The following is a press release from the DOJ. But what it doesn’t explain is how the pharmaceutical employees accessed patient information. If they did so (write prior authorization) without the doctors’ knowledge and/or consent, how did they get access to the patient files? And how were they able to put brochures in patients’ files?
Three former district managers of pharmaceutical giant Warner Chilcott have been sentenced in connection with committing health care fraud and violating HIPAA in order to increase sales of Warner Chilcott osteoporosis drugs.
Landon Eckles, 30, of Huntersville, N.C., was sentenced yesterday by U.S. District Court Judge George A. O’Toole, Jr. to one year of probation and a fine of $10,000. In November 2015, he pleaded guilty to wrongful disclosure of protected health information, in violation of the criminal provisions of the Health Insurance Portability and Accountability Act (HIPAA).
From 2007 to 2012, Eckles served as a Warner Chilcott district manager in the company’s osteoporosis division in a mid-Atlantic district. In 2011, Atelvia®, an osteoporosis drug, was launched, but it was not covered by many insurance companies primarily because a generic alternative was available. Therefore, insurance companies required physician approval, known as a prior authorization, before covering Atelvia®. In order to drive sales, Eckles directed certain sales representatives to fill out Atelvia® prior authorizations even if physicians refused to do so. In doing so, Eckles and his sales representatives accessed patients’ protected health information.
In addition, following directions from his supervisors, Eckles encouraged his sales representatives to ensure that patient medical charts in physicians’ offices were “flagged” with Atelvia® brochures, so that physicians would be reminded to prescribe Atelvia® for their patients. Eckles bragged about this tactic, stating, “I guarantee you that this is going to drive business,” and encouraged his sales representatives to follow suit. In part, as a result of his scheme, Eckles received a bonus of approximately $60,000 in 2011.
Timothy Garcia, 35, of Los Gatos, Calif., was sentenced by U.S. District Court Chief Judge Patti B. Saris on Sept. 27, 2016 to eight months of home confinement and ordered to forfeit $21,500. In October 2016, he pleaded guilty to conspiracy to commit health care fraud.
From 2008 to 2011, Garcia served as a Warner Chilcott district manager in the company’s osteoporosis division managing approximately 12 sales representatives in the San Francisco Bay area. Recognizing that many physicians were hesitant to submit prior authorizations for Atelvia®, Garcia aggressively pushed his sales representatives to prepare prior authorizations themselves. Furthermore, Garcia stressed the importance of concealing the misconduct of his sales representatives.
In 2011, Garcia received a bonus of more than $60,000, and was promoted to senior district manager in Warner Chilcott’s most prestigious sales division. As a result of the scheme, insurance companies, including Medicare, paid Warner Chilcott at least $100,000 for Atelvia® based on prior authorizations that were manipulated by Garcia’s sales representatives.
Jeff Podolsky, 49, of East Meadow, N.Y., was sentenced by Chief Judge Saris on Oct. 11, 2016, to eight months of home confinement and ordered to forfeit $28,237 and pay a fine $10,000. In July 2015, he pleaded guilty to conspiracy to commit health care fraud.
In 2010 and 2011, Podolsky served as a Warner Chilcott district manager in New York City and Long Island, during which time Atelvia®, as well as its predecessor drug, Actonel®, had poor insurance coverage. Podolsky directed the sales representatives in his district to fill out prior authorizations for physicians who prescribed Actonel® and Atelvia®, by using false clinical justifications as to why the patient needed the drugs, and then submit them to health insurance companies.
As a result of the scheme, Podolsky’s district was the top-grossing district in Warner Chilcott’s osteoporosis division. In 2011, Podolsky received a bonus of more than $100,000 and was promoted to senior district manager in a more prestigious sales division. Insurance companies and Medicare paid at least $200,000 for Actonel® and Atelvia® prescriptions that were based on prior authorizations that were manipulated by Podolsky’s sales representatives.
United States Attorney Carmen M. Ortiz; Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; Phillip M. Coyne, Special Agent in Charge of the Department of Health and Human Services Office of Inspector General; Leigh-Alistair Barzey, Assistant Special Agent in Charge of the Department of Defense’s Defense, Office of Inspector General, Defense Criminal Investigative Service, Northeast Field Office; Derek Roy, Resident Agent in Charge of the U.S. Food and Drug Administration’s Office of Criminal Investigations; Donna L. Neves, Special Agent in Charge of the Department of Veterans Affairs, Office of Inspector General; and Scott Rezendes, Special Agent in Charge of the Office of Personnel Management’s Office of Inspector General. Assistant U.S. Attorney David Schumacher and Miranda Hooker of Ortiz’s Health Care Fraud Unit prosecuted the case.
SOURCE: U.S. Attorney’s Office, District of Massachusetts
In addition, the information alleges that from 2011 to 2013, Warner Chilcott employees knowingly and willfully submitted false, inaccurate, or misleading prior authorization requests and other coverage requests to federal health care programs for the osteoporosis medications Atelvia® and Actonel®. The false, inaccurate and misleading information was provided to certain insurance companies in order to overcome formulary restrictions that favored less expensive osteoporosis drugs. For instance, Warner Chilcott was aware that many insurers only paid for Atelvia® if a physician submitted an individualized request explaining why the patient could not be treated with less-expensive medications approved to treat the same conditions. As detailed in the information, Warner Chilcott sales representatives filled out numerous prior authorizations for Atelvia®, using “canned” medical justifications which often were inconsistent with the patients’ medical conditions. In some instances, according to the information, Warner Chilcott sales representatives submitted these prior authorizations directly to insurance companies, holding themselves out to be physicians. In other cases, sales representatives coached physicians and staff about which medical justifications would result in an approved prior authorization, whether or not the justification was true for a particular patient.