AbbVie Inc. generated almost $1.3 billion in tainted health insurance claims for its blockbuster immunosuppressant Humira by paying kickbacks in the form of cash, alcohol, trips and an elaborate network of "nurse ambassadors", California regulators said in a complaint filed Tuesday.
The allegations of AbbVie's misconduct were brought to the attention of the department by a whistleblower, a registered nurse who was employed as an AbbVie Nurse Ambassador in Florida. This amounts to the largest health insurance fraud case in department history, Jones said.
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The kickback scheme "resulted in patients being directed to use the drug, being denied information that they would otherwise need to rely on to make determinations about whether it was appropriate for them to use the drug and significant additional insurance payments for the drug", Jones said in a telephone interview with The Associated Press. Suarez trained nurses who visited Humira patients around the USA, although these nurses also accompanied AbbVie sales reps on visits to physician offices.
"Ultimately, AbbVie gambled with the health and safety of thousands of Californians' lives, including children, by making sure patients continued to take Humira at any cost, all to protect their profits, not the health and well-being of patients", Jones said.
"AbbVie spent millions convincing patients and health care professionals that AbbVie Ambassadors were patient advocates - in fact, the Ambassadors were Humira advocates hired to do one thing, keep patients on a risky drug at any cost", said California Insurance Commissioner Dave Jones in a Tuesday statement.
According to the lawsuit, AbbVie footed the bill for physicians' meals, drinks and travel, all in an effort to induce them to write more Humira prescriptions. "These private nurses, paid by AbbVie, attenuate the direct relationship between the patient and their healthcare provider in troubling ways".
The complaint also alleges that the drugmaker engaged in a more malicious practice: using an elaborate network of nurse ambassadors to ensure the prescriptions were regularly refilled. "Suarez trained nurses who visited Humira patients around the USA, although these nurses also accompanied AbbVie sales reps on visits to physician offices", reports Ed Silverman for Stat.
AbbVie said it 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.
How so? The nurses gained access to patients and "capitalized on their vulnerability" in becoming familiar with a medication that requires assistance to administer.
The company "only provides the Ambassadors as long as the physicians continue to prescribe AbbVie's drug instead of selecting another course of treatment", according to the California Department of Insurance. It also provided physicians with valuable goods and services, such as insurance and prior authorization processing, as well as practice management hardware and software.