Rx-physician relationships will be scrutinized

Gifts to doctors will be examined

Federal investigators and Department of Justice prosecutors will be taking a close look at the financial relationships and business practices — especially concerning gifts, speaker fees, and "educational" trips — between drug companies and physicians, states the Office of Inspector General’s (OIG) 2002 work plan.

"The sheer number of government activities focused on the pharmaceutical industry is unprecedented," says John Bentivoglio, a partner in Arnold & Porter’s Washington, DC, office.

The OIG, for instance, will investigate the amount and nature of drug companies’ gifts and payments to physicians in light of the $12 billion drug companies reportedly spend each year developing relationships with practices as part of their marketing efforts.

"Some of these gifts may present an inherent conflict of interest between the legitimate business goals of manufacturers and the ethical obligation of providers to prescribe drugs in the most rational way," the OIG’s work plan says. It notes that the gifts could also violate federal anti-kickback laws if they are aimed at inducing referrals.

In addition, the work plan said pharmaceutical fraud would be a "special focus area" for the OIG, which plans to issue a formal program guidance on the topic in the near future, say government sources. 

The Top Fraud Trio

According to the Health Information Association of America in Washington, DC, the most common forms of fraud in which health care providers knowingly file claims containing deceptive or false information are:

  • fraudulent diagnosis — 43% of bad claims;
  • billing for services not rendered — 34%;
  • waiver of patient deductibles and copayments — 21%.