The Department of Justice is very interested in hearing from individuals who have knowledge of conduct by pharmaceutical companies and other health care organizations that contributes to rising drug prices.
Also, in the pricing context, the Department of Justice has pursued cases where pharmaceutical companies have failed to report accurate information to the Medicaid program under the Drug Rebate Statute to underpay rebates that they owe. For example, one drug company paid $465 MILLION to resolve allegations that it knowingly misclassified one of its drugs as a generic drug to avoid paying Medicaid rebates. https://www.justice.gov/opa/pr/mylan-agrees-pay-465-million-resolve-false-claims-act-liability-underpaying-epipen-rebates
In this case, the whistleblower that reported the fraud to the Department of Justice was a competitor of the pharma company that paid the $465 MILLION. This qui tam relator received $38.7 million as its share of the federal recovery, plus a share of the states’ recovery. https://www.justice.gov/usao-ma/pr/mylan-agrees-pay-465-million-resolve-false-claims-act-liability”
“In another case, the Department of Justice sued a pharma company under the False Claims Act, alleging that it knowingly underpaid Medicaid rebates that it owed because of its large increases in the price of one of its drugs. https://www.justice.gov/opa/pr/united-states-intervenes-false-claims-act-lawsuit-against-drug-maker-mallinckrodt-alleging-0
This alleged Medicare rebate fraud was brought to the attention of the Department of Justice by an individual with knowledge of the fraud. The individual will be entitled to a share of the Government’s recovery once the lawsuit has ended.
Another type of drug pricing fraud that the Department of Justice has focused on involves pharmaceutical companies that improperly use so-called “foundations” to help patients pay their copays to the Medicare program. There is an important purpose to the copay for patients. It is a form of cost-sharing between the patient and Medicare and helps to prevent over-prescribing and over-billing for unnecessary drugs.
While shifting copays from patients to a third party may sound like a charitable idea, it is not. It is just the opposite of charitable and it is illegal. Shifting copays from patients to third parties has negative consequences: it illegally induces more drug prescriptions, gives the pharma company’s drugs a competitive advantage, and undermines a key safeguard to prevent rising drug costs. In 2020, the Justice Department reported that it has so far collected more than $1 BILLION for these schemes. https://www.justice.gov/opa/speech/remarks-deputy-assistant-attorney-general-michael-d-granston-aba-civil-false-claims-act
If you are aware of old, new, or evolving fraud schemes involving drug pricing fraud, the Department of Justice may be very interested in learning more about the information you have. You may also be entitled to a financial reward. Tell us about the information you have at https://www.fraudfighters.net/. We will provide you a free consultation