The Louisiana Supreme Court has overturned a $257 million verdict against Risperdal drug maker Johnson & Johnson by a vote of four to three after determining that Johnson & Johnson did not violate Louisiana healthcare assistance laws by encouraging doctors to prescribe the antipsychotic drug to treat other diseases even though there were other options that were cheaper and safer.

The large amount awarded to the plaintiff in the Louisiana Risperdal lawsuit was separate from Johnson & Johsnon’s $2.2 Risperdal settlement with the U.S. Justice Department.

There are still dozens of Risperdal lawsuits facing Johnson & Johnson filed by individuals who allege they developed gynecomastia (male breast growth) and other side effects from taking Risperdal.

When Risperdal was first introduced to the market in it was only medication approved by the U.S. Food & Drug Administration (FDA) to treat schizophrenia. However, the government claims in criminal information filed with the U.S. District Court in the Eastern District of Pennsylvania that from Mar. 3, 2002 to Dec. 31, 2003, Janssen Pharmaceuticals, a subsidary of Johnson & Johnson, promoted Risperdal to treat dementia in elderly patients by treating symptoms such as anxiety, agitation, depression, hostility and confusion. The promotional materials made very little mention of schizophrenia.

From 1999 through 2005, Janssen also allegedly promoted Risperdal to be used in children with mental disabilities such as autism, bipolar disorder, attention deficit disorder, oppositional defiant disorder, obsessive-compulsive disorder and other mental disabilities. However, Risperdal increases the development of prolactin, the hormone that both stimulates breast development and milk production.

The Justice Department reached its decision that Johnson & Johnson pay $2.2 billion in November 2013 as part of a settlement related to criminal and civil violations by the drug manufacturer and its subsidiary Janssen over allegations that Risperdal along with Invega and Natrecor were improperly marketed to patients and doctors to be prescribed to treat illnesses for which that they had not been approved.

“The conduct at issue on this case jeopardized the health and safety of patients and damaged the public trust,” said Attorney General Eric Holder. “This multibillion-dollar resolution demonstrates the Justice Department’s firm commitment to preventing and combating all forms of health care fraud. And it proves our determination to hold accountable any corporation that breaks the law and enriches its bottom line at the expense of the American people.”

The Justice Department said that the fines and forfeiture were violations of the False Claims Act that were determined after multiple investigations of Johnson & Johnson and its subsidiaries.

“When companies put profit over patients’ health and misuse taxpayer dollars, we demand accountability,” said Associate Attorney General Tony West. “In addition to significant monetary sanctions, we will ensure that non-monetary measures are in place to facilitate change in corporate behavior and help ensure the playing field is level for all market participants.”

Johnson & Johnson will also now be subject to stringent requirements under a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. The purpose of the agreement is to increase accountability and transparency to prevent future fraud and abuse.