In recent years, more and more employees reported false claims within the pharmaceutical industry. Using long-standing and recent cases to understand the direction of the courts, our attorneys have garnered experience in certain health care laws such as Federal and State False Claims Act (“FCA”), Affordable Care Act (“ACA”), Anti-Kickback Statute (“AKS”), and the Occupational Safety and Health Act (“OSHA”). Pharmaceutical fraud has resulted in over $20,000,000,000 (that is $20 billion dollars) in collected settlements and cases against pharmaceutical companies.
Some of the most popular areas of pharmaceutical fraud include pricing, billing, and marketing schemes such as Pharmaceutical Benefits Manager Fraud, Pharmaceutical Price Inflation Fraud, Drug Price Fraud, Marketing of Off-Label Drugs Fraud, and Unlawful Kickbacks in violation of the AKS Fraud.
Recent cases have exemplified the types of fraud. They include large pharmaceutical companies that paid unlawful kickbacks to physicians in the form of gifts, joint business ventures, seminars at exotic locations, or other phony payments to market and promote their drugs in violation of anti-kickback statute and insurance laws. Other examples include pharmaceutical companies that misclassified products such as Epipen as generic drugs to pay lower rebates to the federal government’s Medicaid program. To be used in the United States, drugs have to be approved by the Food and Drug Administration (“FDA”). When approved by the FDA, these drugs are determined to be for specific uses or indications (also known as label or indications). Accordingly, the pharmaceutical companies must then only market and promote these drugs as determined by the FDA. Therefore, when pharmaceutical companies market or promote drugs to physicians for the “off-label” or unapproved use, those are violations of the FCA.
Since government healthcare programs rely on taxpayer money, the reporting of fraud against these programs is critical. It is also the duty of every American to stem out such corporate greed. In the United States, more than 40 million individuals are dependent on Medicaid. Therefore, when our firm receives reports of Medicaid fraud, we are encouraged to file it under seal and work with prosecutors within the Department of Justice (“DOJ”).
When successful under the FCA, our attorneys have attained court orders requiring corporate defendants to pay triple the actual damages to the government in addition to statutory penalties for each false claim submitted by the defendant. As result, the whistleblower may receive 15 to 25 percent of the total FCA recovery plus attorney’s fees.
The DOJ reviews all cases filed under the FCA. Once the whistleblower case is assessed, the DOJ decides whether it will prosecute (or intervene) or allow the whistleblower to independently bring the complaint on the government’s behalf.
If you witness any potential false claims (Pharmaceutical Benefits Manager Fraud, Pharmaceutical Price Inflation Fraud, Drug Price Fraud, Marketing of Off-Label Drugs Fraud, and Unlawful Kickbacks in violation of the AKS Fraud) by your company, or you are retaliated against for voicing your concern about potential wrongdoing, contact a knowledgeable attorney for guidance.