As discussed on the FIGTree LIVE Show, Friday, September 21, 2018
California Insurance Commissioner Dave Jones has filed an insurance-fraud complaint in Alameda County Superior Court alleging that AbbVie provided illegal kickbacks to healthcare providers for prescribing Humira (adalimumab), Jones said in a teleconference today.
“AbbVie spent millions convincing patients and healthcare professionals that AbbVie Ambassadors were patient advocates — in fact, the Ambassadors were Humira advocates hired to do one thing, keep patients on a dangerous drug at any cost,” Jones said in a news release “Pharmaceutical companies know financial inducements are illegal, and patients depend on their healthcare professionals for straightforward honest information about their care and medication risks.”
Jones added that Humira is an expensive drug with the potential for serious adverse effects and that private insurers have paid out $1.2 billion in pharmacy claims related to the drug.
Claims “Without Merit”
AbbVie responded in a statement to Medscape Medical News that “the allegations are without merit.”
“AbbVie operates in compliance with the many state and federal laws that govern interactions with healthcare providers and patients,” according to the statement from Adelle Infante, director of external communications for AbbVie.
“AbbVie provides a number of support services for patients, once they are prescribed Humira, that both educate and assist patients with their therapy, including nursing support, and these resources are beneficial to patients dealing with a chronic condition. They in no way replace or interfere with interactions between patients and their healthcare providers.”
Jones, the California insurance commissioner, disagrees. “AbbVie’s misconduct is particularly egregious because the company has long known Humira has dangerous side effects,” Jones said. The drug has a US Food and Drug Administration black box warning about adverse effects including serious infections and certain cancers. It is used for the treatment of conditions including arthritis, ulcerative colitis, and Crohn’s disease.
The case has been filed on behalf of the State of California under the Insurance Frauds Prevention Act, and Jones said it is the largest health insurance fraud case in department history.
The complaint alleges that AbbVie “engaged in a far-reaching scheme including both classic kickbacks — cash, meals, drinks, gifts, trips, and patient referrals — and more sophisticated ones — free and valuable professional goods and services to physicians to induce and reward Humira prescriptions.
The professional goods and services included free insurance processing and prior authorizations, gifts of medical practice management hardware and software, and even marketing assistance, all of which save physicians valuable staff time and resources,” according to the news release.
Whistleblower a Florida Nurse
The whistleblower, a registered nurse named Lazaro Suarez, worked as an AbbVie Nurse Ambassador in Florida and claims he initially took the position because he thought he would be helping and educating patients. According to California’s lawsuit, “Mr Suarez became aware of AbbVie’s scheme nationwide, including California, because of his role as a trainer, among other ways.”
“As a nurse, he felt compelled to blow the whistle on AbbVie’s fraud,” Jones said during the teleconference. He “likely saved the lives or prevented injuries to patients who might otherwise have been prescribed Humira because of the incentives offered to physicians in the scheme.”
AbbVie allegedly sent registered nurses directly to patients’ homes. The nurses represented themselves as extensions of the doctor’s office when they were actually working on behalf of the drug company, misleading patients at times and running “a type of interference that kept patients and their physician from communicating directly to one another about side effects and the potential consequences of the drug,” Jones claimed.
“The system AbbVie established takes advantage of the Ambassadors’ nursing background and direct access to patients to serve the biopharma giant’s financial interest in getting patients to take Humira by downplaying its risks. Ambassadors are trained to send patient complaints directly to AbbVie and not the patients’ treating physicians. Ambassadors also provide unbalanced information, as they are trained to tout the drug while at the same time also instructed on methods to avoid directly answering patient questions about risks of the medication, including those pertaining to Humira’s serious and important side effects,” according to the news release.
The AbbVie Nurse Ambassadors provided services including assisting with pharmacy and insurance authorization, providing open enrollment resources, helping with paperwork, and giving advice about insurance products at no cost to physicians. All of these provided significant value to physicians, saving them time, money, and resources. The nurses’ services were provided only as long as physicians continued to prescribe AbbVie’s drug, according to the news release.
Suarez, the whistleblower, referred to in legal terms as a relator, continues to be a party to the lawsuit and is represented by Rachel Geman, Robert Nelson, and Jason Lichtman of the law firm Lieff Cabraser Heimann & Bernstein, LLP.
“In this action, the department seeks injunctive and equitable relief to end the kickbacks, an assessment of three times the amount of each claim for compensation pursuant to a contract of insurance made for Humira in California as a result of the kickbacks, civil penalties of ten thousand dollars ($10,000) for each fraudulent Humira claim presented to an insurance company in California, and attorneys’ fees and costs,” according to the news release.
“We want pharmaceutical companies and other healthcare providers who conspire to put profit ahead of patients’ well-being to know that we have zero tolerance for illegal acts,” Jones said.