Prescription Fraud and False Claims Investigations



Healthcare fraud costs states and the federal government billions of dollars each year, much of it involving prescription drugs.  Common types of prescription fraud include billing 3rd parties, especially government entities, for (a) prescriptions filled but never picked up by patients, (b) prescriptions filled with drugs billed and dispensed to previous patients but subsequently returned to the pharmacy, (c) expensive compounded pain creams for which there are no legitimate uses, (d) diabetic testing supplies obtained from non-approved suppliers, (e) prescriptions for which there is no evidence the pharmacy had sufficient inventory in stock to fill, (f) prescriptions in which the product dispensed was different than the product billed for, (g) “imaginary” prescriptions for real patients, and (h) prescriptions that were not medically necessary (i.e. unauthorized refills, controlled substance prescriptions where “corresponding responsibility” was not met, items for which there are no legitimate medical use, etc.)

CLINIPHARM SERVICES, through its consultant-owner, Jack H. Raber, Pharm.D., has extensive experience working with the United States Department of Health and Human Services, the United States Department of Justice, commercial prescription drug benefit providers, and attorneys representing Qui tam relators (“whistleblowers”) in false claims and fraud investigations involving 3rd party pharmacy benefits.  Dr. Raber also has extensive experience working with attorneys defending pharmacy providers accused of the same.  Services include, but are not limited to, oversight and compliance audits of prescription drug benefit programs and litigation assistance and expert testimony in actions both in support of, and against, pharmacy providers.


Dr. Raber is an active member of the Academy of Managed Care Pharmacy (AMCP) and the American Society for Pharmacy Law.