Roche, Humana settle kickback allegations

INDIANAPOLIS - Roche Diagnostics and Humana have agreed to settle a whistleblower lawsuit for $12.5 million, after the government declined to intervene in the case. 

Roche was charged with violating the Anti-Kickback Statute and False Claims Act, causing false claims to be submitted to the Medicare Advantage program and defrauding taxpayers, in a lawsuit filed in 2014 in the U.S. District Court for the Northern District of Illinois by a former employee of the company. 

Humana and Roche were accused of entering a kickback relationship where debt forgiveness was traded for access to government-funded Medicare business. Roche allegedly forgave millions of dollars owed by Humana in exchange for Humana purchasing Roche diabetes testing supplies and favoring the company’s diabetes testing supplies in Humana’s Medicare Advantage plans. 

“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,” said Inayat Ali Hemani, New York partner and co-chair of Sanford Heisler Sharp’s Whistleblower Practice, which represented the former employee. “Our client has helped the government recover millions of dollars and shed light on secretive transactions between pharmaceutical companies and Medicare Advantage Organizations.” 

The settlement is the first False Claims Act settlement arising from a Medicare Advantage organization accepting a kickback from a pharmaceutical company, according to Sanford Heisler.