With little fanfare but enormous implications, the Trump Administration is reportedly considering a five-year pilot program to allow Medicare and Medicaid to cover weight loss drugs when prescribed for patients with obesity and related conditions like cardiovascular disease. This decision by the Centers for Medicare and Medicaid Services (CMS), long sought by pharmaceutical companies and obesity advocates, is a watershed moment for access to care. It is also a harbinger of massive fraud.
The GLP-1 class of drugs, which includes brand names like Wegovy, Ozempic, and Mounjaro, has exploded in popularity due to its proven effectiveness in helping people lose weight. The drugs are also among the most expensive on the market, with prices exceeding $1,000 per month. These factors—clinical effectiveness, high costs, surging demand, and now an open spigot of government reimbursement—create an attractive target for abuse.
As lawyers who represent whistleblowers under the False Claims Act (FCA), we expect to enter a new era of fraud cases tied to these medications, with a stratospheric tab for taxpayers. The FCA allows private citizens to bring lawsuits on behalf of the government against those who submit false or fraudulent claims for payment—and GLP-1s are poised to generate exactly that kind of misconduct.