A Big Bad Biotech Case and its Effects on Qui Tam
Cell Therapeutics Inc. is a Seattle-based biotechnology company. In April 2007, the company paid $10.5 million to settle charges that it defrauded Medicare for sales of the cancer drug Trisenox. According to the Justice Department, Cell Therapeutics marketed Trisenox for uses for which it was not FDA approved. This could have been just another qui tam suit involving a drug maker, but in this case Cell Therapeutics decided to go after its former consultant and alleged co-conspirator in fraud for contribution.
The case has been anything but by-the-book from the start. The whistleblower, James Marchese, received $1.6 million back in October 2007 as part of Cell Therapeutics' settlement with the government. Marchese was lucky to receive his $1.6 million (15 per cent of the total recovered). Prosecutors from the Justice Department had taken the unusual action of claiming that Marchese should be denied any recovery at all. The Justice Department argued that Marchese had been an initiator of the scheme to defraud Medicare, but the judge rejected this argument. According to experts, it's extremely unusual for the government to argue that a whistleblower should receive a reduced award or no award at all.
In the most recent turn of events in the case, a three-judge panel of the 9th U.S. Circuit Court of Appeals has ruled that Cell Therapeutics can sue the Medicare reimbursement consulting company that advised Cell Therapeutics to market Trisonex beyond its FDA-approved uses. Cell Therapeutics sued the consultant to recover both the $10.5 million it paid to settle the suit with the government, as well as an additional $12.3 million in attorney's fees and damages.
The case is Cell Therapeutics Inc. v. Lash Group Inc., 2009 U.S. App. LEXIS 25297 (9th Cir. 2009).
The back story behind Cell Therapeutics' and the consultant's relationship helps to explain why the court is allowing the biotech firm to sue the consultant. Cell Therapeutics was a relatively young and inexperienced company when it received FDA approval for Trisonex (its first FDA-approved drug) so it hired Lash (now known as Documedics Acquisition Co., Inc.) to handle the Medicare reimbursement issues. Although Documedics claimed to be an expert in reimbursements for cancer drugs, it made a serious mistake in advising Cell Therapeutics. Id. at *6. Documedics mistakenly advised Cell Therapeutics (and Medicare carriers and medical providers) that the non-FDA approved uses of Trisonex were reimbursable by Medicare. The carriers and providers submitted claims to Medicare based on this advice, and Cell Therapeutics stopped doing further research that would have actually determined whether the drug was eligible for Medicare reimbursement. Id.
The government began investigating both Cell Therapeutics and Lash/Documedics. Marchese, the whistleblower, eventually filed his qui tam suit against both companies in 2006. Id. at *7. The government, however, only intervened in the suit against Cell Therapeutics, alleging that it "knowingly and willfully promoted the sale and use of Trisonex . . . for such indications [as] had not been approved as safe and effective by the FDA" and "made false and misleading statements to treating doctors . . . causing them to present false or fraudulent claims to Medicare." Id.
After Cell Therapeutics settled with the government, it sued Lash for indemnification, as well as other causes of action. The trial court decided that a qui tam defendant like Cell Therapeutics could not seek contribution from a co-conspirator in a scheme to defraud the government, and dismissed Cell Therapeutics' action. Id. at *8. Cell Therapeutics appealed, and the circuit court ruled that Cell Therapeutics did in fact have a viable claim against Lash for two reasons.
The first reason the 9th Circuit cited for allowing Cell Therapeutics' suit to go forward is that settlements "generally do not bar claims against non-parties or have issue-preclusive effect (sometimes referred to as 'collateral estoppel') on the subsequent litigation of issues not expressly resolved in the settlement." Id. at 17. The second reason was the concern that if a settlement is determined to be a finding of liability, defendants won't settle False Claims Act cases anymore. Id. at 18.
The 9th Circuit's ruling in this case could have a widespread effect, considering how many False Claims Act defendants decide to settle. It could also prove to be very unwelcome news for consulting companies that make ugly mistakes when advising their clients.
Check out the news articles on the Qui Tam Team site, particularly those concerning pharmaceutical and medical device manufacturers, and note how many of them settle False Claims Act cases with the government rather than admitting liability. These companies consistently pay millions and even billions of dollars to settle cases (see, for example, this article about how much pharmaceutical companies are spending to settle whistleblower suits).
The Billion Dollar Whistleblower?
A huge storm is brewing around a man who may end up being one of the highest-paid whistleblowers ever. Bradley C. Birkenfeld is an ex-UBS banker who divulged the huge investment bank's tax-evasion strategies and whose testimony led to UBS handing over the names and account information of thousands of wealthy investors to the IRS. Birkenfeld's case is very important because it will test the limits of the 2006 whistleblower law that provides compensation--up to 30%--to individuals who bring tax cheats to the IRS's attention.
Birkenfeld was once a high-profile banker at UBS. He had an apartment in Geneva, Switzerland, and a million-dollar home in Zermatt, Switzerland at the foot of the Matterhorn. He worked with a team of bankers who marketed Swiss accounts to wealthy Americans, then figured out how to disguise ownership of the accounts through the use of off-shore shell corporations. Birkenfeld lived a life with a certain amount of intrigue--one court document stated that he smuggled diamonds in a tube of toothpaste onto a trans-Atlantic flight for a client.
According to court documents, in 2005 Birkenfeld became disturbed by an internal UBS document that misrepresented the manner in which the company was conducting its cross-border business. Birkenfeld contacted the legal compliance officer but got no response, so he resigned in late 2005.
Birkenfeld then sent a confidential letter to a UBS executive in 2006 stating that he wanted to invoke his rights under UBS's whistleblowing policy. UBS had denied Birkenfeld a bonus, and he perceived this as retaliation for his raising concerns about UBS's business practices. In 2007, Birkenfeld contacted the Securities and Exchange Commission and a Senate investigative panel, both of which began investigations.
Birkenfeld tried to negotiate immunity from prosecution in 2007, but was unsuccessful. A Justice Department filing states that he refused to discuss his participation in UBS's tax evasion schemes, denying his misconduct, and that he hoped to collect a reward. Birkenfeld was arrested in 2008, and eventually pled guilty to conspiring to defraud the U.S. government. He was sentenced to 40 months in prison and is due to start serving his sentence in January 2010. Prosecutors argued for leniency in Birkenfeld's sentencing based on the fact that he was a whistleblower, but the federal district judge ignored their requests. Birkenfeld was also hit with a $30,000 fine and three years probation.
Birkenfeld is challenging his sentence based on the fact that he helped the government uncover thousands of UBS tax cheats. He is also claiming his compensation under the IRS law, which could add up to billions, and this is where the controversy gets most heated.
Since Congress changed the IRS law regarding whistleblower rewards in 2006, the number of tips about tax evaders owing $2 million or more have jumped more than ten times. Award amounts and amounts collected under the whistleblower program have also increased significantly from pre-2006 amounts. In order to qualify for an award, the whistleblower must meet several criteria. The information the whistleblower provides must:
- relate to a tax noncompliance matter in which the tax, penalties, interest, additions to tax and additional amounts in dispute exceed $2,000,000;
- relate to a taxpayer, and in the case of an individual taxpayer, one whose gross income exceeds $200,000 for at least one of the tax years in question; and
- substantially contribute to a decision to take administrative or judicial action that results in the collection of tax, penalties, interest, additions to tax and additional amounts.
If a whistleblower meets these conditions, he or she will receive between 15 and 30 percent of the proceeds resulting from an administrative or judicial action or a settlement in response to an administrative or judicial action.
Thousands of tax dodgers are now seeking amnesty under an IRS program that allows them to avoid jail time as long as they pay back taxes and various penalties. Tax dodgers have hidden their money in 70 countries on every continent except Antarctica, and as of October 2009, hidden accounts ranged from $10,000 to $100 million. In August, UBS agreed in a settlement to turn over information regarding 4,450 accounts suspected of being used by American customers to hide assets. These UBS clients will pay billions in back taxes, penalties, and interest. Billions more are expected to roll in as a result of the amnesty program, and a large number of those seeking amnesty are also expected to be UBS clients.
Whether Birkenfeld is entitled to billions of dollars in reward money for helping the IRS bring in billions in unpaid taxes could turn out to be, in the words of Birkenfeld's attorney, "a gigantic fight." The Justice Department acknowledges Birkenfeld's contribution; the prosecutor who handled the UBS investigation stated, "Without Mr. Birkenfeld walking into the door of the Department of Justice in summer of 2007, I doubt this massive fraud scheme would have been discovered by the United States government." At the same time, the Justice Department contends that Birkenfeld is not a formal whistleblower because he didn't provide many details on specific UBS clients when he came forward. Birkenfeld's lawyers will argue on appeal to Attorney General Eric Holder that Birkenfeld did in fact provide information about specific clients.
Despite Birkenfeld's misconduct, his information about UBS's practices clearly helped the government recover billions of dollars in taxes and penalties that it wouldn't have received otherwise. It would set a bad example for the IRS to deny Birkenfeld his reward in this case, mainly because it could have a chilling effect on future whistleblowers who have been involved in some type of misconduct themselves, but have useful information. The federal government needs all the tax revenue it can get right now, so it seems unwise to snub potential billion-dollar whistleblowers.
TARP: A Fraud Magnet?
TARP funds have been available for barely a year (Congress passed legislation appropriating $700 billion for the program in October 2008, and expenditures have been funded mainly by increases in national debt) yet the program has already been described as "ripe for fraud." In February 2009, Neil Barofsky, the special inspector general for the Troubled Asset Relief Program, expressed deep concerns about the potential for fraud. He stated that "History teaches us that an outlay of so much money in such a short period of time will inevitably draw those seeking to profit criminally." Barofsky based his concerns in part on the government's experiences with other fraud-plagued outlays of huge amounts of cash, such as the reconstruction of Iraq and the savings and loan bailout of the 1990s.
Fast-forward to mid-November, and we now know that TARP fraud probes have tripled since April. If Barofsky were concerned by the potential for fraud back in February, he must be aghast now. One of the few positive aspects, according to Barofsky, is that Wall Street's reputation has become somewhat clouded and people's perceptions are more objective. Barofsky believes that "we've done a good job of instilling a greater degree of skepticism that what comes from Wall Street isn't necessarily the Holy Grail."
Barofksy's office is known as SIGTARP (Office of the Special Inspector General for the Troubled Asset Relief Program), and it is required to make quarterly reports to Congress on its progress. The most recent report was released in October 2009, and it details the general areas in which SIGTARP is conducting investigations as well as some specific investigations. The vast majority of the investigations are veiled in secrecy, however.
SIGTARP is currently conducting investigations into several different areas, including
complex issues concerning suspected TARP fraud, accounting fraud, securities fraud, insider trading, bank fraud, mortgage fraud, mortgage servicer misconduct, fraudulent advance-fee schemes, public corruption, false statements, obstruction
of justice, money laundering, and tax-related investigations.
One of the first TARP fraud casualties was a financial planner and one-time sports agent named Gordon Grigg. In classic snake-oil salesman style, Grigg lured in clients by telling them that he had invested their money in "TARP-guaranteed debt" and other non-existent securities. Grigg defrauded his clients of almost $11 million. One man told his local news station that he had given Grigg everything he had and is now "59-years-old and crippled." Grigg plead guilty to four counts of mail fraud and four counts of wire fraud, and was sentenced to 10 years in prison.
SIGTARP is also conducting an ongoing investigation into a company called Federal Housing Modification, Inc (FHMA). The Federal Trade Commission is alleging that FHMA violated the FTC Act and telemarketing sales rules by misrepresenting itself as a government agency (it blatantly stuck "Federal" right there in its name) and falsely claiming that it could obtain mortgage modifications for customers for a $3,000 fee.
SIGTARP is conducting other ongoing investigations into the activities of Taylor, Bean & Whitaker Mortgage Corporation/Colonial Bancgroup and Bank of America. Colonial reported that it had received contingent approval from the Department of the Treasury for $553 million in TARP funding, but the funding was never made. SIGTARP, along with other offices including the New York State Attorney General's Office, is continuing its investigation of Bank of America regarding its merger with Merrill Lynch and its receipt of additional TARP funds under TIP. Bank of America recently announced that it is going to repay the money it received under TARP, which will free the bank from federal oversight on executive pay.
TARP is set to expire December 31st, 2009, and Treasury Secretary Timothy Geithner claims that the government will end TARP "as soon as we can." The New York Times reports that the program has helped some big banks bounce back, but has fallen short of many of its other goals. About $140 billion in TARP funds are uncommitted, and about $300 billion are unspent, so there are many billions of dollars that may wind up floating around out there, potentially winding up in fraudster's pockets. The government obviously has an enormous burden in monitoring what happens to all of this money, so regular citizens need to keep their eyes open for fraud. TARP will most likely continue to be a white-hot source of fraud as more money is dispersed.



