employee of an Arizona-based pharmaceutical company faces up to $250,000 in
fines and possible jail time for her involvement in a kickback scheme that
provided illegal financial incentives to medical professionals prescribing the
company’s cancer pain management medication.
Announced in a
press release by the U.S. District Attorney for the District of Connecticut on
July 11, 2017, the former employee pleaded guilty to paying medical
professionals fees ranging from $1,000 to several thousand dollars to
participate in “Speaker Programs.” In reality, these “Speaker Programs” were
non-educational gatherings of the employee’s family and friends, often at
high-end restaurants, with the medical professionals simply being paid for
their attendance. These medical professionals later prescribed or induced
others to prescribe the company’s pain management medication over other viable
alternatives, resulting in false charges to Medicare Part D totaling
approximately $4.5 million.
In addition to
the former employee, several other individuals associated with the
pharmaceutical company, including some prescribing physicians who accepted
fees, have been charged in connection with the kickback scheme.
1) This enforcement action comes as part of
a larger national healthcare fraud initiative publicly announced by the United
States Attorney General on July 13, 2017. Nearly 300 healthcare providers are
being suspended or banned from federal healthcare programs in this nationwide
sweep for instances of fraud and abuse.
2) Healthcare providers, particularly those
dealing with pharmaceuticals, should be cognizant of how their incentive
programs are structured. Programs that could be interpreted by the government
as providing improper incentives to medical providers or that potentially
affect a medical provider’s unbiased medical judgment may be closely
scrutinized as a kickback.
3) Fees provided to medical professionals by
drug marketers and other similarly situated individuals must be for bona fide
consulting services or other related bona fide services. Provision of fees that
do not fit this definition may result in potential criminal kickback liability
for all parties involved in such a transaction.
The health care
practice group at Plews Shadley Racher & Braun LLP regularly works with
physicians, dentists, nurses, physician assistants, and other health care
providers to counsel on False Claims Act, Anti-Kickback Statute and other
regulatory issues. Additional information about Plews Shadley Racher
& Braun LLP and its health care practice is available at www.psrb.com.
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