pause, she asked, “Have you ever been the victim of identity theft?”

Robinhood Fined $65 Million for Misleading Customers

On December 17, 2020, the Securities and Exchange Commission (“SEC”) charged Robinhood Financial, LLC (“Robinhood”) with material misrepresentation and misleading its users about its revenue sources, specifically Robinhood’s receipt of payments from certain principal trading firms for routing its customer orders to them. The SEC charges against Robinhood also relate to certain statements about the execution quality Robinhood achieved for its customers’ orders and Robinhood’s failure to satisfy its duty of best execution. Robinhood agreed to pay $65 million to settle the charges.