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Government Investigations & Fraud Allegations

In working with clients on government investigations and fraud allegations, Brattle often develops and executes several complementary analyses at various stages, including:


Big data analysis


Economic and financial expert analysis


Forensic analysis

Extracting and summarizing the relevant information from unstructured information sources

Determining the effects of alleged misconduct and providing expert testimony


Identifying and tracing patterns in records such as correspondences, phone logs, business transactions, as well as financial metrics

We have been involved in numerous cases of alleged fraud, from the investigation stage through all phases of litigation. We work extensively with proprietary, government, and publicly available datasets, and with economic, actuarial, and industry experts to cover the full range of issues in a given case.

Engagements
REPRESENTATIVE ENGAGEMENTS

Below is a list of representative engagements for our Government Investigations & Fraud Allegations practice.

Medical device kickbacks investigation

In a False Claims Act (FCA) suit, Brattle supported a testifying expert regarding an investigation into consulting payments that a medical device company made to doctors. The device company and two top executives were accused of paying surgeons to use and promote their products by providing kickbacks in the form of consulting and intellectual property payments. We assisted counsel with initial document production overview and the organization of various types of qualitative and quantitative data, including over 5,000 text messages between executives and doctors along with sales and payment records. Our subsequent analyses tracked the timing of payments received by surgeons with their use of the medical devices, as well as whether these payments were made at fair market value. The case settled.

Off-label promotion practices

Brattle worked with a relator’s counsel in a qui tam case alleging that a medical device supplier illegally paid doctors to promote off-label uses of spinal implants, devices, and equipment. Counsel alleged that the supplier had submitted fraudulent claims to federal health insurance programs, even when the device was used for off-label purposes. Brattle completed data analytics to classify information of interest, and collaborated with the counsel’s review team to streamline targeted document and data review. Through this, we identified notable interactions by matching information from marketing agreements, device orders, and payment data. The case ultimately settled with the company, its CEO, and another executive, admitting to alleged violations and paying millions in fines.

Contract analysis to identify coordinated misreporting

A Brattle team advised the US Department of Justice in an FCA investigation into alleged market-wide coordination of improper fee arrangements between pharmacy benefit managers (PBMs) and plan sponsors. The investigation focused on allegedly manipulated and misreported fees that were supposed to be set at arm’s length. Brattle investigated whether indications of artificial pricing were common across PBMs as potential evidence of coordinated behavior in breach of regulations. To analyze the pricing, we created a structured database and extracted data to identify patterns in contract terms over time and across companies. The analysis informed a testifying expert’s evaluation of the fee arrangements in these contracts relative to customary contracts, the method with which these arrangements were reported, and the reporting requirements before the settlement.

Rollover prescription processing for assisted living facilities

Brattle was retained in an FCA matter brought against a pharmacy chain accused of failing to develop an operational system necessary to ensure regulatory compliance. The chain allegedly sought reimbursements for prescription drugs dispensed to patients in assisted living facilities without valid prescriptions. The pharmacy would then allegedly rollover expired prescriptions and continue to dispense the drugs without physician authorization. Brattle structured and analyzed the raw data from discovery, covering millions of prescriptions, and matched that data to outside data on reimbursements for those prescriptions. This work optimized the time and review of the final documentation. Using certain criteria, Brattle’s analysis was used by a subject matter expert to identify a number of apparent invalid prescriptions per patient, as well as the corresponding dollar amounts the pharmacy chain billed to Medicare and Medicaid.

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