Posted on 02/25/2023 5:19:44 AM PST by E. Pluribus Unum
Connecticut Attorney General William Tong is leading 33 states attorneys general in urging the U.S. Supreme Court to overturn a pair of lower court rulings that could have broad implications for whistleblowers, and the government's ability to go after public fraud.
In a 15-page legal brief, Tong and the other AGs are calling on justices to uphold a pair of federal whistleblower lawsuits accusing pharmacy operators of over billing government health insurance programs for prescription drugs.
At issue is whether private companies can shield themselves from fraud lawsuits by claiming an "objectively reasonable" interpretation of the federal False Claims Act, which allows citizens to file lawsuits on behalf of the government.
Lawsuits filed by whistleblowers against Safeway Inc. and SuperValu Inc., accused the retail pharmacy chains of defrauding Medicare and Medicaid by billing them using "artificially high" pricing schemes, while charging most consumers lower prices for out-of-pocket costs through discount programs.
But in a 2-1 opinion, the Seventh U.S. Circuit Court of Appeals in Chicago sided with the companies, saying they were acting under a "reasonable" interpretation of the law when they billed the government higher prices than those charged to uninsured consumers.
In its April ruling, the appeals court agreed the companies had overcharged the government, but ruled they can't be held responsible for fraud because their billing practices were supported by an "objectively reasonable" interpretation of the whistleblower law.
(Excerpt) Read more at justthenews.com ...
The machinations that they designed to determine what to bill the government were, in my mind, obviously illegal.
Instead of billing what the customer paid they devised a convoluted scheme that would bill "usual and customary" prices on the rationale that they could get that much for, as a common example, birth control pills, like the MSRP price that no one pays.
The amount billed to the government could be multiples of what a 'cash customer', paid.
Bkmk
You might get a phone call....
Shhhh...!
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