Yesterday we mentioned the high-profile new federal fraud case against a Chicago psychiatrist, Dr. Michael J. Reinstein. The case stems from allegations that the doctor made choices about what drugs to issue to patients–including many residents in Illinois nursing homes with mental illnesses–based on money that he received from the makers of those drugs. A closer examination of the specifics of the lawsuit offer a reminder of the extreme lengths that some unscrupulous medical professionals might go to in order to pad their own pockets at the expense of those counting on their care.
A copy of the federal complaint which initiated the case can be found here. The complaint details the arrangements that the doctor had with those making clozapine. The drug was created first by a company called Novartis. For many years, the defendant-doctor in this case had special arrangements with the company. He was actually paid by the company to help promote the drug, which went under the trade name Clozaril. During this time a staggeringly large number of the doctor’s patients were given the medication–far higher than national averages.
In 1998 the company’s patent on the medication expired, allowing others to make the drug at far cheaper rates. But, likely in order to preserve his personal relationship to Novartis, the doctor did not switch his patients over to the cheaper version of the drug. It was only in 2003, when Novartis ended its relationship with the doctor, that he began seeking alternatives for his mental health patients.
Sadly, those alternatives were not necessarily in the best interest of the patients–just himself. The doctor entered into another arrangement, this time with the company that manufactured the generic version of the drug. Those arragements included the doctor receiving “consulting fees,” having the company fund a research project that he was invovled with, and paying his nurse for speaking about the drug. According to the suit, in exchange for those arrangments with Ivax Pharmaceuticals, the doctor began switching his patients from Clozaril to the generc version of the drug made by Ivax. In short order the doctor “became the largest prescriber of generic clozapine in the country.”
Taken in total, the doctor’s breach of the law and basic principles of patient safety and well-being are egregious. The complaint alleges that 140,000 claims of Medicare and Medicaid fraud are at issue. All of this is from years of drastically over-prescribing patients with the drug. For example, the complaint notes that, on average, about 4% of medical patients with schizoprhenia are on the drug clozapine. However, with this doctor, over 50% of his patients were on the drug. Did they need it or was the doctor doing it because he was paid by the drug manufacturers?
Perhaps what is so surprising about this case is the brazen way that the doctor acted. The rates of prescriptions were so far in excess of any other physician, that it is a wonder how he thought things would not be noticed by outsiders. It was only after the Chicago Tribune began investigating the matter that real public attention was placed on the doctor. And this lawsuit came several years after that expose. It is a wonder how many other medical professionals might be making similar choices, in their own best interests instead of that of their patients.
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Nursing Homes, Public Funds, and Overbilling