Insurance Fraud & Big PhRMA

The problem of insurance fraud hits many segments of health care.  Before I moved to the west I was a witness in a large Medicare fraud case.  After moving west I was again a witness in several insurance fraud cases involving private insurance and Medicaid.

What struck me as curious was how Washington state dealt with one case involving Medicaid fraud and risk of grave harm to patients as well as a massive effort to fabricate medical records.  The nurse that led all these questionable activities was never investigated.  This was political as she was an inside member of WSNA and therefore could do no wrong. 


The accessory crime was failure on the part of the state's Medicaid fraud unit to not investigate this person who is still in practice in Whatcom County.  The Nursing QA office also failed to investigate and prosecute her while attacking the complainant as part of the cover up.


The clear violation of basic due process rights was staggering.


Lately I have another Medicare issue related to something similar.  I'm getting ready to contact the authorities in what seem to be like the case in this article.  Pay-offs for prescribing.


Our members of Congress, gladly raking in money from the pharmaceutical industry, seem to keep attacking the wrong folks too. 


Nero fiddles while Rome burns.

Massive health insurance fraud alleged in Bristol-Myers Squibb case

Thousands of California doctors were bribed as the company dangled illegal kickbacks and L.A. Laker 'happy hours,' California officials allege. The state has joined a previously sealed whistleblower lawsuit against the company.

By Duke Helfand and Marc Lifsher, Los Angeles Times
March 18, 2011

Pharmaceutical giant Bristol-Myers Squibb bribed thousands of California doctors and pharmacists to promote its drugs, using illegal kickbacks, lavish gifts and "happy hours" with the Los Angeles Lakers to expand its market share in the state, state officials said.

California Insurance Commissioner Dave Jones announced Friday that his office had joined a previously sealed whistleblower lawsuit against the company, calling it the largest health insurance fraud case ever pursued by a California state agency.

Two of the three whistleblowers in the case are former Lakers player Lucius Allen and his wife, Eve, who worked for the drug company as employees and provided access to the basketball team, whose players participated in "Lakers Dream Camps" set up by the drug company for doctors and their family members, the lawsuit said. The lawsuit was filed in 2007 but was sealed until the state joined the case recently.

New York-based Bristol-Myers Squibb issued a statement: "Bristol-Myers Squibb believes this lawsuit has no merit and the company will defend itself vigorously."

The case is the latest major legal action against Bristol-Myers Squibb over allegations of fraud. The pharmaceutical giant paid $515 million in 2007 to settle allegations by the federal government and other states that it used a kickback scheme to defraud the Medicare and Medicaid insurance programs, officials said.

The California lawsuit alleges that Bristol-Myers Squibb targeted the private insurance industry, making thousands of payments to "high prescribing doctors" who wrote prescriptions for its well-known drugs, including Plavix, Abilify and Pravachol.

Jones said that insurance companies in California had spent more than $3.5 billion to cover the costs of the drugs Bristol-Myers Squibb sought to promote through its kickback scheme.

"We need to be sure that doctors are prescribing drugs because those drugs are best for their patients and not because a pharmaceutical company provided doctors with trips and kickbacks," Jones said. "These illegal practices drive up the cost of health insurance for millions of Californians."

duke.helfand@latimes.com     marc.lifsher@latimes.com

Copyright © 2011, Los Angeles Times