Healthcare and Pharmaceutical Fraud

Healthcare is the largest single cost in the federal budget – approximately forty percent of the total — and the cost dramatically increases from year to year. With fraud following that money, the government is highly incentivized to investigate and prosecute corruption in the healthcare and pharmaceutical industries.

False Claims Act violations involve making fraudulent claims for payment from the government healthcare programs.  The largest programs are Medicare (healthcare for the elderly), Medicaid (healthcare for the indigent), and TRICARE (healthcare for the military).  Fraudulent conduct can involve overbilling, or receiving payments under these programs while not in compliance with healthcare regulations.

Most entities that provide healthcare receive some federal government and state funding. Entities that participate in government funded healthcare programs must comply with various government laws tied to the receipt of government funding.

Some Of The Healthcare & Pharmaceutical Fraud Cases Handled by Behn & Wyetzner Include:

Common Types Of Healthcare And Pharmaceutical Fraud Include:

  • Providing kickbacks in the form of any remuneration to healthcare providers in exchange for referring patients or dispensing drugs
  • Duplicate billing for the same drugs, tests or services
  • Marketing drugs for uses not approved by the FDA, i.e. “off-label marketing”
  • Billing for services not rendered or products not delivered
  • “Stark Violations”: Self- referrals to an entity in which a physician has an interest
  • “Upcoding”: billing for excessive services that were not rendered
  • Durable Medical Equipment fraud, such as for DME that was not medically necessary
  • Billing for individualized treatment when treatment was provided in groups
  • Non-compliance with Food and Drug Act (FDA) regulations governing manufacturers and suppliers of pharmaceuticals and other healthcare products
  • Failing to follow federal and state laws regulating pharmaceutical pricing