Humana Roche False Claims Act Action

Case Description

Case Type: Whistleblower/ Qui Tam
Companies: Humana, Roche

Our legal team at Sanford Heisler Sharp recently settled a case that was filed under the False Claims Act against Roche Diagnostics Corp. and Roche Diabetes Care, Inc. (“Roche”) and Humana, Inc., Humana Pharmacy, Inc., and Humana Pharmacy Solutions, Inc. (“Humana”).

Sanford Heisler Sharp represented a whistleblower relator (“Relator”) who filed the case in 2014 in the U.S. District Court for the Northern District of Illinois under the whistleblower provisions of the False Claims Act. Our client will receive a 29% share of the $12.5 million settlement, which amounts to $3,625,000.

About the Lawsuit

Our client, a former employee of Roche Diagnostics, alleged that the Defendants violated the Anti-Kickback Statute and False Claims Act, by submitting false claims to the Medicare Advantage program and defrauding taxpayers.

Speaking about the case, Inayat Ali Hemani, New York Partner and Co-Chair of Sanford Heisler Sharp’s Whistleblower Practice had the following to say:

“This case demonstrates that Medicare Advantage Organizations, pharmacy benefit managers, and pharmaceutical companies can be held responsible for giving or accepting payments in exchange for access to Medicare Advantage funds. Our client has helped the Government recover millions of dollars and shed light on secretive transactions between pharmaceutical companies and Medicare Advantage Organizations.”

Our client accused Humana and Roche taking kickbacks by forgiving debt in exchange for access to government-funded Medicare business. According to our clients allegations, Roche forgave millions of dollars owed by Humana in exchange for Humana purchasing Roche diabetes testing supplies and favoring Roche diabetes testing supplies over competitors’ products in Humana’s Medicare Advantage plans.

After the Government declined to intervene in the matter, Sanford Heisler Sharp litigated the case on the Government’s behalf. After defeating Defendants’ motions to dismiss the case, we aggressively pursued discovery and filed motions on the merits of the case in 2021. The Parties ultimately agreed to settle the case while the motions were pending.

The settlement we reached is the first False Claims Act settlement arising from a Medicare Advantage Organization accepting a kickback from a pharmaceutical company. “The recovery obtained in this case is a testament to the power of whistleblowers in America,” said Michael D. Palmer, Partner in Sanford Heisler Sharp’s New York office. “This is truly an excellent result for both the Government and the Relator.”

Speaking about the integrity of our client and their vigorous pursuit of justice, Kevin Sharp, Managing Partner of the firm’s Nashville office, said, “Our client had the courage to hold Defendants accountable, at great personal risk. We are honored to have represented her and hope that others will continue to demonstrate similar courage and initiative.”

Consult with Our Whistleblower/ Qui Tam Team Today

Sanford Heisler Sharp has a stellar reputation for having the talent, experience, intelligence, creativity, and resources that workers need to hold their employers accountable for wrongdoing. Our award winning law firm focuses on employment discrimination, wage and hour, whistleblower, criminal/sexual violence, and financial services matters. Sanford Heisler Sharp has recovered over $1 billion for clients through many verdicts and settlements. If you need to take legal action against your employer, please get in touch with us so we can review all of your options.

For a case consultation with one of our esteemed lawyers, please call (646) 681-7373 or contact us onlinetoday.