Do you have Evidence that a Pharmaceutical Company or Pharmacy is Guilty of Medicaid Fraud?
A pharmacy or pharmaceutical company submitting a claim to Medicaid for pharma or medical products without proper prescription, alters or forges documents or provides signatures or services without proper licensing or certification is violating their state False Claims Act and committing Medicaid fraud.
Whistleblowers that report pharma fraud and are the first to report that fraud, could earn a large cash reward under their state Medicaid whistleblower law.
Common Pharmaceutical Firm or Pharmacy Schemes Violating State Medicaid False Claims Acts
If you have evidence of a violation of fraudulent billing practices in a pharmacy or pharmaceutical products company, you might earn a cash reward for blowing the whistle on fraud. Typical pharmacy and pharmaceutical fraud schemes used by Medical providers to defraud a Medicaid program include:
- Billing for products not provided: Billing Medicaid for medical devices or pharmaceuticals, when the patient never actually received the product.
- Upcoding: Billing for a brand name pharmaceuticals while providing the generic form.
- Double billing: Submitting claims to both Medicaid and a private insurance company for products or services, or submitting a claim for products or services already rendered and billed for by another provider on the same date.
- Billing for ineligible patients: Submitting claims to Medicaid for patients who are ineligible for Medicaid coverage, whose Medicaid coverage has expired, or who are deceased. May involve Medicaid ID theft.
- Falsifying documents: Keeping inadequate records, altering dates or times, forging signatures, or signing regulated documents by unlicensed staff.
- Illegal prescription sales or gifts: Providing prescription pharmaceuticals without proper physician authorization.
- Anti-kickback violations: Providing discounts or gifts to medical institutions or medical providers in exchange for patient referrals.
- Licensing or certification violations: provides signatures or services without proper licensing or certification
Whistleblower Provisions of Your State False Claims Act Give Cash Rewards to People Who Report Pharmacy or Pharmaceutical Medicaid
State False Claims Acts include a whistleblower provision that pays cash rewards of 15 to 30 percent of any money recovered to someone who is the first to report Medicaid fraud with inside evidence that helps law enforcement build a fraud case.
Tipsters are protected from firing by strong anti-retaliation provisions of state False Claims Acts that make it illegal to demote, harass, or fire an employee for reporting fraud to law enforcement.