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FSS pncmg submissions, and daily "batched" submissions that Omnicare made to the

government as requests for payment.

261.

Federal

and

state

privacy

laws,

such

as

the

Health

Insurance

Portability

and

Accountability Act of 1996 ("HIPAA"), also restrict plaintiff relator's ability to obtain

information about specific prescriptions.

COUNT I False Claims Act 31 U.S.c. §3729 (a)(l) (Against All Defendants)

262.

Plaintiffs reallege and incorporate by reference each and every of the foregoing

paragraphs as if fully set forth herein.

263.

This Count is brought by Lisitza in the name of the United States under the qui

tam provisions of 31 U.S.C. §3730 for the Defendant Manufacturers' violations of 31 U.S.c.

§3729 (a)(l).

264.

At

all

times

relevant

and

material

to

this

Amended

Complaint,

the

Defendant

Manufacturers Bristol Myers, Ortho McNeil, Janssen, and Pfizer knowingly caused false claims

for payment or approval that they knew to be ineligible for reimbursement, to be presented to

officers and employees of the federal and state governments. As a result, the government paid

the false claims submitted for the Defendant Manufacturers' drugs by Omnicare and other

Medicaid provider pharmacies, resulting in great financial loss to the federal and state

governments.

265.

By virtue of the

above-described

acts,

among others,

Bristol

Myers knowingly

caused to be presented false or fraudulent claims for payment or approval, and possibly

continues to cause to be submitted false or fraudulent claims for payment or approval, directly or

70

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