What to Know About Medicare & How to Report Pharmaceutical Fraud
When discussing health insurance, one of the most commonly discussed is Medicare. Specifically designed for individuals 65 years of age or older as well as people with disabilities, Medicare provides coverage for prescription drugs, hospital stays, and other services that may fall under the healthcare umbrella. This is an important form of insurance but due to its reliance, it’s become the subject of fraud over the years. Whether you use Medicare yourself or plan on doing so in the future, here is what you should know about it, as well as how to report pharmaceutical fraud if the opportunity arises.
Established in 1965 under President Lyndon Johnson, Medicare is a type of national health insurance that provides coverage to the aforementioned groups. Furthermore, it’s broken up into four parts: A, B, C, and D, with each representing different types of coverage. Part A focuses on hospital and hospice-related services, including overnight and multi-day stays. Part B covers outpatient services. Part C is Managed Medicare or Medicare Advantage, allowing users to select health plans. Finally, Part D primarily focuses on prescription drugs. Over the years, Medicare has changed and expanded, its benefits shifting to cover chiropractic therapy, care for those with amyotrophic lateral sclerosis, and more.
Given the prevalence of Medicare, not only among the elderly but those with disabilities, it should come as no surprise that it has become the subject of fraud over the years. One of the most common reasons why one may report pharmaceutical company fraud is for the billing of services that were never rendered. As the term suggests, this is when one is charged for any procedure or operation that has never been provided by a company. Such examples of this include filling at dental offices and x-rays at hospitals. Simply put, one will be charged for a service that was never brought to fruition, which makes it a serious form of pharma fraud to address.
One may also wish to report pharma company fraud if billing was done without any medical need for doing so. To expand on this, imagine that an individual is given a prescription drug. A doctor may tell them that this is needed to help reduce pain or allow them to recover faster following surgery, just to name a few possibilities. In reality, the drug may have been inappropriate for its intended purpose or simply not required at all. This is an example of fraudulent billing that negatively impacts the patient while benefitting their healthcare provider.
Off-labeling can also occur, further negatively impacting patients. Generally speaking, when a drug is off-labeled, it’s marketed or advertised in a way that isn’t approved or recommended by the United States Food and Drug Administration. For instance, quetiapine is a substance that’s regularly used for insomnia treatment. However, if that particular substance is marketed for another purpose, such as treating bipolar disorder, it’s seen as off-labeling. This is just one of the ways in which drugs are inaccurately promoted and to say that it’s a serious form of pharma fraud would be an understatement.
Kickbacks also fall under the umbrella of pharmaceutical fraud. For the uninitiated, kickbacks take place when pharma companies offer payments to healthcare providers so that the latter provide specific products or supplies to patients. In turn, patients are encouraged to use said products or supplies over others, even if alternatives are higher quality by comparison. Kickbacks are more common than one may think, especially in pharma, and how it negatively impacts patients makes the act of whistleblowing all the more important.
Now that you know about Medicare, as well as the types of fraud associated with it, you may wish to learn how to report pharmaceutical industry fraud . Before anything else, evidence will be required. The best whistleblowers tend to be those that are employed by companies committing fraud since they are most likely to have access to paperwork that can be used to file cases. Keep in mind that, by law, it’s illegal for an employer to terminate one’s employment due to whistleblowing. What this means is that if you’re concerned about your livelihood, you can set that particular concern by the wayside.
Not only will you be able to protect others if you report pharmaceutical fraud , but you stand to benefit as well. Did you know that a whistleblower reward can be as much as 10 to 30 percent of what the government recovers from a fraudulent case? It’s important to note that the amount one receives can vary based on different factors, including the importance of the information in filing and closing the case. In any event, if you work with a reputable whistleblower attorney , you stand to earn a profit as well. If you are aware of pharmaceutical fraud, speak to an attorney to take those first steps.