November 19, 2012

Doctor Accused of Fraud in Illinois Pharmaceutical Kickback Scheme

by Levin & Perconti

Medical malpractice cases are based on professional negligence: mistakes made by doctors, nurses, and assistants who do not act reasonably. Negligence is different than "intentional" misconduct. In these cases the doctors do not intentionally want to harm patients, but for many reasons--a slip in judgment, fatigue--they make a poor choice. The civil law reasonably provides a way for the individual's harmed in these cases to seek accountability and redress. The suit is not intended to "punish" the one who made the mistake but merely ensure they properly pay for the consequences of their actions.

But there are also cases where medical professionals act inappropriately on purpose. These cases are not truly negligence--a mistake--but intentional actions which fail to prioritize the best interests of the patients. In the medical field, these intentional areas usually stem from conduct that doctors follow in order to make money. Most notably, this involves cases where unnecessary surgeries are performed, exposing patient to risks only so that the medical professional can make more money by performing the operation.

Unnecessary medical procedures are not the only way that doctor intentionally harm patients. Another common area involves used of prescription drugs.

Chicago Anti-Psychotic Medication Kickback Scheme
For example, the Chicago Tribune reported last week on a big new lawsuit filed against a Chicago doctor who allegedly made choices about prescriptions to patients based on money he was receiving from the companies that made those drugs. This kickback scheme apparently lasted for years, affecting thousands of the most vulerable patients in our community.

The report argues that the doctor submitted tens of thousands of false claims to Medicare and Medicaid. Those claims stemmed from his "pharmocologic management" of many medical patients, often residents at nursing homes. The care he provided to those residents was not based only on their unique needs but instead on agreements he had on the side with drug companies, according to the complaint filed in the latest federal lawsuit.

The Acting U.S. Attorney dealing with the case noted that “this is the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago.”

Past Suspicions
This legal case comes amid various concerns raised by observers in recent years about this particular doctor's prescribing patterns. In fact, a previous Chicago Tribune expose on the man suggested that he was engaging in "assembly line" care. That refers to bizarre patterns of prescribing drugs in a "one-size-fits-all" manner with little concern for the unique needs of individual patients. He first came under suspicion when a search of public records revealed that his use of certain medication was far higher than any other physician.

If the complaint allegations are proven true, then we will know that the outlier prescription statistics were rooted in distorted caregiving principles. In particular, the doctor received kickbacks in various forms--"consulting fees," speaking arrangements, and research funding--in exchange for pushing the drugs on the thousands of patients with mental illnesses with which he worked.

See Our Related Blog Posts:
Nursing Homes, Public Funds, and Overbilling

Nursing Home Medicaid Kickback Lawsuit