Under federal law, it can pay to read your bills closely
The $2.6 million settlement the Massachusetts Eye and Ear Infirmary agreed to earlier this week with the US Justice Department started out with a single customer who believed he was charged more than he should have been for treatment of a chronic sinus infection.
Benjamin Schwarz went to Mass Eye and Ear for two visits in 2017 and came away convinced the clinic charged him and his insurer for a more complicated – and more expensive – procedure than he actually received. Under a section of the False Claims Act that allows ordinary citizens to file complaints on behalf of the federal government, Schwarz assumed the federal Medicare and Medicaid programs were being overcharged, so he took Mass Eye and Ear to court. [CORRECTION: The original version of this story said Schwarz’s insurer was Medicare.]
Such cases are not uncommon. Gregg Shapiro, who previously headed the section of the US Attorney’s office in Boston that handles such cases and now works in private practice, said more than 600 cases of this type were filed last year across the country. Typically, he said, 10 to 20 are filed each year in Massachusetts.
Once the case is filed, the Justice Department can decide whether it wants to get involved in pursuing evidence or stay on the sidelines. If the agency gets involved and the case is successful, the original claimant can receive anywhere from 15 to 25 percent of any settlement or judgment. If the government does not get involved and the original claimant proceeds alone, he or she can receive anywhere from 25 to 30 percent of the settlement or judgment.
In 2017, the pharmaceutical company Mylan agreed to pay $465 million to settle charges that it violated the False Claims Act by misclassifying EpiPen as a generic instead of a branded drug to avoid paying rebates to Medicaid. According to the settlement, Mylan raised the price of EpiPen by approximately 400 percent between 2010 and 2016.
The lawsuit against Mylan was initiated by a competitor, Sanofi, which sold its own branded version of the same type of drug and alerted federal authorities to what Mylan was doing. For its efforts, Sanofi received $38.7 million as its share of the federal settlement.
In the Mass Eye and Ear case, the US Attorney’s office investigated and determined that Schwarz was on to something, but not what he originally thought. The settlement reached this week concluded Mass Eye and Ear had improperly pocketed about $1 million in extra fees for office visits that weren’t warranted over an eight-year period. To settle the charges, Mass Eye and Ear agreed to pay a total of $2.6 million, with Schwarz receiving 15 percent, plus $78,000 in attorney fees.
Joseph Bonavolonta, special agent in charge of the FBI’s Boston office, issued a statement thanking Schwarz for coming forward with the original allegation. “We’d like to encourage others to do the same because standing up for what’s right and safeguarding taxpayer dollars is critical, given that every year the submission of false claims to the government costs taxpayers billions,” he said.
Gov. Charlie Baker said his administration is asking the federal government to adjust its vaccine shipments, lowering what’s sent to states that aren’t using all of their current allocations and increasing the amount sent to states like Massachusetts where the vaccines are in high demand. “There are counties and there are states that are no longer even taking down the allocation that’s made available to them by the feds,” Baker said at a press conference in Pittsfield. “They’re basically saying, ‘Don’t send us anymore, we haven’t been able to put the stuff you’ve sent us recently to work.’ That is not what’s going on here in Massachusetts.” Read more.
Amid growing attention being paid in Massachusetts to the high cost of prescription drugs, independent pharmacists are pointing a finger at a little known culprit: the middlemen who mediate between drug manufacturers, insurers, and pharmacies. Read more.
The former head of the state’s Commission for the Deaf and Hard of Hearing is suing the Baker administration in federal court, claiming he was instructed to apologize in the wake of a report about racist behavior at his college fraternity, then terminated because “it was no longer politically correct to employ him.” Read more.
Republican State Committeeman Jay Fleitman says it’s time for a digital tea party for Big Tech, including Google, Facebook, and Twitter. Read more,
FROM AROUND THE WEB
The state Senate will take up a $600 million bond bill to build a new Holyoke Soldiers’ Home. The House version of the bill cost $400 million, and the additional $200 million was added to expand veterans’ services in other parts of the state, in response to concerns about regional equity. (MassLive)
Gov. Charlie Baker signs an executive order requiring executive agencies to take a series of steps to reduce greenhouse gas emissions and improve climate resilience. (State House News Service)
A Berkshire Eagle editorial suggests the state of emergency should ease on Beacon Hill and backs efforts to give the Legislature a regular say in how roughly $4.5 billion in federal aid is spent.
A Salem city councilor is criticized for using a derogatory term to refer to people with disabilities on a Salem TV show. (Salem News)
Dalton’s Lonnie Durfee pleads guilty to lighting a hale bale display on fire last year and is sentenced to a year in jail. (Berkshire Eagle)
Residents are circulating a petition to recall Daniel Freitas, the chair of the Fairhaven board of selectmen. (South Coast Today)
Brockton officials want to take three downtown sites by eminent domain to make way for a new public safety facility. (The Enterprise)
Gov. Charlie Baker has no immediate plans to lift the state’s mask mandate but says more guidance on reopening could come by the end of the month. (Salem News)
Mass. General Hospital is pushing ahead with a $1.9 billion expansion project. (Boston Globe)
The leader of a union for grocery store workers calls on the Baker administration to do more to set up vaccination sites for the industry’s front-line workers. (Boston Herald)
Most Americans favor greater scrutiny of police practices, according to a new national poll. (Washington Post)
Transparency and accountability in the Boston Police Department is becoming a major issue in the unfolding race for mayor. (Boston Globe) Mayor Kim Janey pushes back against criticism from rivals urging her to do more. (Boston Herald)
In the latest in a wave of area bank mergers, Rockland Trust will acquire East Boston Savings Bank in a $1.15 billion deal.
Massachusetts education officials push for an expansion of early college programs in order to address racial disparities in college education rates. (MassLive)
UMass Amherst will return to normal, in-person operations this fall, but will require students to be vaccinated. Same for Hampshire College. (Daily Hampshire Gazette)
The Peabody Essex Museum appoints Lynda Rosco Hartigan as its new executive director. (Salem News)
President Biden’s new clean energy plan would require rapid and massive shifts in nearly every part of the country’s economy to meet the goal he put forward of halving emissions by 2030 from their 2005 levels. (New York Times)
The man arrested for walking into Gov. Charlie Baker’s home is trying to convince a judge to let him remove his GPS monitoring bracelet. (Gloucester Daily Times)MEDIA
Sue O’Connell and Jeff Coakley put Bay Windows and the South End News up for sale. (Media Nation)