Medicaid Fraud Scorecard

Executive Summary

Pharma's $2 billion in payouts since 2000 to settle claims of fraudulent Medicaid-related marketing and pricing practices has left the industry in flux, as it seeks to determine the kinds of packages and programs that will pass government muster. It appears that the strength of many current and presumed future fraud cases will be based on establishing a company's reasonable foreknowledge of the activities of its customers, with the argument even extended to gray areas including improper encouragement of off-label drug usage and the development of data to support those uses--issues that will affect device companies at least as much as Pharma.