Trump wants Medicare to pay for your Ozempic treatment. Taxpayers may foot the bill for billions in fraud

ary·MedicareTrump wants Medicare to pay for your Ozempic treatment

Taxpayers may foot the bill for billions in fraudBy Ari YampolskyBy Max VoldmanBy Ari YampolskyBy Max Voldman Ari Yampolsky and Max Voldman are partners at Whistleblower Partners.Will Ozempic lead to Medicare fraud?Getty ImagesWith little fanfare but enormous implications, the Trump Administration is reportedly considering a five-year pilot gram to allow Medicare and Medicaid to cover weight loss drugs when prescribed for patients with obesity and related conditions 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 Wegovy, Ozempic, and Mounjaro, has exploded in ity due to its ven effectiveness in helping people lose weight

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

GLP-1s are uniquely susceptible to fraud

They mise rapid weight loss with minimal effort, and many people who fall just shy of CMS’ ultimate eligibility criteria will nonetheless be eager to obtain them, especially if they can do so at low cost through Medicare or Medicaid

What’s more, GLP-1s have massive demand—very few prescription drugs appeal to more than 70 percent of the population

As a result, viders and clinics may stretch, bend, or outright fabricate diagnoses of obesity or cardiovascular disease to qualify patients for coverage

History tells us this will happen: upcoding, falsified documentation, and medically unnecessary prescribing are well-trodden paths in the annals of healthcare fraud

Even more concerning is the competitive pressure among pharmaceutical giants to dominate this gold rush

GLP-1s are not interchangeable generics—these are branded, heavily marketed drugs from deep-pocketed global pharmaceutical companies

With the race for market already on, we expect to see aggressive (and potentially illegal) tactics to induce viders to favor one drug over another, including kickbacks disguised as speaker fees, consulting contracts, and lavish events

The temptation to blur the lines will be strong, especially as GLP-1s are increasingly hailed not just as diabetes treatments or obesity drugs, but as miracle solutions for everything from heart health to addiction

We also won’t be surprised to see abuse on the pharmacy and telehealth fronts

Compound pharmacies and online weight loss clinics are already booming thanks to GLP-1s, and some may bill the government for unapved formulations or skirt required face-to-face evaluations

Expect scrutiny over whether prescribing practitioners are actually evaluating patients or merely rubber-stamping prescriptions based on thin records and virtual checkboxes

None of this is hypothetical

To be sure, the worst-case scenario is not inevitable

CMS could design the pilot gram with strong guardrails—tight eligibility verification, rigorous audit tocols, and real-time claims monitoring—to detect and deter abuse before it snowballs

The federal government has, in some areas, gotten better at deploying advanced data analytics to flag suspicious prescribing patterns and identify outlier viders

Drug manufacturers, aware of the scrutiny they already face under the FCA and anti-kickback laws, may tread more cautiously than in past scandals

And many clinicians will the rules faithfully, prescribing GLP-1s only to patients who meet medical criteria and benefit from them

Effective oversight, coupled with ethical medical practice, could make this expansion a boon to public health without becoming a bonanza for bad actors—but history suggests that such vigilance must be constant, not assumed

The GLP-1 revolution is here

But it will also test the integrity of our healthcare system

Now more than ever, Uncle Sam will be looking for courageous insiders to step forward to ensure that the mise to treat disease doesn’t become an opportunity to fleece taxpayers instead

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