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The Department of Justice (DOJ) has charged 15 people, including six medical professionals, in connection with healthcare fraud schemes that allegedly generated $2 billion in fraudulent claims, in today's bite-sized hospital and health industry news from the District of Columbia, Maryland, and New Jersey.
- District of Columbia: DOJ has charged 15 people, including six medical professionals, in connection with healthcare fraud schemes that allegedly generated $2 billion in fraudulent claims. In one case, prosecutors allege that four defendants were behind a $1.6 billion abuse treatment scheme in California, which DOJ called the largest sober-home/substance abuse fraud scheme it has ever prosecuted. Other alleged schemes include $134 million in fraudulent Medicare claims for unnecessary atherectomy procedures that led to patient injuries and over $138 million in fraudulent Medicare billing for hospice care when patients were not terminally ill. "Under President Trump's leadership with the White House Task Force to Eliminate Fraud, stealing from American taxpayers will no longer be tolerated in this country," said FBI Director Kash Patel. "This FBI will continue to move aggressively with our Department of Justice to dismantle fraud networks stealing from hard-working taxpayers." (Gleeson, Fierce Healthcare, 10/26)
- Maryland: FDA has approved a first-of-its-kind medicine from GSK and Ionis Pharmaceuticals that could potentially be a "functional cure" for persistent hepatitis B infections. The treatment, which is called Hibsago, was approved for use along with standard antiviral therapies in certain adults with chronic hepatitis B infections who have not yet developed cirrhosis. Hibsago is given via periodic injections over a six-month period. Although patients with chronic hepatitis B typically rely on lifelong antiviral therapy, Hibsago is an RNA-based medicine that can both stop the virus's ability to replicate and help generate an immune response. In two late-stage clinical trials, a combination of Hibsago and antivirals was able to effectively clear the virus in roughly 20% of participants, compared to none who received a placebo with antivirals. "Despite current therapies, many people living with chronic hepatitis B remain on treatment indefinitely and continue to face the risk of serious liver complications," said Tony Wood, GSK's chief scientific officer. "For the first time, U.S. patients have the potential to achieve functional cure after a six-month treatment course." (Alvarado, BioPharma Dive, 10/21)
- New Jersey: U.S. District Judge Zahid Quraishi recently denied a request from Novo Nordisk to block an advertising campaign from Eli Lilly that compared their respective GLP-1 medications, Wegovy and Zepbound. In the lawsuit, Novo argued that the advertisements used outdated studies to compare higher doses of Lilly's medicine to lower doses of Novo's, which caused "irreparable harm" and did not account for more recently approved, higher doses of Wegovy. However, Quraishi ruled against Novo, saying that the company failed to prove its case since prescription volumes for Wegovy didn't decrease when the commercials aired. He also noted that the ads acknowledged that there were higher-dose versions of Wegovy. In a statement, a Novo spokesperson said the ruling "does not constitute a final resolution of the merits of Novo's false advertising claims and instead only addresses whether the court will issue such an order at this early stage of the proceedings." (Gardner, BioPharma Dive, 10/27)
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