Avoiding False Claims Liability in Pharmacy Practice

The federal government funds pharmacy services through programs such as Medicaid, Medicare, and TRICARE. To promote program integrity, the government prosecutes pharmacists and pharmacies that are alleged to have submitted a fraudulent request for payment. The federal False Claims Act is the statute that is commonly used as the basis for these prosecutions. Many of the prosecutions are initiated by “relators” who act as whistleblowers to describe (relate) to the government the fraudulent actions they have witnesses in their pharmacy. This program describes how a False Claims Act case can be asserted against a pharmacy. The responsibility of pharmacy team members to avoid the submission of false claims is discussed. Techniques for preventing false claims litigation are addressed.