EUSA Pharma: Advice to Submit More Than One Claim

In the EUSA ProstaScint Medicare settlement, EUSA Pharma agreed to pay $180,000 to resolve allegations of inflated imaging claims. The government alleged that EUSA advised health care providers to submit multiple claims for certain scans after the Society of Nuclear Medicine had told the company that only one claim should be submitted. A former employee brought the case.

EUSA Pharma, headquartered in Langhorne, Pennsylvania, made and sold ProstaScint, a radiopharmaceutical used before the imaging scans at issue. This pharmaceutical fraud case followed the manufacturer’s advice into the providers’ Medicare bills.

EUSA Allegedly Urged Multiple Claims After Notice

The prior notice gives the case its point: what the company had been told, and what it then told the people billing Medicare.

The Justice Department’s account of the alleged conduct puts the manufacturer and the healthcare provider in different parts of the transaction. EUSA sold the product and gave the billing advice. Providers performed the imaging scans following its use and submitted the claims the government challenged.

For an employee familiar with those communications, the sequence matters. Advice sent before a company learns of a billing problem tells one story. Advice sent after it receives contrary information raises the question of who kept that instruction in circulation.

The department described the commercial purpose as increasing sales by inflating government reimbursements. On that account, Medicare was being asked to make the product more attractive to providers through extra scan claims. Taxpayers would finance the sales pitch through the resulting bills.

How a Manufacturer’s Advice Reaches Medicare

A manufacturer can face a False Claims Act case over claims it causes a provider to submit. The company selling the product and the practice billing for care occupy different places in the business, but the reimbursement advice can connect them.

Medicare Part B includes coverage for certain drugs furnished as part of a physician’s service. These include drugs that patients do not usually administer themselves, supplied as part of a physician’s professional service. The product sits inside a provider’s care and billing workflow, with a hospital outpatient counterpart to that coverage. That makes the provider a customer for the medicine and a participant in the payment chain. For an insider looking at a manufacturer’s reimbursement message, both sides matter: what the supplier told the practice and what the practice subsequently asked Medicare to pay.

In its October 3, 2001 announcement concerning TAP Pharmaceutical Products, the Justice Department described a criminal indictment involving free Lupron samples billed to Medicare. The manufacturer’s message about reimbursement was part of how it sold the drug.

The government described TAP as marketing the gap between the discounted price physicians paid and the higher Medicare reimbursement based on average wholesale price. It alleged that TAP told physicians to report the higher published price instead of what they actually paid. The sales appeal was the money a practice could retain after buying the drug. The free samples in the criminal indictment took that pitch further: the practice could seek payment for a drug it had received at no cost. The civil allegations and the criminal charge both put the manufacturer’s sales message inside the practice’s financial decision about which product to use.

With EUSA, the alleged instruction concerned the number of scan claims. With TAP, the disputed billing included free goods, according to the criminal indictment, and the price physicians reported, according to the civil allegations. In both, an insider’s account of what the manufacturer told providers helps explain the bills that reached the government.

EyePoint’s Promise Addressed the Buyer’s Risk

EyePoint Pharmaceuticals sold DEXYCU, an injectable for inflammation after cataract surgery. Its case shows another way a manufacturer can use reimbursement promises to encourage purchases. In its July 17, 2026 settlement announcement, the Justice Department alleged that EyePoint offered to compensate ambulatory surgical centers when insurers denied claims or paid less than the centers’ purchase cost. The alleged compensation arrangement had a name: the Assurance Program. The department also alleged that EyePoint supplied excessive free samples to induce purchases and use of DEXYCU.

The whistleblower’s EyePoint complaint alleged that physicians received two free DEXYCU samples for every prescription purchased. It described the samples as subsidizing surgeries for patients whose insurers would not pay for the drug, while encouraging continued purchases for patients covered by government programs. In that account, the free supply helped sell the paid supply. The manufacturer’s offer reached across the practice’s patients with different insurance coverage.

That promise to cover reimbursement shortfalls addressed what happened if the buyer failed to get paid. EUSA’s alleged advice addressed what the buyer should submit. The distinction helps focus an inquiry on the actual sales message: a promise about payment, an instruction about billing, or both.

A Former Employee Brought the EUSA Case

A former EUSA employee filed the qui tam case under the False Claims Act. The Justice Department announced the settlement on March 23, 2012 and said the former employee would receive a share of the government’s recovery.

The EUSA case shows why pharmaceutical whistleblowers’ knowledge of the business matters: an employee brought the manufacturer’s alleged conduct into a case concerning providers’ bills. The business knowledge starts where the instruction originated and can help explain what happened farther along the payment chain.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

The Records Behind the Instruction

For a case involving advice to submit extra scan claims, we would compare the manufacturer’s billing instructions, the contrary notice it received, the services performed and the claims submitted.

The correspondence also gives the sequence substance. We would examine who received the notice, which version of the billing advice reached providers afterward, and how the company responded when the issue arose. Dated communications would let us distinguish the advice a provider actually received from a later description of company policy.

An employee who knows the reimbursement instructions may see the manufacturer’s side. Someone working with the provider’s billing may see how those instructions affected claims. Connecting those accounts is where the case becomes specific: the advice, the service and the government payment belong to the same transaction.

You Know What Providers Were Told

If you saw a manufacturer keep sending billing advice after learning it was wrong, you know where the sales message and the Medicare bills meet. We work alongside you to build the case and bring in pharmaceutical fraud whistleblower lawyers who understand how manufacturer communications reach Medicare billing. Speak to one of our whistleblower experts and build your strongest pharmaceutical whistleblower case.