Atlanta Pharmacy Fraud
In 2020, Americans spent more than $500 billion on prescription drugs. Indeed, roughly 70% of Americans take at least one prescription drug, and over 50% take two or more. As the population continues to age, we anticipate all these numbers to increase this decade.
Because the industry is so large, the opportunity for fraudulent conduct is a real possibility. Government health insurance programs like Medicare and Medicaid pay for the bulk of prescription drugs, and some doctors and pharmacists cheat the system by filing false claims. Because the costs of prescriptions continue to increase, the opportunity for scammers to make huge, illegal profits only increases. Fortunately, concerned citizens can fight back by reporting pharmacy fraud in Atlanta.
Fraudulent Schemes Involving Pharmacies
There are many different schemes put into practice. But, at base, fraudulent schemes involve getting health insurers to pay for unnecessary prescription drugs. For example, the following are different types of fraudulent schemes:
- Charging for a higher-cost prescription when a cheaper one is provided to the patient.
- Billing for a prescription that is never prescribed.
- Billing multiple payers for one prescription.
- Providing a patient with generics but billing for brand-name medications.
- Making prescriptions using unnecessary ingredients to increase profits.
In some schemes, only the pharmacist and staff are aware of the scheme. However, doctors often get in on the action as well, such as when they prescribe unnecessary medications and receive a cut from the pharmacy for doing so.
False Claims Act & Pharmacy Fraud
Because the federal government is the largest health insurance provider, it has prioritized rooting out fraud and corruption. To that end, it has criminalized the submission of a false claim to the federal government or the offer or acceptance of kickbacks for the referral of government-paid health care.
Pharmacy fraud is difficult for most people to detect. They are grateful to receive any medicine which they believe will make them well.
For its part, the government regularly reviews statistics to try and uncover fraudulent claims billed to Medicare and Medicaid. But even regulators lack adequate information to uncover some of the more complicated schemes.
This is where a whistleblower comes in. If you have evidence of fraud, you can file a False Claims Act and receive a portion of the money recovered due to the fraudulent scheme (roughly 15-25%). This law incentivizes regular citizens to hold health care scammers accountable in court using a private enforcement mechanism.
Speak with Our Atlanta Pharmacy Fraud Attorney
Many of our clients suspect their pharmacy or doctor is prescribing unnecessary medications, but they lack solid proof of fraud. Please contact our law firm today so we can review what you know and advise you on whether to speak to government regulators. Please schedule a free, totally confidential consultation for a convenient time.
