There has long been concern that kickbacks sway healthcare providers to make decisions based on personal greed, as opposed to patient need. But for years, healthcare providers have argued that even illegal payments from outside sources have no material impact on their medical decision-making. Some courts believed these arguments and dismissed cases alleging illegal kickbacks under the False Claims Act (FCA).
Then, in 2010, Congress responded by enacting legislation that, in effect, rejected claims for payment submitted by providers receiving kickbacks. Under this per se rule, the kickbacks taint the claims as being “false or fraudulent” under the federal False Claims Act. See 42 U.S.C. § 1320a-7b(g). Since this has been the law of the land, billions of dollars have been recovered under the FCA from pharmaceutical manufacturers and their kickback-receiving prescribers.
But, the question remains: Do pharmaceutical payments actually influence the prescribing habits of American doctors?
Well, thanks to a recent meta-analysis, the clear answer is yes.
Specifically, in a 2021 article in the Annals of Internal Medicine, researchers dissected the results of 36 studies comprising 101 analyses. The conclusion: “The association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.”
This begs the question: How many US doctors are receiving payment from the pharmaceutical industry?
According to the above research, in recent years 67% of all US physicians received payments from the pharmaceutical industry. This number climbed above 80% for such high-dollar specialties as oncology and orthopedic surgery. In 2018 alone, the pharmaceutical industry paid US physicians over $2 billion.
So, billions of dollars flow each year from the pharmaceutical industry to US doctors. Research now shows that these payments conclusively influence their prescribing habits. And when these payments are illegal kickbacks, whistleblowers are incentivized to step forward and file an FCA action.
Jeb White is the President & CEO of The Anti-Fraud Coalition