Novo Nordisk Pays $58M+ For Not Giving FDA-Required Warnings ABout Victoza Cancer Risks

September 11, 2017

Pharmaceutical Manufacturer Novo Nordisk Inc.’s $58.65 million settlement resolving charges it failed to comply with the Federal Drug Administration (FDA)-mandated Risk Evaluation and Mitigation Strategy (REMS) for its Type II diabetes medication Victoza illustrates the potential consequences that pharmaceutical companies risk by failing to provide FDA-required warnings about potential side effects of their drugs.

The settlement announced by the Department of Justice (DOJ) on September 5, 2017 resolves a DOJ civil complaint filed September 5, 2017 charging that Novo Nordisk violated a FDA requirement in effect at the time of Victoza’s approval in 2010 that Novo Nordisk provide information regarding Victoza’s potential risk of MTC to physicians.  The FDA required the notice to mitigate the potential risk in humans of a rare form of cancer called Medullary Thyroid Carcinoma (MTC) associated with the drug.   DOJ charged that some Novo Nordisk sales representatives gave information to physicians that created the false or misleading impression that the Victoza REMS-required message was erroneous, irrelevant, or unimportant. The complaint also alleges that Novo Nordisk failed to comply with the REMS by creating the false or misleading impression about the Victoza REMS-required risk message that violated provisions of the FDCA and led some physicians to be unaware of the potential risks when prescribing Victoza.

 According to the government’s complaint, after a survey in 2011 showed that half of primary care doctors polled were unaware of the potential risk of MTC associated with the drug, the FDA required a modification to the REMS to increase awareness of the potential risk. Rather than appropriately implementing the modification, the complaint claims that Novo Nordisk instructed its sales force to provide statements to doctors that obscured the risk information and failed to comply with the REMS modification. Novo Nordisk has agreed to disgorge $12.15 million in profits derived from its unlawful conduct in violation of the FDCA.

A manufacturer that fails to comply with the requirements of the REMS, including requirements to communicate accurate risk information, renders the drug misbranded under the FDCA.

Under the agreed settlement, Novo Nordisk will pay an additional $46.5 million to the federal government and the states to resolve claims under the FCA and state false claims acts. This portion of the settlement resolves allegations that Novo Nordisk caused the submission of false claims from 2010 to 2014 to federal health care programs for Victoza by arming its sales force with messages that could create a false or misleading impression with physicians that the Victoza REMS-required message about the potential risk of MTC associated with Victoza was erroneous, irrelevant, or unimportant and by encouraging the sale to and use of Victoza by adult patients who did not have Type II diabetes. The Food and Drug Administration (FDA) has not approved Victoza as safe and effective for use by adult patients who do not have Type II diabetes. As a result of the FCA settlement, the federal government will receive $43,129,026 and state Medicaid programs will receive $3,320,963.

The FCA settlement also resolves seven lawsuits filed under the whistleblower provision of the federal FCA, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the government’s recovery. The civil lawsuits are captioned as follows: United States, et al. ex rel. Kennedy, v. Novo A/S, et al., No. 13-cv-01529 (D.D.C.), United States, et al. ex rel. Dastous, et al. v. Novo Nordisk, No. 11-cv-01662 (D.D.C), United States, et al., ex rel. Ferrara and Kelling v Novo Nordisk, Inc., et al., No. 1:11-cv-00074 (D.D.C.), United States, et al., ex rel. Myers v. Novo Nordisk, Inc., No. 11-cv-1596 (D.D.C.), United States, et al. ex rel Stepe v. Novo Nordisk, Inc., No. 13-cv-221 (D.D.C.), United States et al. ex rel Doe, et al. v. Novo Nordisk, Inc., et al., No. 1:17-00791 (D.D.C.), and United States ex rel. Smith, et al. v. Novo Nordisk, Inc., Civ. Action No. 16-1605 (D.D.C.). The amount to be recovered by the private parties has not been determined.

About the Author

Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: Erisa & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications. Ms. Stamer works with health industry and related businesses and their management, employee benefit plans, governments and other organizations deal with all aspects of human resources and workforce, internal controls and regulatory compliance, change management and other performance and operations management and compliance. For additional information about Ms. Stamer, see here, e-mail her here or telephone Ms. Stamer at (214) 452-8297.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.
If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advise or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Leave a Comment » | false claims act, FDA, Pharmaceudical, Uncategorized | Tagged: , , , , , , , | Permalink
Posted by Cynthia Marcotte Stamer

Christus Pays $12.24M Settlement Resolves False Claims Act Charges From “Donations” To New Mexico

September 11, 2017

CHRISTUS St. Vincent Regional Medical Center (St. Vincent) and its partner, CHRISTUS Health (CHRISTUS), have agreed to pay $12.24 million, plus interest  to resolve charges by the U.S. Department of Justice (DOJ) and U.S Department of Health and Human Services Office of Inspector General (OIG) they violated the False Claims Act by making illegal donations to county governments that the counties used to fund the state share of Medicaid payments to the hospital.  The settlement announced  September 1, 2017 highlights the needs for States and private healthcare providers to use care to ensure that creative partnerships don’t violate federal Medicare or other program requirements as well as the risk that the False Claims Act or other whistleblower rules will incentivize disgruntled employees or other service providers to bring aggressive conduct to the attention of federal officials.

The settlement resolves allegations made in U.S. ex rel. Stepan v. Christus St. Vincent Regional Medical Center Corp. et al., Civil Action No. 11-cv-572 (D.N.M.) that St. Vincent and CHRISTUS allegedly caused the State of New Mexico to present false Medicaid claims in violation of the False Claims Act by making non-bona fide donations to the State of New Mexico that New Mexico improperly used to fulfill the requirement that the State pay 25% “matching” share  to fund the New Mexico Sole Community Provider Program (SCP) between 2001 and 2009.

Under the now defunct SCP Program, federal law required that New Mexico fund 25% of the costs of the SCP program to qualify for reimbursement from the federal government for approximately 75 percent of its health care expenditures under the SCP program. Under federal law, New Mexico’s 25 percent “matching” share of SCP program payments had to consist of state or county funds, and not impermissible “donations” from private hospitals. Congress enacted this restriction on the use of private hospital funds to satisfy state Medicaid obligations to curb possible abuses and ensure that states have sufficient incentive to curb rising Medicaid costs.

The charges resolved by the settlement originally were brought in a qui tam lawsuit filed by a former Los Alamos County, New Mexico Indigent Healthcare Administrator .  The whistleblower will receive $2.249 million as her share of the recovery in this case.

The prosecution and its settlement drive home both the importance for States receiving Medicaid funds and private health care partners providing services to patients reimbursed by these funds to use care to comply with all applicable program requirements, as well as the continuing risk of exposure and resulting liability from whistleblower claims brought by unhappy employees or others looking to use their knowledge of questionable conduct to realize profitable recoveries.

About the Author

Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: Erisa & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications. Ms. Stamer works with health industry and related businesses and their management, employee benefit plans, governments and other organizations deal with all aspects of human resources and workforce, internal controls and regulatory compliance, change management and other performance and operations management and compliance. For additional information about Ms. Stamer, see here, e-mail her here or telephone Ms. Stamer at (214) 452-8297.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.
If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advise or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Leave a Comment » | Academic medicine, Anti-KickBack, Conditions of Participation, Corporate Compliance, Employment, false claims act, Federal Sentencing Guidelines, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Reform, health care reimbursement, Hospital, Hospital, Medicaid, Uncategorized | Tagged: , , , , , , , | Permalink
Posted by Cynthia Marcotte Stamer

Oklahoma Nursing Home Settles HHS HIV Discrimination Charges

September 8, 2017

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) has entered into a Voluntary Resolution Agreement with Heritage Hills Living & Rehabilitation Center, LLC (Heritage Hills) that resolves a HHS complaint alleging that Heritage Hills discharged a seriously ill patient from its facility upon learning that she was HIV positive and in violation of Section 504 of the Rehabilitation Act of 1973 and Section 1557 of the Affordable Care Act.  Part of HHS’ expanding  civil rights enforcement emphasis, the resolution agreement reminds health care providers and others receiving or providing services funded by programs managed by HHS of their growing exposure to civil rights prosecutions and liability for failing to comply with federal civil rights law nondiscrimination rules.

Heritage Hills is a for-profit, 81-bed, certified skilled nursing facility located in the City of McAlester, in Pittsburg County, Oklahoma. Because Heritage Hills receives Federal financial assistance through its participation in the Medicare and Medicaid programs, it is subject to the requirements of Section 504 and Section 1557.

Heritage Hills agreed to resolve the complaint after OCR initiated an investigation into whether Heritage Hills discriminated against the complainant’s daughter on the basis of the daughter’s disability (HIV/AIDS) in violation of Section 504 and Section 1557.

Under the Resolution Agreement, Heritage Hills agrees to:

  • Ensure compliance with Section 504 and Section 1557;
  • Report admissions and discharge data to OCR for a 12 month period;
  • Appoint a Civil Rights Coordinator;
  • Publish and post a new non-discrimination policy;
  • Iimplement a new patient grievance procedure and inform patients of their right to file complaints with OCR;
  • Rrequire its staff to receive training on HIV/AIDS and Federal non-discrimination obligations; and
  • Rrevise its admissions policy to ensure that all individuals with disabilities, including but not limited to HIV/AIDS, are provided equal access to and an equal opportunity to participate in all programs, benefits and services offered by the facility.

The HHS enforcement action reminds health care providers about the importance of properly managing their civil rights compliance. During the last five years, OCR has engaged in more than 200 enforcement and outreach efforts involving HIV/AIDS, including public education campaigns, HIV-related civil rights complaint investigations, HIV-related health information privacy investigations and 12 joint civil rights/health information privacy compliance reviews, which were the subject of OCR’s report, Protecting the Civil Rights and Health Information Privacy of People Living with HIV/AIDS. The report is available here.

Of particular note, OCR has launched an Information is Powerful Medicine public education campaign, which encourages those living with HIV to be proactive in their health care. The campaign explains individuals’ health information privacy rights, including how individuals can monitor and access a copy of their medical records.

OCR’s enforcement in this and other HIV discrimination actions is part a broader nondiscrimination and civil rights enforcement initiative under Section 1551 and other federal laws which has resulted in a growing list of multi-million dollar settlements from health care providers, state and local government agencies and others receiving federal funding from programs managed by the Department of Health & Human Services.  See here. Health care providers should verify their policies and operations comply with these civil rights nondiscrimination rules.

About the Author

Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: Erisa & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for 30+ years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications. Ms. Stamer works with health industry and related businesses and their management, employee benefit plans, governments and other organizations deal with all aspects of human resources and workforce, internal controls and regulatory compliance, change management and other performance and operations management and compliance. Her experienced includes more than 20 years of experience advising and defending health industry and other organizations about disability and other civil rights discrimination law compliance and risk management.  For additional information about Ms. Stamer, see here, e-mail her here or telephone Ms. Stamer at (214) 452-8297.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.   If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advise or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Leave a Comment » | ADA, Corporate Compliance, Cultural diversity, Disability Discrimination, Discrimination, Federal Sentencing Guidelines, Health Care, Health Care Finance, Health Care Provider, HIPAA, Home Health, Hospice, Hospital, hospitals, Inpatient Rehabilitation, Inpatient Rehabilitation Facility, Medicaid, Medical Privacy, Medicare, Medicare Advantage, OCR, Pharmacy, Rehabilitation Act, Skilled Nursing Facility, Uncategorized | Permalink
Posted by Cynthia Marcotte Stamer

HHS Issues Hurricane Irma Relief For Puerto Rico, U.S. Virgin Islands & Florida

September 8, 2017

In preparation for anticipated disruptions and damage from Hurricane Irma, Health and Human Services (HHS) Secretary Tom Price, M.D. declared a Public Health Emergency in Puerto Rico and the U.S. Virgin Islands on Wednesday, September 6, 2017 and in Florida on Thursday, September 7, 2017.

By declaring the disaster and before the Hurricane makes landfall, HHS seeks to maximize the flexibility of healthcare providers to respond to the anticipated deluge of health care needs anticipated to occur around the Hurricane by using its authority under Social Security Act 1135 to waive and modify certain health care rules under Medicare, Medicaid and certain other federal programs. See  here.

Beyond modification of these requirements, the declaration also triggers limited relief for covered health care providers from certain otherwise applicable requirements of the Health Insurance Portability & Accountability Act (HIPAA) Privacy Rules. See here for OCR’s latest guidance on the limited waiver of HIPAA Sanctions and penalties during a declared emergency.

About the Author

Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: Erisa & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for 30+ years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications. Ms. Stamer works with health industry and related businesses and their management, employee benefit plans, governments and other organizations deal with all aspects of human resources and workforce, internal controls and regulatory compliance, change management, disaster and other crisis preparedness and response, and other performance and operations management and compliance. Her experienced includes career long involvement in advising and defending health industry and other organizations about disaster and other crisis preparation, response and mitigation arising from natural and man-made disasters, government enforcement, financial distress, workplace emergencies and accidents, data breach and other cybersecurity and other events.  For additional information about Ms. Stamer, see here, e-mail her here or telephone Ms. Stamer at (214) 452-8297.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.
If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advise or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Leave a Comment » | 1335 Waiver, Academic medicine, Ambulatory care, Border Health, Childrens Health Insurance Program, Conditions of Participation, Disaster Relief, DME, Doctor, EMTALA, Federal Health Center, Health Care, Health Care Finance, Health Care Provider, Health Care Quality, health care reimbursement, Health Plan, healthcare, HIPAA, Hospice, Hospital, hospitals, Inpatient Rehabilitation Facility, Medical Privacy, Medical Records, Medicare Fee Schedule, OCR, Physician, Physician Licensing, public health, Public Policy, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

%d bloggers like this: