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Scams In Pharmaceutical Sectors

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Pharmaceutical fraud involves activities that result in false claims to insurers or programs such as Medicare in the US or equivalent state programs for financial gain to a pharmaceutical company. Several different schemes are used to defraud the health care system, which is particular to the pharmaceutical industry. These include:

  • Good Manufacturing Practice (GMP) Violations,
  • Off Label Marketing,
  • Best Price Fraud,
  • CME Fraud,
  • Medicaid Price Reporting, and
  • Manufactured Compound Drugs.

Every now and then news is in the air for frauds related with pharmaceutical industry, and is climbing uphill. Some Big Daddys of Pharma frequently end up pyaing compensation  against the law suits imposed on them for various fradulent activities,misrepresentation of data and other such corruption allegations levelled out against them.

In the last years, global pharma giants have paid fines to the tune of $11 billion for criminal wrongdoing, including withholding safety data and promoting drugs for use, beyond any licensed condition;
GlaxoSmithKline paid a $3 billion settlement,
Pfizer $2.3 billion settlement,
Merck $650 million settlement

July of 2021 saw Bolton pharmacist David “Jason” Rutland pleading guilty to conspiracy to solicit and pay kickbacks and bribes in a $182.5m fraud case in which Rutland himself pocketed $13.3m. This conspiracy is noted as the state’s largest health care/pharmaceutical fraud to date. It is estimated that more than $515 million in fraudulent prescription billings were made to TRICARE, Medicare, Medicaid, and private health care benefit providers in Mississippi.

Common Fraud in the Pharmaceutical Industry Includes:

Unlawful Kickbacks
Clinical trials manipulation/fraud against the Food and Drug Administration (FDA)
Off-label marketing/Food Drug and Cosmetic Act (FDCA) violation
Failure to comply with Current Good Manufacturing Practices (CGMP) requirements
Compounded drug fraud
Illegal drug-switching
Misuse of the 340B drug discount program
Medicaid best price fraud
Medicare Part D Fraud
Fraud by Pharmacy Benefit Managers (PBMs)
Understanding the Most Common Types of Pharmaceutical Industry Fraud Reported by Whistleblowers

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