Opinion ID: 1085252
Heading Depth: 2
Heading Rank: 2

Heading: Federal Health Insurance Reimbursements

Text: We next summarize Simpson's allegations regarding federal health insurance reimbursements. Simpson's SAC focused on a number of aspects of the manner in which Bayer generally marketed Baycol. Simpson alleged Bayer made false statements about Baycol's efficacy in lowering cholesterol when it introduced the drug into the general marketplace. Simpson further alleged Bayer misrepresented the risks of adverse side effects associated with Baycol. Simpson also alleged Bayer used illegal kickbacks to physicians to induce them to begin prescribing Baycol or to increase their prescriptions of Baycol. Finally, as significant for purposes of this appeal, Simpson then alleged the general manner in which Bayer marketed Baycol was causally connected to payments the government made under Medicare, Medicaid, and the Federal Employees Health Benefits Program (FEHBP) when individuals participating in those programs received a prescription from a physician for Baycol, filled the prescription at a pharmacy, and -6- the pharmacy or individual submitted the prescription to the government for reimbursement through those federal health insurance programs. Simpson specifically alleged the Government purchased and/or reimbursed significant quantities of Baycol when it would not otherwise have done so if Bayer had fully disclosed the truth regarding the safety of its drug. Id. at ¶ 266; Appellant's App. at A-128. Simpson further alleged Bayer caused false claims to be submitted by patients and organizations because physicians relied on Bayer's assertions when they prescribed Bayer, thus causing false claims to be submitted to the Government[.] Id.; Appellent's App. at A-129. Finally, Simpson alleged had the Government known the full truth it would not have paid the claims. Id.