Have you ever heard of the Physician Payments Sunshine Act? Most people haven’t. It was part of the comprehensive “Obamacare” healthcare reforms. Under the Act, pharmaceutical companies drugs and medical device companies that receive government healthcare monies (Medicare and Medicaid) must report all financial relationships with physicians and teaching hospitals. The goal of the law is to increase the transparency of financial relationships between health care providers and pharmaceutical manufacturers and to uncover potential conflicts of interest.
Although passed several years ago, 2014 was the first full year of reporting. That year, payments to doctors and hospitals clocked in at $7.46 billion. Did the new reporting slow down these payments? No! 2015 data suggests the problem is growing worse.
According to just released 2015 payment information, total payments have grown to $7.52 billion.
Since this data is now public, researchers have been pouring through the data and the results are startling. A study just released in the Journal of the American Medical Association (JAMA) found a distinct correlation between “sponsored meals” and the prescribing patterns of doctors. Give a doctor a free pizza and he or she is more likely to prescribe pricey drugs instead of more affordable generics.
The federal Anti-Kickback Statute has long made it illegal to pay bribes or kickbacks in order to influence healthcare decisions. But where does one draw the line? According to the JAMA study, the average meal price was less than $20 but it was enough to influence prescription sales. In the words of the study, “Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted.”
Congress required the Sunshine legislation after several high profile faculty members at top medical schools were discovered to have accepted cash payments of tens of thousands of dollars from big pharmaceutical manufacturers. Lawmakers were worried that these payments could influence important medical research undertaken at these universities.
If you are interested in what pharmaceutical companies are making these payments and the doctors accepting them, the data is public. Anyone can search the database. My physician, for instance, received 5 payments totaling about $300. Two were for meals and entertainment. Illegal, no. Cause for concern? Probably not.
If my physician tried to prescribe expensive drugs and I found that she had accepted meals from the company whose drug she was peddling I might be concerned, however.
There are no easy answers to the problem. A pizza is probably not going to get anyone in trouble (even though it obviously can influence a medication decision). What gets folks in trouble – and sometimes in jail – are companies that create sham medical directorships and research grants. That is where the big money changes hands. And those bribes – yes bribes – are not limited to payments by pharmaceutical companies to doctors.
Earlier this week we wrote about a New Jersey physician facing five years in prison for taking payments from a diagnostic laboratory company. So far 27 doctors have convicted from taking disguised payments from that same lab. According to the feds, the doctor was convicted over just $15,000 in payments.
Why would the Justice Department get so excited by such a small amount of bribes? (And why would a doctor risk his license over such an amount?) For the Justice Department the answer is easy, patient safety. Healthcare decisions should be based on medical necessity and the best interest of the patient. Not on who buys the most pizzas or who doles out the best “grants.”
Cash Whistleblower Awards Available for Information about Illegal Medicare Bribes
Under the federal False Claims Act, a whistleblower with inside information about bribes within the healthcare industry can earn substantial cash rewards. To qualify, the information must be about physicians, labs, hospitals, home care companies or others receiving Medicare, Medicaid or Tricare dollars.
It is illegal to pay or receive anything of value for the purpose of influencing healthcare decisions. It is also illegal for physicians to refer patients to a facility in which they have an ownership interest.
With triple damages and penalties of up to $11,000 per false claim (soon to double!) the penalties can quickly add up to millions. With whistleblowers receiving between 15% and 30% of whatever the wrongdoer must pay, those rewards add up quickly too.
If you have information about Medicare fraud involving bribes, payments or self referrals, give us a call. Our whistleblower clients have received over $100 million in awards. Worried about retaliation? Its against the law and carries even more penalties. We have an employment lawyer well versed in whistleblower retaliation on staff.
For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct dial). All inquiries are covered by the attorney – client privilege and kept in complete confidence. (Feel free to also download our free 11 Step Guide to Blowing the Whistle.)
MahanyLaw – America’s Medicare Fraud Whistleblower Lawyers