AbbVie Deployed Nurses As 'Runners And Cappers' In Humira Kickback Scheme, Suit Alleges
Executive Summary
California Insurance Commissioner claims AbbVie gave kickbacks for healthcare providers to prescribe Humira and had nurse 'ambassadors' insert themselves between patients and physicians.
Drug makers have faced numerous suits over the years alleging they paid kickbacks to induce physicians to prescribe their drugs. But California's complaint against AbbVie Inc. takes a different approach, focusing on registered nurses that were hired as a go-between for doctors and their Humira (adalimumab) patients.
California Insurance Commissioner Dave Jones filed the suit on Sept. 18 in Alameda County Superior Court on behalf of the state of California. The complaint supersedes a suit filed by whistleblower Lazaro Suarez, a registered nurse who worked for AbbVie as a nurse educator under a contract with Quintiles Transnational Holdings Inc.
The suit alleges AbbVie engaged in "classic" kickbacks – cash, meals, drinks, gifts, trips, and patient referrals – and more sophisticated ones, including free professional goods and services to physicians, such as free insurance processing and prior authorizations.
"The fulcrum of the scheme, and among the most troubling aspects of it, is AbbVie's insertion of its own personnel directly into the homes of patients," the complaint states. "When doctors prescribe Humira, AbbVie sends registered nurses – which AbbVie calls 'Ambassadors' – into patients' homes, representing them as an extension of the doctor's office."
The complaint claims the nurses are trained to tout the benefits of Humira and to downplay its risks and avoid directly answering questions about its side effects.
Suarez and his colleagues "did not know that they were effectively being used by AbbVie as runners and cappers, people working at the behest of AbbVie in connection with its concrete, internal financial goals," the complaint says.
AbbVie could not be reached for comment on the suit.
Nursing Network Served As Kickback, Suit Says
In a press briefing announcing the complaint, Jones said the alleged activity occurred throughout the state from 2013 through August 2018 and during that time private insurers paid out approximately 1.2bn in Humira claims.
The complaint, filed under the Insurance Frauds Prevention Act, seeks a court order to halt the alleged practices, a civil penalty of $10,000 for each fraudulent claim presented to an insurance company, and assessment of three times the amount of each claim.
Humira, used to treat rheumatoid arthritis and other autoimmune diseases, is the world's top-selling drug with more than $18bn in global sales in 2017.
Most of the 47-page complaint is redacted, including details on the "Ambassador Program," which the suit says is a network of nurses across the country that provide services to patients using Humira that would ordinarily be provided by healthcare providers. It says AbbVie contracted with QuintilesIMS to implement the program and used registered nurses employed through Quintiles to serve as company representatives in direct dealings with doctors, office staff, and patients.
This "nursing kickback is aimed squarely at getting healthcare providers to write more Humira prescriptions and refills," the complaint states. "If given the choice between two medications, one which comes with free nurses and administrative staff and another that requires the provider to pay professional salaries, the provider cannot but help factor the substantial nursing kickback into their prescribing calculus."
The California Department of Insurance has reached settlements with several pharmaceutical companies. In July 2016, it reached a $30m settlement with Bristol-Myers Squibb Co. to resolve kickback allegations involving several drugs and in 2015, it reached a $23.2m settlement with Warner Chilcott PLC to resolve allegations of paying kickbacks and falsifying prior authorization forms.
Company marketing and sales practices are routinely the subject of government investigations. Thirteen of the top 25 pharma companies have reported probes ranging from pricing, relationships with charities and advisory services. (Also see "Government Pharma Investigations Target Pricing, Opioids, Trade Practices" - Pink Sheet, 4 Sep, 2018.)