Pharmaceutical Fraud

When drug companies break the law, patients can be put at risk and taxpayers often foot the bill through federal health programs. Attorneys at Siri & Glimstad represent whistleblowers who have the courage to report pharmaceutical fraud and hold wrongdoers accountable.

The False Claims Act (FCA) is a law that enables ordinary people to help the government combat fraud. You can file a lawsuit against individuals or companies that submit fraudulent claims to the United States. In the pharmaceutical industry, fraud often appears when unlawful practices drive prescriptions or claims for reimbursement, which are paid for by government healthcare programs.

These schemes can be hidden behind marketing campaigns, rebate arrangements, speaker programs, “consulting” deals, or complex pricing and reporting systems.

• Illegal kickbacks to physicians, clinics, hospitals, pharmacies, or patients to induce prescriptions or purchasing
• Using medicines “off-label” to treat medical problems that they were not approved for
• False pricing or reporting (for example, inflating or misreporting pricing benchmarks that affect government reimbursement)
• Misrepresenting a drug’s safety, efficacy, or medical necessity in ways that drive improper payment
• Rebates and formulary arrangements structured to disguise improper inducements
• Waiving co-pays for prescribed medicines
• False certifications of compliance tied to government payment requirements
• Violating the Medicaid Best Price rule by, for example, charging the government more for a certain drug than private insurers pay

If you’re not sure whether what you saw “counts” as fraud, that’s normal. Many strong cases begin with a straightforward question: Is the government paying money it should not be paying because of this conduct?

Pharmaceutical fraud is rarely visible from the outside. It has to be uncovered through internal emails, sales directives, pricing submissions, call notes, speaker program rosters, and contracting records. Whistleblowers are essential because they can connect the dots between what is happening inside a company and what is ultimately billed to government programs.

The FCA empowers a private individual (called a relator) to bring a case in the name of the United States. If a case succeeds, the relator may be eligible for a share of the recovery, often between 15% to 30% of the funds.

Timing and strategy matter. Missteps such as tipping off the wrong people, mishandling sensitive materials, or waiting too long can weaken a case or create avoidable risk. Experienced counsel can help you evaluate the facts, preserve information appropriately, and present the strongest possible case to the government.

We focus on representing whistleblowers. Our job is to protect you while building the strongest possible presentation of the fraud for the government. Our support typically includes:

• Confidential case evaluation (what happened, how it ties to government payment, and where the strongest proof may exist)
• Evidence strategy and case development (organizing key documents, timelines, witnesses, and program impact)
• Preparing the required disclosure package for the government and drafting the sealed complaint
• Filing and managing the case under seal and communicating with DOJ attorneys and investigators
• Guiding you through the investigation phase (including interviews and follow-up requests)
• Litigation and resolution strategy (intervention, settlement, or continued prosecution)
• Protection from retaliation and advice on employment-related risk

The goal is simple: assist the government with investigating and understanding the scheme while helping you navigate the process safely and strategically.

Federal law prohibits employers from retaliating against whistleblowers for engaging in protected activities while investigating or reporting FCA violations. Depending on the circumstances, remedies can include reinstatement, back pay, and other relief.

If you are worried about your job, your license, or your reputation, we will talk through risk and options—confidentially.

• Marketing and Training Materials: Slide decks, sales call scripts, or training manuals that explicitly encourage or coach representatives on how to promote drugs for unapproved (“off-label”) uses.
• Kickback Trails: Spreadsheets, CRM logs, or expense reports tracking speaker fees, expensive dinners, or sham consulting contracts tied directly to a physician’s prescribing volume.
• Suppressed Data: Internal studies, emails, or clinical trial drafts showing that the company knowingly hid adverse side effects or falsified efficacy data.

Speak Confidentially with a Pharmaceutical Fraud Whistleblower Attorney at Siri & Glimstad today.

If you have information about fraud involving a drug company, pharmacy, PBM relationship, speaker program, pricing submission, or rebate arrangement, you may be in a position to help stop misconduct and protect patients. Contact Siri & Glimstad for a confidential case review.