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Drug company to pay $125 million for health care fraud scheme

WarnerChilcottLTD_retina_1

Warner Chilcott was sentenced Monday in a federal court to pay $125 million to resolve criminal and civil charges arising from the illegal promotion of some of its prescription drugs.

“Doctors’ diagnoses must be based on the best interests of the patient and not swayed by lavish meals or cash incentives,” said U.S. Attorney Carmen M. Ortiz. 

“The illegal marketing of pharmaceuticals and the payment of kickbacks puts patients at risk of receiving inappropriate treatment purely for profit motives,” said U.S. Office of Personnel Management Acting Inspector General Norbert E. Vint.

A U.S. District Court judge sentenced Warner Chilcottto pay a criminal fine of $20.7 million, to forfeiture $2 million, and to pay more than $197.9 million in restitution to two insurance companies, Humana and Blue Cross Blue Shield of Massachusetts. The company also agreed to pay $102.1 million to resolve related civil claims.

In October 2015, Warner Chilcott pleaded guilty in a health care fraud scheme involving the illegal promotion of the drugs Actonel, Asacol, Atelvia, Doryx, Enablex, Estrace, and Loestrin.

From 2009 to 2013, Warner Chilcott paid physicians to get them to prescribe Warner Chilcott drugs, which is illegal. Warner Chilcott provided payments, meals, and other compensation associated with what the company called “Medical Education Events,” the U.S. Justice Department said.

These events, which were often held at expensive restaurants, frequently contained little or no educational component, and were instead used to pay prescribing physicians in an attempt to gain a competitive advantage over other pharmaceutical companies. 

Warner Chilcott also paid high-prescribing physicians to be “speakers” for the company for the primary purpose of obtaining prescriptions.

Warner Chilcott also submitted false prior authorization requests to federal health care programs for the osteoporosis medications Atelvia and Actonel, the department said. A prior authorization request contains protected health information, including biographical data and information concerning a patient’s medical condition.

Warner Chilcott falsified prior authorizations by providing false medical justifications for the prescriptions, often filling out the prior authorizations themselves. The fraudulent requests were provided to some insurance companies to overcome restrictions that favored less expensive osteoporosis drugs. In some cases, Warner Chilcott sales representatives submitted prior authorizations directly to insurance companies, saying they were physicians.

In addition, Warner Chilcott made claims when marketing the drug Actonel although the claims weren’t supported by clinical evidence. Physicians that were told Actonel was superior to other bisphosphonates due to its supposedly unique “mechanism of action.”

Several individual were prosecuted in the health care fraud scheme:

  • Former district managers Jeffrey Podolsky and Timothy Garcia pleaded guilty to health care fraud in connection with manipulating prior authorizations.
  • Former district manager Landon Eckles pleaded guilty to wrongful disclosure of individual health information.
Copyright 2016, Rita R. Robison, Consumer Specialist

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