It Pays To Have Experience On Your Side.
free consultation917-639-5370

Are you implicated in pharmacy benefit managers fraud?

There are several types of fraud involving pharmacists and pharmacies, including drug switching, bribes and kickbacks and auto-refilling schemes.

You have just learned that the company you recently went to work for is about to be investigated for pharmacy benefit managers fraud. What does this mean, and what should you do?

About PBMs

A pharmacy benefit manager is a third-party entity that administers prescription drug programs for insurance plans, managed care companies, unions and government programs such as Medicaid and Medicare. The PBM serves as a middleman between government programs, pharmacies and pharmaceutical manufacturers. PBMs get better pricing than a single plan would because they purchase drugs and medical supplies in bulk. In the U.S., there are three major PBMs and dozens of smaller such companies.

PBM fraud

A PBM's main job is to negotiate prices of pharmaceuticals, and their failure to do so is a serious violation of their responsibilities, tantamount to fraud. Fraud also occurs when the PBM offers kickbacks or some other reward to pharmacies as incentives to switch from cheaper to more expensive drugs. PBMs commit an illegal act if they keep rebates that they receive from drug manufacturers when those rebates should go to government programs. Other fraudulent acts include switching drugs, recycling drugs that mail-order customers return, using undisclosed locked-in pricing or dispensing either expired or modified drugs.

The next step

As a new employee of the pharmacy benefit manager, you may not know how the company may have an involvement in any kind of fraudulent activity. The possibility of fraud was probably brought to light by a whistleblower employee who may no longer work for the PBM. You are likely very concerned about this turn of events because your career, as well as your reputation, are in jeopardy. Your next step is to obtain legal counsel. It is wise to prepare for all eventualities, especially when an investigation into the PBM you work for may touch you personally.

No Comments

Leave a comment
Comment Information

Honors and Memberships

Super lawyer American college trial lawyers The national trail lawyers AV Preeminent
Contact us

contact our law firm

If you are facing a criminal charge or securities dispute, it pays to have experienced lawyer on your side. Contact us today online or by telephone at 917-639-5370 to speak with an experienced New York City defense lawyer.

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

New York
Bachner & Associates, P.C.

New Jersey
Bachner & Associates, P.C.

New York Office
39 Broadway, Suite 1610
New York, NY 10006

Phone: 917-639-5370
Phone: 212-344-7778
Fax: 212-344-7774
New York White Collar Crimes Office

West Caldwell Office
New Jersey Office
175 Fairfield Avenue, Suite 3D
West Caldwell, NJ 07006

Toll Free: 877-388-6461
Phone: 212-344-7778
Fax: 212-344-7774
Map & Directions