Two pharmacy owners were recently convicted of trying to defraud pharmacy benefit managers of tens of thousands of prescriptions, which were submitted to both private and federally-funded healthcare programs. The PBMs paid claims to the conspirator-owned pharmacies in a multimillion dollar scheme. They face up to 17 years in prison and $50 million in restitution.
Case background
The co-conspirator pharmacists hired a telemarketer to get more prescriptions for their pharmacies. The telemarketer cold-called people and manipulated them into accepting prescriptions. The telemarketer also paid physicians to sign off on prescriptions, with zero patient interaction. They also obtained health insurance information to process the claims. Over the course of three years, the co-conspirators submitted claims for reimbursement for over 60,000 fraudulent prescriptions.
Because this scheme misbranded prescription drugs, it also put patients’ health at risk. The co-conspirators specifically chose drugs that could be submitted for inflated reimbursement, without regard for patient safety.
As a result, the conspirators defrauded the government and private health insurance companies out of millions of dollars. This wastes taxpayer money, but also increases private healthcare premiums to make up for the insurer’s losses.
Qui tam lawsuits
A private citizen is allowed to file a “qui tam” whistleblower lawsuit. In this case, a pharmacy or PBM employee could have reported the scheme. When a qui tam lawsuit is successful, the whistleblower plaintiff can receive up to 15 to 25 percent of the government’s damages.
If you’ve uncovered pharmaceutical, Medicare or Medicaid fraud, consider reporting it to the government—but talk to an experienced whistleblower attorney first. Whistleblower lawsuits can be lengthy and stressful, with employment consequences.
Discussing your case with a trusted whistleblower attorney at Kardell Law Group can prepare you for a qui tam lawsuit. Call our office today to learn more.
