Tiny Key West Pharmacy Blows Whistle on Medicaid Fraud

Monday, October 22, 2012

By Danielle M. Murray, J.D.

On September 27, 2012, Public Citizen, a watchdog group, reported whistleblowers have initiated $6.6 billion in penalties against drug manufacturers in 2012. Most of these penalties are for fraudulently overcharging government programs. The report names a small Key West, Florida, pharmacy as one of the top whistleblowers in the country. The pharmacy noticed and reported that drug manufacturers were charging highly inflated prices to Medicaid.

To read the entire report on from Public Citizen, click here.

Whistleblowing Pays.

The study shows that the government collected billions of dollars, just in 2012, as a result of whistleblower efforts.

For whistleblowers such as the Key West pharmacy, helping the government fight fraud has its rewards. According to the Miami Herald, the government collected an estimated $1.3 to $2.5 billion dollars thanks to the pharmacy. As a reward for its whistleblowing, the government gave the pharmacy an estimated $340 million dollars.

Click here to read the Miami Herald article.

One major victory was in 2012, the pharmacy won a settlement with Boehringer Ingelheim, a large pharmaceutical company, for $289 million for overcharging government health programs for various drugs.

To read the entire whistleblower complaint file, click here.

Budget Shortfalls Cause States to Look at Medicaid Fraud.

It's no surprise that states are short on funds to pay for Medicaid. As a result, fraud enforcement is increasing, in hopes that the recoveries will make up that deficit. According to studies, states that have elected to enforce whistleblower claims against the pharmaceutical industries have found that the outcome pays for the cost of enforcement.

How This Affects Providers.

If states find that fraud recovery produces large results, they will increase their efforts in other areas besides the pharmaceutical industry. This could result in additional audits against individual providers, with states hopeful that they will uncover overpayments and other problems that would allow recoupment of funds. In fact, this is already happening in some areas, and the auditors are actually incentivized to find mistakes that providers make.

Faced with an Medicaid Audit? Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


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Dorschner, John. "Key West Pharmacy Top Whistle-Blower." Miami Herald.(September 27, 2012). From: http://www.miamiherald.com/2012/09/27/3023894/key-west-pharmacy-top-whistleblower.html

About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tag Words: Medicaid, Medicaid fraud, Medicaid auditdefense attorney, Medicaid defense attorney, legal defense, Medicaid fraud defense attorney, Florida defense attorney, Medicaid scheme, False Claims Act, FCA, qui tam suits, whistleblower, whistleblower protection, legal representation, government health programs, audit, Medicaid overbilling
"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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