HARRIS PROPRIETARY 1 assuredcommunications™ NCMA Each of Medco Health’s False Claims Was “Knowingly Submitted” Because Medco Health Had No Effective Corporate.

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Presentation transcript:

HARRIS PROPRIETARY 1 assuredcommunications™ NCMA Each of Medco Health’s False Claims Was “Knowingly Submitted” Because Medco Health Had No Effective Corporate Compliance Program to Detect and Prevent False Claims. 146.Medco Health acted knowingly, as that term is used in the False Claims Act, 31 U.S.C. § 3729, that is, with reckless disregard or deliberate ignorance of the truth or falsity of information it submitted to the United States and its contractors in support of its claims. 147.This reckless disregard or deliberate ignorance arose from the following actions and course of conduct by Medco: a.Medco Health’s Board members and officers failed to satisfy their obligation to assure “that information and reporting systems exist in the organization that are reasonably designed to provide to senior management and to the Board itself timely, accurate information sufficient to allow management and the Board, each within its scope, to reach informed judgments concerning the corporation’s compliance with the law….” In Re Caremark 698 A.2d 959, 969 (Del. Ch. 1996). b.Medco Health failed to implement a corporate compliance program which satisfied the requirements of proper corporate practice and Delaware law.

HARRIS PROPRIETARY 2 assuredcommunications™ NCMA c.The compliance program in place at relevant times was not reasonably capable of reducing the prospect of misconduct. Most employees were either entirely unaware of the existence of such a program, or were not familiar with its details. d.There were no specific high-level personnel within Medco with direct responsibility for overseeing compliance, with direct access to the CEO and Board of Directors. e.There was no compliance officer within Medco Health with responsibility for independently investigating and acting on matters related to compliance, including the flexibility to design and coordinate internal investigations. Rather, it was the practice to assign responsibility for investigations to executives within whose area of responsibility the alleged wrongdoing occurred. f.There were no regular reports to the Board concerning internal investigations. g.There was no effective, timely communication to employees about the program. h.There was no effective methods of monitoring, auditing, or reporting on compliance.

HARRIS PROPRIETARY 3 assuredcommunications™ NCMA i. There was no effective anonymous hotline. j.There was no effective protection of whistleblowers. k.There was no consistent enforcement through corrective actions; rather, certain management, supervisors, and employees who engaged in illegal activities were rewarded with substantial severance packages in return for protecting more senior executives, and agreeing not to report violations to outside investigators. l.There were no systems to assure reasonable steps to respond to reported offenses, including detection of violations and investigation of violations. m.Such reporting of violations as did occur was false and misleading, and designed to hide the extent of the violations, the effect on patients, the role of senior executives in the violations, and the need for further investigation of violations. n.There was no effective code of ethics as that term is used in SEC Release Nos and o.There was inadequate due diligence to support the representation under 18 U.S.C. § 1350 set forth in the May 14, 2003 certification by a Medco Health board member that “any fraud, whether or not material, that involves management” had been disclosed.

HARRIS PROPRIETARY 4 assuredcommunications™ NCMA Final definition of “Code of Ethics”* The final rule defines the term “code of ethics” as written standards that are reasonably designed to deter wrongdoing and to promote: Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships; Full, fair, accurate, timely, and understandable disclosure in reports and documents that a registrant files with, or submits to, the Commission and in other public communications made by the registrant; Compliance with applicable governmental laws, rules and regulations; The prompt internal reporting to an appropriate person or persons identified in the code of violations of the code; and Accountability for adherence to the code. * SEC Release Nos ; (January 24, 2003) (Disclosure Required by Sections 406 and 407 of the Sarbanes-Oxley Act of 2002)