A doctor was arrested on December 13, 2018 for improperly distributing opioids to his patients and billing Medicare for the drugs. The doctor now faces 45 federal charges relating to healthcare fraud for not only prescribing illicit drugs to patients but requiring those with insurance to accept injections so that he could bill additional costs to public health programs like Medicare. While this is an extreme example of pharmaceutical fraud, there are numerous smaller incidents of pharmaceutical fraud that take place every day. If you believe your employer or healthcare provider is engaging in pharmaceutical fraud or any type of healthcare fraud, contact the qui tam attorneys at Willoughby Brod immediately to report the fraud.
What is Pharmaceutical Fraud?
Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the False Claims Act (FCA) or California False Claims Act (CFCA) and result in false claims to insurers and Medicare/Medicaid.
How to Detect Pharmaceutical Fraud
If you detect any of the following actions from your healthcare provider or employer, you may want to pay closer attention to their billing patterns and actions and gather any evidence that may indicate that there is fraudulent activity in their practice.
- Your healthcare provider advises you to take certain drugs or injections that seem unnecessary or far more intense than what you believe you require;
- Your employer submits false claims about drugs prescribed to patients that were not actually prescribed;
- Your healthcare provider writes you a prescription without asking for documentation of your medical history or conducting a check up to determine whether a prescription is actually needed;
- Your employer aggressively solicits or bribes in order to encourage and reward referrals for services reimbursed by public health programs such as Medicare;
- Your healthcare provider refuses to prescribe certain drugs to you unless you agree to accept injections or additional medical treatment;
- You notice your employer writing a significantly higher number of prescriptions than what the average doctor writes during a specified time period;
- Your prescription from your healthcare provider is rejected at a pharmacy; or
- You notice your employer submitting higher value claims that the actual service that was rendered.
The foregoing is not a conclusive list of signs that your employer or healthcare provider might be engaging in fraud. The reality is that many instances of fraud, such as the type of fraud conducted by the doctor mentioned above, go unreported because the doctors engaging in the fraud target a vulnerable audience and take advantage of their addiction.
Contact a California Qui Tam Attorney Today
If you believe you have witnessed pharmaceutical fraud in violation of the FCA or the CFCA but are unsure of your next steps, contact the qui tam attorneys at Willoughby Brod today to learn more about your options. Remember that without whistleblowers, pharmaceutical companies would have scammed the government (and the public) out of over $4.5 billion in one year alone, so by stepping forward as a whistleblower, you are not only helping the government but also your fellow citizens. Contact us today at (800) 427-7020 or visit us online to schedule your confidential and free consultation.
(image courtesy of Jonathan Perez)