Articles Posted in Pharmaceutical fraud

pharmacy-fraud-300x200Massive Pharmacy Fraud Scheme Involved Bribes for Patient Information

A Florida man was sentenced to 15 years in prison for pharmacy fraud that involved $100 million in scams. The wide-reaching scheme impacted private insurance companies, and Medicare and TRICARE.

The Pharmacy Fraud

addictionMost people are aware that there is a serious Opioid crisis in America. But how many people know that the company who makes OxyContin, the highly addictive painkiller, is owned by a single family who has reaped billions of dollars of profits?

To say that the Sackler family has an impressive roster of monuments to their wealth would be an understatement. The Sackler family has had entire museums, wings, labs, stairways, and courtyards erected in their name.

From buildings and monuments to philanthropy, the Sackler name is everywhere, but the family itself is hardly ever seen.  In 2015 Forbes magazine added the family to the list of America’s richest families.  The billionaire family is descended from Mortimer and Raymond Sackler, two psychiatrist brothers from Brooklyn. Consisting of about 20 members, Forbes cited their wealth at a low-ball of 14 billion dollars. The family never comments publicly on the source of all that wealth – and that’s not a surprise. Most of their wealth came from sales of the narcotic painkiller, OxyContin. Since 1966 when the drug began being sold by the American branch of the Sackler’s pharmaceutical empire, Purdue Pharma, more than 200,000 people have died from overdoses on OxyContin and other painkillers.

The DOJ’s Opioid Fraud Unit is Seeing Movement in The Courts

opioid fraudThe Department of Justice’s newly formed Opioid Fraud Unit is seeing a bit of movement in the court’s system.  According to the blog White-Collared from Lexology, the Opioid Fraud Unit got its first indictment of what it considers an opioid dealer in the form a Pennsylvania physician.

The Indictment

Pharmaceutical Companies Who Provide Gifts to Doctors Are More Likely to Get Their Drugs Prescribed

drug brandsA new study is highlighting a long-lauded concern: when doctors are given gifts by pharmaceutical companies, they tend to give patients more “branded” drugs.  It’s been a theory of those who oppose big pharma’s growing influence on the medical community and now a new study out of Georgetown University Medical Center confirms just that, according to a new article in

Startling Numbers

Eli Lilly & Co.,  manufacturer of insulin, is discounting the injectable drug by as much as 40%.  The move comes after several years of skyrocketing price increases in which top-selling insulins have more than doubled in price since 201. Some conclude that the increases are a result of  an increase of middlemen known as pharmacy-benefit managers who negotiate rebates and fees based on list prices.

Both the buying consumers and Congress have express their anger over the increase in drug prices generally.

Lilly announced that the cuts are being accomplished through a partnership with Express Scripts to reduce costs for people who pay full retail prices at the pharmacy. Its focus is individuals without health insurance or who are in  high deductible insurance plans.

The Food and Drug Administration announced that it has signed an agreement with PatientsLikeMe for access to data generated by the sites 350,000 members in order to help the FDA in post market surveillance of drugs on the market.The FDA needs the information because companies whose drugs are approved with minimal clinical trials do not provide much information on safety and effectiveness of a drug until after the public has tried it for a while. Companies often provide information and small populations, sometimes just a few hundred patients, from which the FDA is supposed to determine a drug’s risks.

“Most clinical trials only represent the experience of several hundred or at most several thousand patients, making it impossible to anticipate all the potential side effects of drugs in the real world. Patient-generated data give a more complete picture about a drug’s safety by providing a window into patients’ lives and healthcare experiences over time,” PatientsLikeMe Co-Founder and President Ben Heywood said in the press release. “We’re very encouraged by the FDA’s action to evaluate newer sources of data to help identify benefits and risks earlier.”

PatientsLikeMe allows members to interact with others with similar conditions and diseases, share experiences with drugs and volunteer medical data which can be used by industry, researchers, non-profit groups and now the FDA to get a better picture of the drug’s safety profile and provide better services. Patients can also learn what to expect or how to cope or avoid certain adverse events linked to drugs and medical procedures from other patients’ experiences.

Pharmaceutical company Shire Pharmaceuticals LLC will pay $56.5 million to settle civil allegations that it violated the False Claims Act as a result of its marketing and promotion of several drugs, the Justice Department announced today.  Shire, located in Wayne, Pennsylvania, manufactures and sells pharmaceuticals, including Adderall XR, Vyvanse and Daytrana, which are approved for the treatment of attention deficit hyperactivity disorder (ADHD), and Pentasa and Lialda, which are approved for the treatment of mild to moderate active ulcerative colitis.
The allegedly fraudulent promotional claims included marketing Adderall XR based on unsupported claims that the drug would prevent poor academic performance, loss of employment, criminal behavior, traffic accidents and sexually transmitted disease. Shire also allegedly promoted Adderall XR for the treatment of conduct disorder without approval from the Food and Drug Administration (FDA).

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The Irish drug manufacturer Amarin, has filed a lawsuit seeking to limit the powers of the Food and Drug Administration (FDA) in prohibiting so called “off  label” promotion of uses of drugs. The FDA gives approval of specific uses of drugs after reviewing the proper testing data submitted by the drug companies. That approval is the “on label” use allowed. However, many drug companies promote and sell their drugs to physicians for different uses. The lawsuit seeks to have a federal court rule that the FDA prohibitions of off-label promotion violates the company’s First Amendment rights and that its sales representatives should be able to convey off label uses to doctors.

Amarin filed the suit after the FDA denied the company the right to sell its prescription fish-oil pill Vascepa to individuals who do not have very high levels of triglycerides, a fat in the blood which can lead to heart disease. Presently the oil is allowed to be marketed only to individuals with very high levels of triglycerides. The pharmaceutical companies want more freedom to promote their products without constraint. Patient advocates say that this would undermine the drug-approval process and essentially allow the companies to go around the FDA.

The issue of off –label drug promotion is a problem with wide scale dimensions involving billions of dollars to the drug manufacturers. In November 2013, John & Johnson paid $1,391 Billion to settle a False Claims Act case for its off-label promotion of Risperdal, Invega and Natrecor. Risperdal had been approved only to treat schizophrenia by Janssen, a Johnson and Johnson subsidiary promoted it to physicians to treat elderly dementia patients for symptoms such as anxiety, agitation, depression and confusion. Continue reading

New York and 48 other states and the District of Columbia have reached a settlement with Daiichi Sankyo, Inc. (Daiichi), a global pharmaceutical company with US headquarters in New Jersey which will pay $39 million. It was alleged that Daiichi violated the False Claims Act by using lavish meals and speaker programs to improperly induce physicians to prescribe the drugs Azor, Benicar, Tribenzor and Welchol. Under the agreement, Daiichi agrees to pay the United States and the state Medicaid programs 39 million dollars, 10 million dollars to the state Medicaid Programs and 19 million to other Federal programs.

The settlement resolves allegations that Daiichi caused the submission of false claims for reimbursement by the Medicaid program (and other federal programs) for Azor, Benicar, Tribenzor and Welchol. The claims were false because they resulted from kickbacks that Daiichi provided to prescribing physicians. Specifically, the agreement alleges that the kickbacks took the form of honoraria payments, meals and other remuneration to physicians who participated or supposedly participated in physician opinion & discussion programs from January 1, 2005 through March 31, 2011 and other speaker programs from January 1, 2004 through February 4, 2011.

It is contended that the programs were in fact kickbacks because the physicians were paid by Daiichi even if the physician spoke only to members of his or her own staff in their office; physician participants took turns accepting “speaker” honoraria for duplicative discussions; the audience included the honoraria physician’s spouse; the speaker was paid even if the event was cancelled beforehand; and/or the dinners were lavish and even exceeded Daiichi’s own internal cost limitations of $140 per person.

According to the Department of Justice, AstraZeneca LP, a pharmaceutical manufacturer based in Delaware, has agreed to pay the government $7.9 million to settle allegations that it engaged in a kickback scheme in violation of the False Claims Act, the Justice Department announced today.  AstraZeneca markets and sells pharmaceutical products in the United States, including a drug sold under the trade name Nexium.

The settlement resolves allegations that AstraZeneca agreed to provide payments to Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities related to those Medco formularies.  The United States alleged that AstraZeneca provided some or all of the remuneration to Medco through price concessions on drugs other than Nexium, namely on Prilosec, Toprol XL and Plendil.  The United States contended that this kickback arrangement between AstraZeneca and Medco violated the Federal Anti-Kickback statute, and thereby caused the submission of false or fraudulent claims for Nexium to the Retiree Drug Subsidy Program.

This civil settlement resolves a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens with knowledge of false claims to bring civil actions on behalf of the government and to share in any recovery.  The lawsuit was filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle, who will collectively receive $1,422,000.