As the cost of healthcare continues to rise, the government is taking a closer look at pharmaceutical companies that are engaging in Medicare fraud. Pharmaceutical Medicare fraud occurs when a pharmaceutical company or its representatives attempt to defraud the government by overcharging for drugs, upcoding, or submitting false claims. Pharmaceutical companies are particularly vulnerable to misuse of Medicare funds or false claims related to Medicare payments, as they are responsible for providing medications and treatments to millions of Medicare recipients and often operate in areas, such as tele-medicine or referral networks, that may allow for fraud to go unchecked. This type of Medicare fraud is a serious problem and growing problem that costs taxpayers hundreds of millions of dollars every year.
Examples Of Pharmaceutical Qui Tam Cases
There is no single type of pharmaceutical Medicare qui tam case as this area of the law is constantly evolving and, unfortunately, only bound by the creativity of those who would wrongfully use taxpayer funds. However, there are some traditional schemes:
Overcharging: Pharmaceutical companies may engage in fraud by overcharging for medications, billing for medications that were never delivered, or providing medications with false or misleading labels.
Kickback Schemes: In addition, some pharmaceutical companies have been accused of bribing doctors and healthcare providers to prescribe certain medications, even when they are not medically necessary. Kickbacks are payments made to induce healthcare providers to prescribe certain medications. These payments can take the form of cash, gifts, or other benefits. They are illegal because they interfere with the impartiality of medical decision–making.
Upcoding: Upcoding which is the practice of billing for a more expensive service or drugs than was actually performed.
Whistleblowers Crucial In Reporting Pharmaceutical Fraud
The government relies on whistleblowers to bring fraud to light and help recover stolen funds. The False Claims Act (FCA) is the primary law used to combat Medicare fraud. The FCA provides incentives for whistleblowers to come forward and report fraud. These whistleblowers, known as qui tam relators, can receive a portion of the money recovered from the fraudsters. Whistleblowers are essential to uncovering and stopping pharmaceutical Medicare fraud. They are often the first to recognize the signs of fraud and can provide detailed evidence of the wrongdoing. Whistleblowers can be current or former employees of the company committing the fraud, or they can be people outside of the organization that have knowledge of the fraud. Whistleblowers can file a qui tam lawsuit under the FCA. In these cases, the whistleblower is represented by a qui tam law firm. The qui tam law firm will investigate the allegations of fraud and build a case against the company. If the case is successful, the whistleblower can receive a portion of the money recovered from the fraudsters. When whistleblowers come forward, they are protected from retaliation. The FCA provides protection for whistleblowers from being fired, demoted, harassed, or otherwise mistreated for reporting fraud. This protection is essential for encouraging whistleblowers to come forward and report fraud. Whistleblowers play an essential role in uncovering and stopping fraud. The False Claims Act provides incentives for whistleblowers to come forward and report fraud, and qui tam law firms provide the legal representation necessary to build a successful case. W By working together, whistleblowers and qui tam law firms can help the government recover stolen funds and protect taxpayers from fraud.
What To Do If You Have Witnessed Pharmaceutical Medicare Fraud.
If you have witnessed pharmaceutical medicare fraud, contact us today to explore your options through a confidential and no-cost consultation. Our law firm’s qui tam practice is dedicated to recovering funds lost to fraud and bringing justice to those who have been wronged. If you believe that you have knowledge of fraud involving Medicare or other government programs, you may be able to file a qui tam lawsuit and be rewarded for your role in recovering taxpayer funds. Contact us today for a free initial consultation and review of your case.
