Pharma Fraud in Healthcare

What is a Pharmaceutical fraud?

Fraud in the pharmaceutical industry usually utilizes methods to bypass the procedures and rules set by the U.S. Food and Drug Administration (FDA). Along with the FDA, other regulatory agencies also enforce strict requirements to maintain and ensure the safety and well-being of consumers. Unfortunately, it is no secret that big pharmaceutical companies are driven by greed. This not only causes the US Government and taxpayers billions of dollars each year, but puts the lives and health of the American public in danger.

Pharmaceutical companies have over the years developed methods to defraud the government by forming relations with unethical, immoral or uninformed medical professionals. Pharmaceutical companies commit fraud by persuading physicians to prescribe medication or medical equipment that are not FDA-approved or in compliance with governing regulations. If Government healthcare programs are then  billed for the medication or equipment, then both the prescribing physician and the pharmaceutical company may be liable under the False Claims Act.

Off-Label Marketing

When a drug is prescribed for a use or purpose that has not been cleared by the FDA, that is called off-label use. Off-label use of drugs poses safety concerns, since the drug may not have been rigorously tested for that use. Federal law prohibits pharmaceutical companies from promoting unapproved, off-label uses that have not been demonstrated to be safe and effective. Despite this, many pharmaceutical companies resort to promoting off-label uses to increase revenue and market share.

If the pharmaceutical company induces or encourages off-label uses in their marketing or promotional materials or sales methods, that may give rise to a violation of the False Claims Act. Signs of unlawful off-label marketing include:

  • Paying sales representatives a bonus based on volume of sales for off-label use
  • Employing medical professionals to encourage other providers to adopt a drug for off-label use (also known as “white-coat marketing”)
  • Paying kickbacks to physicians to prescribe drugs for off-label use
  • Instructing providers on how to code their claims and document their medical records to support payment for off-label use

Kickbacks in pharma

Kickbacks in pharma shadow the Kickbacks in the healthcare space. Read about Kickback in Healthcare.

Kickback schemes in Pharma consist of illegal and unethical marketing of drugs to medical professionals such as financial incentives, “consulting trips to seminars” which are vacations for doctors and healthcare providers, networking opportunities and more benefits. The Federal Law strictly prohibits compensation of any kind in return for physicians and staff prescribing a certain drug.

Reporting Pharma Fraud in Healthcare the Right Way

Whistleblowers have over the years helped the government recover billions of dollars by reporting healthcare misconduct like fraudulent pharma schemes that violate FDA protocols, and thereby helped to protect patients, taxpayer dollars and the integrity of the healthcare system.

You as an insider witnessing healthcare abuse and waste in the form of kickbacks at a pharmaceutical company could help uncover those who undermine the system and put lives at risk. If you blow the whistle the right way, you can provide an important public service and win a whistleblower award that’s a percentage of the potentially millions of dollars recovered by the government. If you blow the whistle the wrong way, your case could be over before it begins. Contact us at Brown, LLC today to discuss your case confidentially at (877) 561-0000.