Can’t You Hear the Whistle Blow

11742853 - money and pills

Government benefit programs rely on the honesty and integrity of insiders to report fraud, waste and abuse. Large financial rewards can be given to whistleblowers who share any information that may be helpful in stopping the misuse of benefits intended for qualified beneficiaries. Today’s ”Fraud of the Day” article from calls attention to two whistleblower lawsuits filed regarding some pretty serious alleged infractions committed by a pharmaceutical company. The settlement requires the company to repay Medicaid $31 million.

The story states that a drug manufacturer allegedly underpaid Medicaid rebates instead of offering the ”best price” available; offered kickbacks to nursing home pharmacy companies to sell their medications; misrepresented drug prices to Medicaid; and, promoted the use of one of its antidepressant drugs in unsafe conditions which included treating children and teens. (The company was accused of basically advertising its drugs for conditions that were not FDA-approved and supposedly cheating Medicaid at the same time.)

The law suits were originally filed in Texas and Massachusetts; however, other states, as well as the federal government, will benefit from the $31 million settlement. Other states cashing in on the lawsuit include New York ($2.5 million), Missouri (623,000), Kentucky ($350,000), Indiana ($181,000) and Idaho ($53,000).

If it weren’t for these whistleblower lawsuits, this pharmaceutical company would have continued to bilk the Medicaid program. Kudos goes out to the health care professionals who recognized the criminal actions and took a stand against fraud, preventing further abuse. Their efforts have helped to preserve the integrity of the Medicaid program and restore benefits to those who truly deserve them.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Organon to Pay $31 Million Over FCA Medicaid Allegations,” written by Erica Teichert and posted on on October 15, 2014.

Drug manufacturer Organon USA Inc. has agreed to pay $31 million to settle allegations from the federal government and several states, including New York and Kentucky, that it underpaid rebates to state Medicaid programs, several state attorneys general said Wednesday.

Organon faced two separate lawsuits in Texas and Massachusetts federal court, claiming the company underpaid Medicaid rebates, offered improper financial incentives to nursing home pharmacy companies, misrepresented drug prices and promoted drugs for off-label uses, according to the state attorneys general.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.