Practice Areas

Whistleblower/Qui Tam

Healthcare and Pharmaceutical Fraud

Clinics and hospitals are often the target of qui tam lawsuits, as many of their patients are recipients of Medicare, Medicaid or other government-funded programs. Healthcare providers that bill for services not performed, bill for unnecessary medical testing or examination, fail to meet various requirements relating to patient care or treatment, conceal defective goods, or accept illegal kickbacks can be liable under the False Claims Act. These types of lawsuits can also involve the administration of government benefits.

Fraud frequently occurs in the pharmaceutical industry as well. Payment for off-label use of prescription drugs by government-funded healthcare programs such as Medicare and Medicaid is highly regulated and restricted. In general, drugs prescribed for off-label use are not eligible for reimbursement under Medicare and Medicaid. Federal law also prohibits pharmaceutical kickbacks (i.e., payment of money to doctors to prescribe certain drugs) because of the risk that the kickbacks encourage doctors to prescribe those drugs over other, more effective drugs. When drug manufacturers promote their drugs off-label, or provide kickbacks to doctors who then write prescriptions for those drugs to their Medicare and Medicaid patients, it may violate False Claims Act.

James H. Kaster

Whistleblower Attorney
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