Pharmaceutical Fraud

Washington DC Qui Tam Attorneys

The making and marketing of pharmaceuticals is a multi-billion dollar industry in the United States, and a large percentage of pharmaceutical purchases are made or reimbursed by the federal government under Medicare, Medicaid, and TRICARE. This means that there are ample opportunities for unscrupulous pharmaceutical companies and other healthcare industry players to defraud government healthcare programs.

If you have knowledge of healthcare fraud, the False Claims Act affords strong legal protections if you become a whistleblower and file a qui tam complaint to report it. In addition, whistleblowers in qui tam cases are often entitled to between 15% and 30% of the amount recovered as a whistleblower reward.

The qui tam lawyers of Chaikin, Sherman, Cammarata & Siegel, P.C. can help you prepare and litigate your whistleblower lawsuit in a way that maximizes the possibility of a significant whistleblower reward. Because the manufacture, marketing, and sale of pharmaceuticals are heavily regulated, there are dozens of ways for the industry to run afoul of the law. In addition, any purchase of pharmaceuticals with government funding, such as Medicare and Medicaid, is subject to the False Claims Act.

This combination of facts makes reporting pharmaceutical fraud extremely lucrative for whistleblowers because once a pharmaceutical company or provider breaks the law, all Medicare, Medicaid, and TRICARE payments tainted by the unlawful activity can be considered false claims. Qui tam recoveries in pharmaceutical fraud cases can reach into the millions of dollars, with a much as 25% or 30% designated as a whistleblower reward.

Types of Pharmaceutical Fraud

Essentially, pharmaceutical fraud can occur any time a pharmaceutical company or healthcare provider receives Medicare, Medicare, or TRICARE payments while not in compliance with federal regulations. Some common types of pharmaceutical fraud include:

Off-Label Marketing
Pharmaceutical Kickbacks
GMP Violations
Medicare Rebate Price Reporting Fraud
Marketing Unapproved DESI Drugs

A large majority of all pharmaceutical fraud cases involve either off-label marketing or violations of the Anti-Kickback Statute. The former, off-label marketing, occurs when pharmaceutical companies or sales reps market a drug to healthcare providers for uses that are not approved by the Food and Drug Administration (FDA).

Off-label uses for prescription drugs are legal, but may not be reimbursed by Medicare or Medicaid. Therefore, off-label marketing practices that result in government reimbursement or subsidies of pharmaceuticals for off-label uses may be considered Medicare/Medicaid fraud and is subject to qui tam lawsuits under the False Claims Act.

The Anti-Kickback Statute prohibits both offering and accepting any financial or in-kind incentive intended to encourage a physician or healthcare provider to recommend or prescribe a certain drug. Pharmaceutical kickbacks not only violate medical ethics, but also endanger patients as physicians who receive kickbacks are less likely to make decisions that are in patients’ best interests. Any government payment for drug prescriptions tainted by pharmaceutical kickbacks may be considered a false claim against the government and is subject to qui tam action.

If you have knowledge of any type of pharmaceutical fraud or healthcare fraud, please contact the qui tam attorneys of Chaikin, Sherman, Cammarata & Siegel, P.C. today for a confidential evaluation of you potential whistleblower case.

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