Pharmaceutical fraud includes a number of activities in which an individual makes false claims to Medicare, Medicaid or private insurance companies who pay for the patient’s drug therapies. There are many behaviors which fall in the definition of “pharmaceutical fraud.”
When someone commits pharmaceutical fraud, larger companies are often identified as responsible, and the companies may face criminal and civil liability. Depending on the specifics of the situation, penalties can total millions of dollars, and those who facilitated the fraud crimes may also face charges. A New York defense lawyer at Spodek Law Group, PC can represent healthcare professionals, doctors, pharmaceutical corporations and others accused of involvement with pharmaceutical fraud schemes. Call us today for more information about our legal services.
Pharmaceutical Fraud Examples
Fraud can take several forms throughout the pharmaceutical industry, including:
– medicaid and Medicare fraud schemes. Pharmaceutical companies are required to report pricing data in order for Medicaid to accurately calculate its reimbursement rate for the covered drug therapies. Fraud charges may result when pharmaceutical companies fail to follow regulations for reporting on drug prices to Centers for Medicare and Medicaid Services. In addition, any type of false reporting of drug origin, price or status may also be considered a form of fraud.
– Intentional deception of Good Manufacturing Practices (GMP) regulations. A pharmaceutical company may fail to ensure its facilities are appropriately equipped, fail to maintain stringent control over the drug manufacturing process or fail to train its personnel. When a company hides inadequacies in its manufacturing processes or facilities or when it purposefully misleads investigators, these situations are considered a form of pharmaceutical company fraud.
– Marketing drugs for off-label purposes. The U.S. Food and Drug Administration (FDA) prevents pharmaceutical companies from marketing products for uses other than the purposes for which it has previously approved the drugs. Although doctors often prescribe off-label, drug makers can face fraud charges if they use marketing tactics that push medications to treat conditions unapproved by the FDA.
– Illegal kickback schemes. When pharmaceutical companies pay or provide valuable incentives to healthcare providers for prescribing a particular drug to their patients, they may face criminal charges. Similar to marketing drugs for off-label purposes, drug makers may take it upon themselves to ensure their products and not those of their competitors are prescribed to patients.
Other types of pharmaceutical company false claims include pricing fraud, average sales price fraud and clinical trial fraud, in which a pharmaceutical company misrepresents or outright lies about the results of clinical trials in order to receive funding for its products. If defendants are convicted of acting illegally, they may face serious criminal penalties and possible federal investigations.
Penalties for Pharmaceutical Fraud
In many cases, pharmaceutical companies settle civil lawsuits. Whistleblowers are encouraged to come forward and file qui tam lawsuits under the False Claims Act, receiving generous financial incentives if they help the U.S. government recover funds improperly paid to drug makers as a result of illegal activity or wrongdoing.
Pharmaceutical company employees, hospitals and doctors who violate the law may also face criminal charges as well — some of which carry penalties of decades in jail. Under 42 U.S. Code Section 1320-a-7b, it is a felony offense to conceal facts, make false statements or make false representations when applying for payments or benefits from federal healthcare programs.
It is important to work with a pharmaceutical fraud attorney throughout all stages of the process. Defendants must know that they may face multi-count indictments, and they must understand each charge against them as well as the penalties for their alleged illegal activities.
Contact a New York Pharmaceutical Fraud Lawyer for More Information
The attorneys at Spodek Law Group, PC have extensive experience with pharmaceutical fraud claims. We understand how complex drug price-setting, marketing and manufacturing can be, and we vigorously fight to prevent criminal penalties from being imposed on our clients as they work in the pharmaceutical industry.
We have the dedication and knowledge necessary to help you aggressively respond if you are facing charges. The outcome of the case could take your freedom and significantly alter your financial future, so contact us today to learn how one of our New York City pharmaceutical fraud attorneys can help with your case.

Unraveling the Complicated Web of Pharmaceutical Fraud

Pharmaceutical fraud is an alarming and complex issue that involves a broad range of activities, including making false claims to Medicare, Medicaid, or private insurance companies for patients’ drug therapies. The consequences of these fraudulent behaviors can be devastating for the companies and individuals involved, often leading to criminal and civil liabilities, potential penalties in the millions of dollars, and charges for those who facilitated the fraud crimes. A New York defense lawyer at Spodek Law Group, PC can provide expert representation for healthcare professionals, doctors, pharmaceutical corporations, and others accused of involvement in these intricate pharmaceutical fraud schemes. Don’t hesitate to contact us today to learn more about our legal services.

Examples of Pharmaceutical Fraud: A Multifaceted Problem

Pharmaceutical fraud can manifest itself in various forms throughout the industry, including:

• Medicaid and Medicare fraud schemes: Pharmaceutical companies must report pricing data to ensure Medicaid calculates accurate reimbursement rates for covered drug therapies. Fraud charges may ensue if companies fail to adhere to regulations for reporting drug prices to the Centers for Medicare and Medicaid Services, or if they falsely report drug origin, price, or status.
• Intentional Deception of Good Manufacturing Practices (GMP) regulations: Pharmaceutical companies might evade ensuring their facilities are properly equipped, maintaining strict control over the drug manufacturing process, or training their personnel. If these companies deliberately mislead investigators or hide inadequacies in their manufacturing processes or facilities, it is considered pharmaceutical company fraud.
• Marketing drugs for off-label purposes: The U.S. Food and Drug Administration (FDA) prohibits companies from marketing products for uses other than those it has previously approved. While doctors may prescribe off-label, drug makers can face fraud charges if their marketing tactics encourage medications to treat unapproved conditions.
• Illegal kickback schemes: Pharmaceutical companies that provide valuable incentives or payments to healthcare providers for prescribing specific drugs to patients can face criminal charges. Similar to off-label marketing, drug makers may work to ensure their products, and not their competitors’, are prescribed to patients.

Other fraudulent activities in the pharmaceutical sector include pricing fraud, average sales price fraud, and clinical trial fraud. The latter involves pharmaceutical companies misrepresenting or outright lying about clinical trial results to receive funding for their products. Convicted defendants may face severe criminal penalties and potential federal investigations.

Penalties and Consequences of Pharmaceutical Fraud

Pharmaceutical companies often settle civil lawsuits, and whistleblowers are encouraged to file qui tam lawsuits under the False Claims Act. These whistleblowers may receive substantial financial incentives if they help the U.S. government recover funds improperly paid to drug makers due to illegal activities or wrongdoing.

However, pharmaceutical company employees, hospitals, and doctors who break the law may also face criminal charges, some carrying penalties of decades in jail. Under 42 U.S. Code Section 1320-a-7b, concealing facts, making false statements, or making false representations when applying for payments or benefits from federal healthcare programs is a felony offense.

It is crucial to work with an experienced pharmaceutical fraud attorney throughout all stages of the process. Defendants must understand the multi-count indictments they may face, each charge against them, and the penalties for their alleged illegal activities.

Contact a New York Pharmaceutical Fraud Lawyer Today

The attorneys at Spodek Law Group, PC have extensive expertise handling pharmaceutical fraud claims. We comprehend the complexities of drug price-setting, marketing, and manufacturing, and vigorously defend our clients to prevent the imposition of criminal penalties in the pharmaceutical industry.

Our dedication, knowledge, and aggressive strategies can help you respond if you face charges. The outcome of your case could gravely impact your freedom and significantly alter your financial future. Don’t hesitate—contact us today to learn how one of our New York City pharmaceutical fraud attorneys can assist in your case.