The Medicare Part D Program for senior citizens was enacted in 2003 and went into effect on January 1, 2006. The program provides access to prescription drug coverage for Medicare recipients. Tens of millions of Americans are covered under Part D plans each year. Under the Part D program, seniors pay a premium to Part D plan sponsors in exchange for coverage, or partial coverage, of prescription drugs and access to negotiated pricing of prescription drugs.
Across the United States, there are nearly 1,500 Part D Prescription Drug Plans. However, out of all of the plans offered, the majority of the Part D plan market is controlled by just a few of the largest companies. Because of the significant sums of government money available and the sheer volume of participants in the program, sometimes Part D plan sponsors and/or their Pharmacy Benefit Managers (PBMs) engage in fraudulent practices that result in the improper claims for payment to federal programs, and can therefore form the basis for claims under the False Claims Act.
Real World Examples of Recent Medicare Part D Fraud False Claims Act Cases:
- 2012: RxAmerica paid over $5 million to settle False Claims Act lawsuits in which it was alleged that the company misrepresented the cost of prescriptions on the Medicare Prescription Drug Plan Finder on the Centers for Medicare & Medicaid Services' website. The whistleblowers, two of which were represented by Rabon Frazier LLP, shared in an award of $900,000.