In May 2015, Express Scripts Inc., a subsidiary of Accredo Health Group Inc., had agreed to pay $60 million as part of a False Claims Act qui tam settlement with federal and state governments in an alleged kickback scheme with Novartis Pharmaceutical Corporation to increase sales of Novartis’s Exjade drug. As a condition of the settlement, Accredo “agree[d] to cooperate with the United States in the prosecution of the claims against Novartis.” On the same day, the government announced that it was intervening in a companion qui tam action against Novartis.
By their very nature, healthcare kickback schemes involve at least two parties—a payor and a receiver. As the saying goes, “It takes two to tango.” This is true in dancing and it is true when it comes to kickbacks impacting government healthcare dollars.
In the alleged Accredo-Novartis kickback scheme, Novartis supposedly orchestrated a scheme whereby it offered kickbacks, in the form of patient referrals and other benefits to certain specialty pharmacies, including Accredo, in exchange for increasing their Exjade refills, accomplished through biased recommendations to patients. According to the government, Accredo was part of a Novartis-created exclusive distribution network for Exjade called the Exjade Patient Assistance and Support Services (“EPASS”), and through this network NOVARTIS was able to refer Exjade patients to particular pharmacies within the network.
Now, with one of the EPASS pharmacies “cooperating” with the government, additional evidence may come to light in the companion qui tam against Accredo’s alleged dance partner Novartis.
More information for potential whistleblowers is located at the Nolan Auerbach & White website.