Do You Need a Whistleblower Attorney for Pharmaceutical Fraud?

What is pharmaceutical fraud?

Pharmaceutical fraud encompasses a wide variety of illegal schemes used by pharmaceutical manufacturers, pharmacies or other health care providers resulting in the submission of claims for reimbursement from Medicare, Medicaid, TRICARE or another government program for drugs that are improperly manufactured, marketed or priced.

Between October 31, 1987 and September 30, 2015, the United States recovered more than $30 billion under the False Claims Act from companies that defrauded Medicare, Medicaid and other government health care programs.  The overwhelming majority of this amount is attributable to False Claims Act qui tam lawsuits against members of the pharmaceutical industry, pharmacy chains as well as drug manufacturers.

Recoveries are sizeable in this area not only because of the tremendous amount Medicaid and Medicare spend each year to cover medications for our indigent and our elderly, but also because many members of the industry have employed illegal schemes as business models to maximize profit. With corporate compliance departments often reporting to the very executives who oversee these schemes, and with the perceived benefits of the schemes ordinarily greater than the perceived costs, these illegal schemes have proliferated. Thanks to the courageous efforts of whistleblowers, and the enforcement actions by federal and state authorities, we may finally succeed in turning the tide.

VSG Settlements

National Chain Pharmacy Over-Bills Medicare and Medicaid for Insulin Pens

Walgreens, the nation’s second largest pharmacy chain, paid $209 million in January 2019 to settle allegations by two VSG clients that the pharmacy knowingly billed government health programs for medically unnecessary quantities of insulin pens. The whistleblowers, both of whom worked for Walgreens, claimed that Walgreens programmed its dispensing and billing software program so that pharmacists could not dispense less than 5 insulin pens at a time – the amount in a carton of pens, understated the dispensed “days’ supply”  on claims to payers, and then refilled prescriptions prematurely. Read Press Release

Pharmaceutical Whistleblower Cases - Drug Manufacturer Kickbacks

Drug Manufacturer Kickback on Specialty Medications

Novartis Pharmaceuticals Corporation paid $390 million to settle a False Claims Act lawsuit brought by a VSG client who alleged the company paid kickbacks to specialty pharmacies so they would recommend to doctors and patients six of Novartis’ specialty medications. The $465 million aggregate recovery in the case was, at the time, the largest recovery ever in a qui tam suit based solely on a kickback theory. Read Press Release

Drug Manufacturer Kickbacks - Pharmaceutical Whistleblower Lawsuits

Drug Manufacturer Kickbacks to Specialty Pharmacies

Accredo Health Group, Inc. and Bioscrip, Inc. two specialty pharmacy chains, paid a combined total of $75 million to settle qui tam whistleblower claims in a False Claims Act lawsuit that also named as a defendant the Swiss drug manufacturer, Novartis Pharmaceuticals Corp. The case alleged the companies participated in a kickback scheme involving the iron-chelating drug Exjade, a specialty drug that costs government health programs thousands of dollars per month to cover a single prescription. Read Press Release

Pharmaceutical Fraud Qui Tam Settlement - Off Label Marketing

Off-Label Marketing

Pfizer Inc. paid $491 million to settle allegations raised by a firm client that Wyeth Inc., a pharmaceutical manufacturer acquired by Pfizer, had illegally marketed the kidney transplant drug Rapamune for uses that had not been approved by the Food & Drug Administration. The firm’s client shared the relator share award with whistleblowers in another case with partially overlapping allegations. Read Press Release

Qui Tam Lawsuits - Pharmacy Usual and Customary Fraud Cases

Violating Usual & Customary Charge Requirments

Omnicare, Inc. paid more than $20 million to resolve allegations made by a firm qui tam whistleblower client that the pharmacy chain knowingly overbilled the Medicaid programs of Massachusetts and Michigan as a result of its failure to comply with the “usual and customary charge” billing rule. Read Press Release

Pharmaceutical Whistleblower Case - Pharmacy Kickbacks to Omnicare

Kickbacks to Long Term Care Pharmacy

Johnson & Johnson, Inc., paid $149 million to settle allegations in cases filed by two qui tam whistleblowers, including a firm client, that the pharmaceutical giant paid kickbacks to long term care pharmacy chain Omnicare to induce Omnicare to recommend the atypical antipsychotic Risperdal for residents of nursing homes serviced by Omnicare. Read Press Release

See All Pharmaceutical Fraud Settlements

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"It’s rare when one is rewarded so richly for doing the right thing," said whistleblower Mark Campbell.