March 13, 2013

Reminder on Dangers of Medicaid Fraud & Prescription Drug Damage

by Levin & Perconti

This week the House GOP budget chairman, Rep. Paul Ryan, released a proposed budget plan that, he claims, would eliminate the federal deficit in ten years. To accomplish such a feat, the proposal calls for significant cuts in various programs, including Medicare and Medicaid. It eliminates the provisions of the Affordable Care Act (Obamacare), while keeping the revenue enhancements in place.

While we all might have different views on how to handle these budgetary issues, virtually everyone agrees that waste and misspent funds within these programs should be rooted out. When we are considering eliminating support for programs that many vulnerable community members depend on, at the very least it is critical to ensure that the money that we are spending is going toward vital services and not unnecessarily enriching those abusing the process.

Yet, cases still pop up of doctors (and entire facilities) failing to follow Medicare and Medicaid guidelines--milking significant funds from public coffers unnecessarily. Not only that but significant harm can actual befall patients as a result of this misconduct.

The Dr. Reinstein Example in Chicago
Perhaps the most cogent example of this situation in the Chicago area is that of Dr. Michael J. Reinstein. As the Chicago Tribune reported on in a series of articles last November, Dr. Reinstein is accused of taking kickbacks from drug companies and illegally prescribing one particular drug to thousands of patients will various mental illnesses in our region.

Late last year a lawsuit was filed against the doctor that the attorney general called “the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago."

Essentially the lawsuit suggests that the doctor provided “assembly line” care to many patients--usually those with mental illness living in nursing homes in the city’s north side neighborhoods. In particular, red flags were raised about Reinstein’s massive use of the drug clozapine. It is an antipsychotic medication that has long been on the radar of those worried about overuse of these medication. It has been linked to several deaths. Data suggests that Reinstien’s clozapine prescriptions were so numerous that he individually ordered more use of the medication than was prescribed by all the physicians in the state of Texas combined.

The quantity of the clozapine prescriptions raised red flags, prompting further investigation. It wasn’t long before more information was uncovered. Specifically, the doctor is accused of taking kickbacks from two different companies. First, he allegedly received “support” from the makers of clozapine. Even when the drug’s patent expired (and cheaper alternatives became available), the doctor continued to prescribe the original. It wasn’t until the makers of clozapine stopped making payments to the doctor that he switched over to other versions for this patients, claim the suit.

Perhaps not surprisingly, the makers of the generic version of the drug also entered into unique “arrangements” with the doctor, including payment of “research” fees and “speaker” fees. The lawsuit even goes so far as noting how the pharmaceutical company which made the generic drug paid for various trips and entertainment expenses for the doctor and his associates. It wasn’t until the suspicious relationship began public that the payments finally stopped.

See Other Blog Posts:

Medicaid Waste: Billions Spent on Poor Care

Failing to Blow the Whistl