The False Claims Act, a 150-year-old law written to prevent war profiteering, prohibits any fraud against the U.S. government. It also bars bilking the federal government by overcharging for services or paying kickbacks to attain contracts you aren’t entitled to. Federal programs like Medicare and Medicaid pay for a significant percentage of all prescription drug purchases, so any sort of fraud occurring in the pharmaceutical industry is ripe for a False Claims Act claim by a whistleblower. Remember, a whistleblower can receive 15% to 30% of any money that the government recovers, which can be significant given that these cases frequently run into the tens of millions of dollars.
But even if you are aware of specific information detailing massive fraud in some corner of the pharmaceutical industry, you must plead your case in a way that satisfies the legal requirement of the False Claims Act. If you fail to do that, your case will go nowhere. If you are considering becoming a whistleblower here in Mississippi, you will need the help of an experienced whistleblower attorney. Contact Barrett Law now at (800) 707-9577 to attain the guidance you require.
Common Types of Pharmaceutical Fraud
Auto-Refilling Fraud
It is common for patients suffering from long-term or chronic health problems to have their prescriptions set to auto-refill. This means that they do not have to renew their prescription, it automatically renews and is refilled by the pharmacy. In turn, the pharmacy bills the federal government for the prescription. However, those patients often get well, stop needing their prescription, or die, and while they may no longer need their prescription, it continues to refill automatically. In that situation, some pharmacies continue to bill Medicare and Medicaid indefinitely for the cost of the medication. This is doubly profitable fraud, as the pharmacy can then resell the unused drug; in essence, they sell the pharmaceuticals twice.
Average Manufacturer Price/Best Price Fraud
In the Medicare and Medicaid programs, extensive rebate programs help reduce the cost of pharmaceuticals for patients and the government. The more rebates that the pharmaceutical companies provide, the less money they make. Pharmaceutical manufacturers engage in fraud when they manipulate prices to reduce Medicaid and Medicare rebates.
Drug Switching
Drug switching is precisely what the name implies—a pharmacy provides a patient with a generic or cheaper drug and charges Medicaid or Medicare for the full priced version. The pharmacy keeps the profit, while the federal government pays full price and consumers sometimes get a less effective product.
Illegal Kickbacks
Illegal kickbacks occur when a pharmaceutical company provides some incentive—cash, vacations, gifts, golf outings—to a pharmacy in exchange for filling prescriptions with the company’s specific products.
Off-Label Drug Marketing
The U.S. has a rigorous drug evaluation program. Part of that program assures that the drugs being marketed for a given use are only sold for that use. Another name for that official use is its “label.” When a drug is sold “off-label,” that means that a pharmaceutical company is marketing a drug for uses beyond what the government certified it for. This can be a cost saving measure for drug companies and pharmacies but may end up harming consumers and defrauding the U.S. government, which is often paying for a specific drug to treat certain particular remedies.
What Should You Do if You are Considering a Pharmaceutical Industry Whistleblower Claim?
The reward for submitting a successful pharmaceutical industry whistleblower claim can be massive. But you will only receive this sort of award with the help of an experienced False Claims Act attorney. The United States Department of Justice gets thousands of potential whistleblower claims each year, and only those that are reported in a way that triggers their interest are investigated. Careful pleading is key to this process and will require the help of an experienced whistleblower counsel. Contact Barrett Law now at (800) 707-9577.
Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.
