Close

US nets biggest penalties for fraud from pharma

Note* - All images used are for editorial and illustrative purposes only and may not originate from the original news provider or associated company.

Related stories

When to Bring in Outside Help for FDA Cybersecurity Compliance (and What to Look For)

Medical device cybersecurity has become too important to treat...

Billerud Introduces New Pharmaceutical Packaging Option

Billerud has officially introduced PharmaKraft, a specialized fibre-based packaging...

AstraZeneca Advances AI Drug Discovery Deal with insitro

AstraZeneca has inked a billion-dollar AI drug discovery partnership...
- Advertisement -

The US crackdown on healthcare fraud is paying huge dividends to the exchequer, accounting for three quarters of the money recovered as penalties in fraud cases exposed by whistleblowers between 1987 and 2013-over $21 billion of the total $27 billion. Over half the whistleblower cases registered under the False Claims Act since 1987 were related to healthcare and pharmaceutical products, followed by cases related to the department of defence, which accounted for 16% of cases and led to the recovery of just $2.7 billion.

This emerges from the statistics on cases under the Act from 1987 until the end of 2013 put together by the US Department of Justice. The cut-off was 1987 because the legislation in its current form came into being through amendments to the Act in 1986.

False claims cases involving healthcare and pharmaceuticals resulted in the largest recoveries in 2013, about $2.6 billion. Of this, the bulk was paid by Johnson & Johnson, about $2.2 billion, to resolve a whistleblower case alleging kickbacks and promotion of drugs for unapproved uses, which included the anti-psychotic drugs, Risperdal and Invega, as well as Natrecor, a drug used in certain heart diseases. 

The total number of fraud cases under the Act is divided into ‘qui tam’ cases and ‘non-qui tam’ cases. Qui tam cases are ones in which a whistleblower or a private individual who assists a prosecution can receive all or part of any penalty imposed. About 70% of recoveries in fraud cases came from whistleblower cases or qui tam cases– $27 billion out of almost $39 billion recovered till 2013. Qui tam cases jumped from just 30 cases filed in 1987 to 635 cases in 2011, 652 in 2011 and 753 in 2013.

Though the government intervened or pursued only about 25% of such cases, they accounted for over 96% of the money recovered, showing how much the chances of success of a case improved with government intervention. This trend held good for cases related to healthcare fraud, defence related frauds as well as other kinds of fraud.

Till 2000, non-qui tam cases brought in recoveries totalling over $3.6 billion while qui tam cases raked in over $4 billion in penalties. Since 2001, that mix has changed dramatically. While non-qui tam cases brought in just over $8 billion, qui tam or whistleblower cases brought in a whopping $23 billion. In the 1987-2013 period, whistleblowers got $4 billion or 15% of the total recoveries in qui tam cases.

Statistics show that whistleblower cases are mostly related to healthcare fraud. In the case of non-qui tam cases, though healthcare fraud cases comprised just 17% of the total, they accounted for 49% of recoveries. In the case of recoveries from qui tam cases, healthcare fraud related recoveries amount to 77% of the total, almost $21 billion out of a total of over $27 billion.

Pharmacetical companies have shelled out the bulk of the healthcare fraud recoveries. The steadily increasing healthcare fraud cases each year, especially those involving the drug industry, fly in the face of the industry’s claim that their misdemeanours are a thing of the past and that they are committed to ethical business. Quite obviously, the government’s initiative in the mid-80s that established significant whistleblower rewards under the FCA – , 15-30% of the recovered amount – is paying off.

 

Never miss a pharmaceutical headline

The pharmaceutical industry moves fast – stay on top of it with our must - read briefings.

  • The top pharma and life sciences stories, straight to your inbox
  • The biggest news, features, interviews, and analysis
  • Dedicated coverage of the key developments driving the global pharmaceutical sector

Subscribe

- Never miss a story with notifications

- Gain full access to our premium content

- Browse free from any location or device.

Media Packs

Expand Your Reach With Our Customized Solutions Empowering Your Campaigns To Maximize Your Reach & Drive Real Results!

– Access the Media Pack Now

– Book a Conference Call

– Leave Message for Us to Get Back

Latest stories

Related stories

When to Bring in Outside Help for FDA Cybersecurity Compliance (and What to Look For)

Medical device cybersecurity has become too important to treat...

Billerud Introduces New Pharmaceutical Packaging Option

Billerud has officially introduced PharmaKraft, a specialized fibre-based packaging...

AstraZeneca Advances AI Drug Discovery Deal with insitro

AstraZeneca has inked a billion-dollar AI drug discovery partnership...

Managing Quality and Regulatory Risks in Pharmaceutical Technology Transfer

Technology transfer moves more than manufacturing instructions. It moves process knowledge, supplier dependencies, labeling requirements, packaging specifications, and the evidence needed to demonstrate control. For medical device manufacturers, including those supporting drug-device combination products, these interfaces can become recurring sources of compliance gaps during site transitions, acquisitions, and remediation. The central problem is often not a missing procedure. It is a quality system that allows connected activities to change independently. A label revision may be approved while packaging artwork, supplier instructions, or production-system data still reflect an obsolete version. Staying inspection-ready requires manufacturers to manage these dependencies as one controlled system. Why Compliance Gaps Keep Recurring Findings are treated as documentation defects Revising a procedure can resolve an immediate discrepancy without changing the behavior that caused it. If unclear decision rights, weak escalation, or ineffective training remain, the same failure may surface elsewhere. Corrective and preventive action should distinguish the observed finding from its underlying cause and establish how effectiveness will be demonstrated. Ownership is divided across connected functions Quality, Regulatory Affairs, labeling, packaging engineering, operations, suppliers, and digital-system owners often maintain separate workflows. Each team may complete its assigned task while an interface remains uncontrolled. For example, changing an instruction for use can affect packaging configuration, translations, technical documentation, inventory disposition, and release controls. Transitions expose unresolved weaknesses Acquisitions and site transfers can introduce conflicting procedures, incomplete knowledge transfer, or different assumptions about validated processes. Regulatory changes add further demands. When these events coincide with CAPA or change-control backlogs, teams may prioritize administrative closure over risk reduction. Without a coordinated impact assessment, local fixes can create new gaps downstream. Establish the Regulatory Baseline Inspection readiness starts with knowing which requirements apply to the product, activity, and market. Pharmaceutical, device, and combination-product obligations are not interchangeable; transfer planning should identify the applicable requirements rather than assume one quality framework covers every operation. According to FDA’s Quality Management System Regulation overview and FAQs, the QMSR became effective on February 2, 2026, incorporates ISO 13485:2016 by reference, and introduced the updated device inspection process under Compliance Program 7382.850. ISO 13485 certification does not exempt a manufacturer from FDA inspection or guarantee compliance with FDA requirements. For devices marketed in the European Union, Regulation (EU) 2017/745, Annex I, Section 23, provides the primary requirements for information supplied with devices, including labels and instructions for use. Teams should assess the applicable provisions alongside relevant language, product-specific, and market requirements. A labeling review should therefore evaluate required content and consistency with the device’s intended purpose and supporting documentation—not merely artwork accuracy. How to Identify the Real Gaps Begin with a cross-functional assessment that follows actual product and information flows. Select representative transfers, label changes, supplier changes, and CAPAs, then trace each from initiation through implementation and effectiveness review. Map dependencies: Identify affected specifications, suppliers, packaging components, systems, validation activities, and training. Compare records with practice: Check whether approved procedures match what operators and reviewers actually do. Test traceability: Follow a requirement through technical documentation, labeling, production instructions, and release evidence. Examine recurrence: Look for repeated deviations, reopened actions, overdue changes, and findings shared across sites. Assess capacity: Determine whether qualified owners have enough time and authority to complete corrective work. Prioritize gaps by potential patient or user harm, regulatory impact, likelihood of recurrence, and detectability. Document the rationale; an old overdue item is not automatically more important than a newly identified high-risk weakness. Align Quality, Labeling, Packaging, and Change Control Create a coordinated remediation plan with one accountable owner for each action, named contributors, acceptance criteria, and required evidence. Separate immediate containment from systemic correction. Containment might prevent obsolete labels from being issued; correction might redesign approval and implementation controls so obsolete versions cannot return. Use change control as the integration point. Before approval, evaluate effects on regulatory submissions or notifications, technical documentation, supplier controls, packaging performance, validation, electronic master data, inventory, and training. Record both identified impacts and justified decisions that particular activities are unaffected. During technology transfer, define readiness gates before production or release responsibilities move. These should address the transfer of process knowledge, acceptance criteria, receiving-site capability, required qualification or validation, approved documents, and personnel competence. The appropriate evidence depends on the product and process; a generic checklist cannot replace a documented assessment. Finally, verify implementation where the work happens. Confirm that current instructions are available, suppliers received approved requirements, systems contain correct versions, and affected personnel can perform their tasks. A signed approval is not evidence that every downstream change took effect. Mistakes That Undermine Inspection Readiness Closing CAPAs on task completion alone: Effectiveness checks should test whether the underlying failure has been controlled. Updating labels in isolation: Assess packaging, supplier, system, documentation, and inventory consequences. Counting closures instead of evidence: Dashboards need defensible records behind their status indicators. ...

Subscribe

- Never miss a story with notifications

- Gain full access to our premium content

- Browse free from any location or device.

Media Packs

Expand Your Reach With Our Customized Solutions Empowering Your Campaigns To Maximize Your Reach & Drive Real Results!

– Access theMedia Pack Now

– Book a Conference Call

– Leave Message for Us to Get Back

Translate »