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Health Care Fraud Happens All Over the Country, and It Has Been Exposed

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A woman by the name of Lisa, code name Pampers, put herself at risk when she agreed to wear a wire for the FBI. She was eight months pregnant at the time and had worked as a sales representative for a pharmaceutical company. After hearing about the incentives the company would give to doctors to prescribe certain drugs, she knew she had to do something to expose it. And she did.

The company she worked for, Warner Chilcott, like so many other pharmaceutical companies, was offering incentives to doctors that prescribed their drugs. These companies provide those incentives in a number of ways, whether it’s providing free lunches and dinners for doctors, giving them outright cash, or even making their job easier by filling out extensive paperwork for them. The company Lisa worked for also broke privacy laws by looking through patient files.

Warner Chilcott, now owned by Allergan, and so many other pharmaceutical companies have two goals in mind when doing this. The first of course, is to get more people to use their drugs, so they can make more profit. The second, and perhaps even bigger goal, is to get their drug on Medicaid’s preferred drug lists.

Those preferred drugs are meant to meet the balance of providing the most effective drugs at the most affordable prices. While the drug company’s product may not meet this criteria, they are always willing to pay to make sure it does. That is because being on the list means it is easier for a doctor to prescribe the drugs.

It is clear that something needs to be done in order to protect the safety of patients, and to put their well-being, both physically and financially, above the profit of the drug companies. In the case of Warner Chilcott, it was. After being found guilty of submitting false information to the states providing Medicaid, they were charged with felony health care fraud in 2015. After the verdict, they were required to pay $125 million in civil and criminal fines.

“Unfortunately,” says John L. McCraw, III, of The McCraw Law Group, “while the case of Lisa may be unique, the case of Warner Chilcott is not. It is a problem happening all around the country.”

And it is. Three out of five doctors currently voting on Medicaid decisions in different states are receiving the same kinds of perks from drug companies.

The patients are also not the only ones suffering from it. The individual states are, too. From the years 2008 to 2016, Medicaid drug costs increased by nearly 50 percent per patient, which nearly doubled the amount Medicaid was spending on drugs, putting the total at $31 billion.

It is clear that, in the best interests of the states and more importantly, of the people that desperately need drugs that are affordable and effective, patients can only hope that there will be more whistleblowers like Lisa in the future. And that drug companies and doctors alike will be held accountable for their unethical practices.