The federal government has been working to make pricey prescription drugs more affordable for the roughly 54.1 million people who are enrolled in the Medicare prescription program, known as Part D.
However, fraud threatens to cost both the government and individuals suffering from health conditions significant amounts of money. Whistleblowers — working people who witness wrongdoing and courageously report it — can play a key role in protecting both.
The government has been pursuing drug price fraud to protect both the public and the Medicare program. A generic pharmaceutical manufacturer, Glenmark Pharmaceuticals Inc., USA, recently reached a $25 million civil settlement to resolve allegations that it fixed the price of a generic drug used to treat high cholesterol. The settlement followed last year’s announcement that seven generic pharmaceutical companies — including Glenmark — collectively agreed to more than $681 million in criminal penalties related to price-fixing, bid-rigging and market-allocation schemes affecting many generic medicines.
In August, a whistleblower prompted Humana to reach a $90 million settlement over allegations that the health insurance company caused individuals and the government to pay more than their share of Medicare prescription drug costs.
Deceptive activity undermines ongoing efforts to cut drug prices. The Centers for Medicare & Medicaid Services has negotiated directly with drug companies for lower prices, starting in 2026, for 10 of the most frequently dispensed drugs in the Medicare program. These drugs treat conditions such as heart disease, diabetes and cancer.
When the change takes effect, the 9 million people with Medicare who use at least one of the drugs could save, collectively, an estimated $1.5 billion in out-of-pocket costs. Medicare stands to save even more — about $6 billion a year.
Entities that knowingly and falsely claim money — or don’t pay owed money — affecting the federal government face triple damages and penalties under the False Claims Act.
The False Claims Act allows whistleblowers to be compensated 15 percent to 30 percent of recoveries from successful cases. In fiscal year 2023, whistleblowers filed 712 qui tam suits, or lawsuits alleging false claims on behalf of the government.
At Keller Grover, we help whistleblowers protect the country against fraud and make sure public money gets to its intended beneficiaries. Through our confidential, free consultations, we advise potential whistleblowers about the best path forward from the very beginning. Our deep experience litigating both fraud and employment law uniquely equips us to represent whistleblowers.