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Pharmaceutical Pharmaceutical Fraud Fraud in a Qui Tam in a Qui Tam World World Patrick J. O Patrick J. O ’ ’ Connell Connell

Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

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Page 1: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Pharmaceutical Pharmaceutical Fraud Fraud

in a Qui Tam World in a Qui Tam World

Patrick J. OPatrick J. O’’ConnellConnell

Chief, Civil Medicaid Fraud Chief, Civil Medicaid Fraud Office of the Attorney General Office of the Attorney General

Page 2: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General
Page 3: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

How to Get A Million Dollars and Never Pay Taxes!

• 1. First, Get a Million Dollars

• 2. When the IRS asks why you did not pay your taxes, you say: “I forgot”.

Page 4: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Get Yourself a Case

• 1. MFCU

• 2. Qui tam statute

• 3. Types of pharma cases:• Pricing or “AWP”• Rebate• Off Label Marketing• PBM• Misrepresentation of efficacy or side effects

Page 5: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General
Page 6: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Chapter 36, Texas Human Resources Code

    -Automatic Trebles    -Fees and Costs

    -Penalties from $1,000-$10,000 Per unlawful act

    -Automatic exclusion from program for minimum of 10 years

Page 7: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General
Page 8: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General
Page 9: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General
Page 10: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Get Some Lawyers

Page 11: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

• In-house Lawyers and Staff

• Relator Lawyers and Staff

• Outside Lawyers and Staff

• Coordination with Other States Through NAMFCU

Page 12: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Get Some Money

• Experts

• Travel

• Videographers

• Court Reporters

Page 13: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

State of Texas ex rel Ven-a-Care of the Florida Keys vs. Dey, Warrick &

Roxane• Filed Sept. 2000• Lawyers for Good Guys: 6• Lawyers for Bad Guys: 10+• > 130 Depositions• > 1,000,000 pages of documents• Travel to California, Tennessee, Ohio, New York, New

Jersey, Connecticut, Alabama• Sanctions against each company for discovery abuse• Largest sanction ever awarded in Travis County for

perjury in civil matter• Finally settled Nov. 2005• Recovery of $55.6 million, including $12.7 million in fees

and costs

Page 14: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

State of Texas vs. Abbott Labs, Baxter & B. Braun

• Filed May, 2004• Settled with Baxter and B. Braun for $12.3

million• Texas Lawyers: 3• Relator Lawyers: 3• Abbott Lawyers: 15+• Current Fees and Costs: $5 million +• Mandamus to Ct. App. twice• Mandamus to Tex. Supreme Ct. twice• Removed and Remanded

Page 15: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Results

Page 16: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Results

• Since 1999, recoveries of $217 million

• Texas recoveries of $127 million– Federal: $58 million– State: $50 million– Relator: $19 million

Page 17: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

Be Careful What You Wish For!

• Current Caseload: 175

• Current Unsealed Cases: 4

• Current Lawyer Staffing: 10

• Requested Staff Increase Approved By Legislature: 27

• Requested Appropriation Approved for Biennium: $10.5 Million

Page 18: Pharmaceutical Fraud in a Qui Tam World Patrick J. O’Connell Chief, Civil Medicaid Fraud Office of the Attorney General

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