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 Raiser & Kenniff, 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 Raiser & Kenniff, 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.
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