Pharmaceutical Fraud and Qui Tam Whistleblowers

When drug companies break the law, patients can be put at risk and taxpayers often foot the bill through Medicare, Medicaid, TRICARE, and other federal health programs. Attorneys at Siri & Glimstad represent qui tam whistleblowers who courageously report pharmaceutical fraud and help hold wrongdoers accountable.

The Federal False Claims Act (FCA) is a powerful tool that enables ordinary people to help the government combat fraud. In simple terms, the FCA imposes liability on individuals or companies that knowingly submit, or cause the submission of, false or fraudulent claims for payment to the United States. In the pharmaceutical context, 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. What matters the most is whether the misconduct caused the government to overpay or to pay for claims that are improper.

• Illegal kickbacks to physicians, clinics, hospitals, pharmacies, or patients to induce prescriptions or purchasing
• Off-label promotion that causes reimbursement claims for uses that are not covered or are not medically accepted under program rules
• 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
• Upcoding, in which providers bill the government for more costly procedures than what were actually performed
• Rebates and formulary arrangements structured to disguise improper inducements
• Copay assistance or “charitable” support used as a conduit to steer federally insured patients towards a pharmaceutical company’s brand name drugs
• 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 often lives in 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 qui tam case in the name of the United States. These cases are typically filed under seal at the outset, giving the government an opportunity to investigate before the defendant is publicly served with the lawsuit. If a case succeeds, the whistleblower may be eligible for a share of the recovery, subject to statutory factors: often 15% to 25% if the government intervenes, and 25% to 30% if the government allows the whistleblower to proceed without government intervention.

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.

1. Confidential Intake – Speak privately with our FCA team at Siri & Glimstad about what you observed.
2. Case Assessment – Evaluate FCA theories, program impact, evidence, and practical risks.
3. Investigation & Development – Build a clear narrative, timeline, and proof structure.
4. Sealed Filing – File the complaint under seal and serve the government (not the defendant).
5. Government Investigation – DOJ investigates and decides whether to intervene.
6. Resolution – If the case succeeds, the whistleblower may be eligible for a relator’s share.

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.