How can pharmaceutical companies and pharmacies violate the FCA?
Pharmaceutical fraud now accounts for the largest FCA recoveries by the U.S. Government and private citizens. There are many financial pressures upon pharmaceutical companies and their employees to ignore federal laws designed to prevent fraud and curb costs, especially with the advent of the Medicare prescription plan. Pharmaceutical fraud can take a variety of forms, such as: Charging for drugs not used and returned to pharmacy providers; Marketing, promoting, and selling drugs for uses other than those approved by the FDA; Marketing drugs to physicians through illegal means, such as providing financial or other incentives, such as expense-paid 'consulting' trips to doctors and providers who participate in drug marketing promotional meetings; Charging prices to the government that are higher than the law allows; and Providing substandard care. Pharmacy-related violations can include the following: Partially filling prescriptions, but charging as if a full prescription was provided; Providing kickbacks to a medical provider in order to induce the provider to prescribe certain drugs; Prescribing unneeded medications, drugs, or treatment; Charging Medicare or Medicaid patients a higher rate than others for the same prescription; Knowingly providing defective products or services; Falsely diagnosing a more severe ailment than the one the patient actually has, known as 'upcoding' a diagnosis, thereby justifying a more expensive drug therapy or other treatment than that which the patient's health really requires; Inappropriate changes in patients' prescriptions from one drug to another as a result of kickbacks or for other improper reasons; and Falsely reporting drug research grant information to government agencies.