Pharmacy Cases / Prescription Fraud

The United States Department of Justice (“DOJ”) has placed an enhanced focus on pharmacies because of the opioid crisis.  The claims against pharmacies typically involve the Controlled Substances Act and the False Claims Act.

Under the Controlled Substances Act and its accompanying regulations, a prescription is valid only if it is “issued for a legitimate medical purpose.”  False Claims Act liability also applies because pharmacies submit claims for reimbursement for drugs dispensed to Medicare beneficiaries and certify compliance with all federal laws, regulations and Centers for Medicare and Medicaid Services.

However, the DOJ is not only targeting pharmacies for opioids.  There are a number of theories the DOJ can assert under the broad scope of health care fraud laws.  This makes  pharmacies, compounding pharmacies and pharmacists suspected of False Claims Act violations a major target for False Claims Act liability.