Humana Roche False Claims Act Action
Case name: United States of America ex rel. Crystal Derrick v. Roche Diagnostics Corp. et al.
Case type: Whistleblower & Qui Tam
Filed in: [United States District Court for the Northern District of Illinois]
Docket: [Case no. 1:14-cv-04601]
Case Summary
In 2014, Sanford Heisler Sharp McKnight filed a whistleblower action on behalf of the Relator, a former employee of Roche Diagnostics, alleging that the company violated the Anti-Kickback Statute and False Claims Act by submitting false claims to the Medicare Advantage program, and that when the whistleblower reported this fraudulent activity to corporate management she was terminated in retaliation.
The whistleblower Complaint alleged that Indianapolis-based Roche Diagnostics, which manufactures and markets medical devices to monitor and manage blood sugar, and co-defendant Humana, based in Louisville, Ky., and which administers Medicare Advantage health plans, entered into a kickback relationship.
Medicare Advantage health plans (sometimes called Medicare Part C) are Government-funded health plans that are administered by private companies known as Medicare Advantage Organizations.
According to the Complaint, Roche forgave millions of dollars owed by Humana in exchange for Humana (through its subsidiaries Humana Pharmacy and Humana Pharmacy Solutions, Inc.) purchasing Roche diabetes testing supplies over competitors’ products. In this way, Roche traded debt forgiveness in exchange for Humana favoring Roche diabetes testing supplies for purchase over competitors’ products in a government-funded Medicare business, the Complaint alleged.
In June 2018, litigating on behalf of the government and the Relator, Sanford Heisler Sharp McKnight attorneys defeated Defendants’ motions to dismiss the case and aggressively pursued discovery. In 2021, as motions on the merits of the case were pending, the parties agreed to a settlement in which Roche and Humana would pay $12.5 million to settle the government’s claims of fraud, with the Relator receiving a 29% share of the settlement, or $3,625,000.
The case was the first False Claims Act settlement arising from a Medicare Advantage Organization accepting a kickback from a pharmaceutical company.
Procedural History
News Coverage
- Whistleblower Won’t Get Atty-Client Docs In Debt Deal Suit
- Health Plans Facing More Kickback Risk
- Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit
- Humana faces anti-kickback, False Claims Act suit over diabetes testing equipment
- Roche, Humana Can’t Flee FCA Suit Over Debt Deal
- Sanford Heisler Sharp McKnight’s False Claims Act Action Against Medicare Advantage Organization Moves Forward — Court Denies Defendants’ Motions to Dismiss
Attorneys Involved in the Case
Judge Kevin Sharp
Co-Vice Chairman
Michael Palmer
Co-Managing Partner of the New York Office
Albert Powell
Staff Attorney