Good Research Proposal About Healthcare Fraud
Type of paper: Research Proposal
Topic: Bad Faith, Fraud, White Collar Crime, Health, Company, Crime, Law, Medicine
Healthcare fraud involves medical fraud, health insurance fraud, and drug fraud. The people who are engaged in healthcare fraud keep on looking for new ways to dodge the law. The False Claims Act is used to recover the damages caused by healthcare fraud. Every year the US spends a lot of money on healthcare. There are plenty of insurance claims that are processed, but not all the claims are genuine (NHCAA, 2015). Some pharmaceutical companies commit medical fraud because they are more focused on making sales. A good example is the fraud case of GlaxoSmithKline (GSK). The company had to settle the case by paying $3 billion.
GSK was said to have broken the US laws while marketing and developing pharmaceutical products. The GSK products that were involved in the case included Avandia, Wellbutrin, and Paxil (Ingram, 2012). Paxil is an antidepressant and was intended only for adults. GSK made the mistake of targeting patients who were below the age of 18. GSK was also faulted for marketing Wellbutrin for unapproved applications. Wellbutrin had not been approved for treating sexual dysfunction and weight loss, but GSK actively marketed the drug for these functions. Some of the marketing strategies that were used by GSK included the distribution of medical journals that were misleading; provision of spa treatments and meals to doctors (Ingram, 2012). These methods were termed as illegal by the prosecutors. The drug Avandia was developed so as to treat diabetes, but GSK did not avail safety data to the US Food and Drug Administration. The prosecutors said that failure to avail the safety data violated the US law.
These shortcomings were carried out for a long period of time. GSK pleaded guilty to the accusations that were made. Many people were surprised with GSK’s plea considering that most companies do not plead guilty. The case of GSK served as a warning to other companies that carried out illegal activities. The $3 billion fine was composed of civil fines worth $2 billion and criminal fines worth $1 billion (Ingram, 2012).
The CEO of GSK made statements that informed the public that such misconduct would not happen in GSK again. He said that the company was remorseful about its illegal actions, and that a new era had dawned on the company. The company promised to uphold the law, and keep away from medical fraud. GSK was not the only company that had been involved in a pharmaceutical case. Pfizer had made a settlement of $2.3 billion after it had been accused of using illegal marketing methods in promoting its drugs (Ingram, 2012). The pharmaceutical companies had changed their marketing methods so as to reduce the high costs incurred while using government programs.
The civil fines imposed on GSK included underpayments made to Medicaid (Ingram, 2012). Medicaid is a healthcare program that is intended to serve the poor people. GSK had underpaid Medicaid from the year 1994 to the year 2003. Another portion of the civil fines was used to pay the whistleblowers. The whistleblowers helped the government in carrying out the investigation.
GSK agreed to adopt new restrictions that were enforced by the government so as to avoid using illegal methods while marketing and developing the pharmaceutical products. The company had to change its compensation program for the executives so as to avoid the temptation to engage in misconduct. Any employees that were caught carrying out illegal activities were fired by GSK so as to promote legal conduct (Ingram, 2012).
NHCAA, (2015). The Challenge of Health Care Fraud. National Health Care Anti-Fraud Association. Retrieved from: http://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx
Ingram, D., (2012, Jul 2). GlaxoSmithKline Settles Healthcare Fraud Case for $3 Billion. Retrieved from: http://www.reuters.com/article/2012/07/02/us-glaxo-settlement-idUSBRE8610S720120702