On Tuesday, September 18, 2018, California’s insurance commissioner filed a complaint against AbbVie, Inc., alleging a kickback scheme designed to convince physicians to prescribe Humira over competing medicines. The lawsuit alleges that AbbVie’s attempts to keep patients on Humira included illegal cash payments and gifts to prescribers, as well as providing more sophisticated kickbacks, such as insurance processing to the doctors who wrote prescriptions for Humira.
Also alleged in the lawsuit is a claim that AbbVie relied on registered nurses, known as “ambassadors” and employed through a contractor, to downplay patient concerns with Humira and act as a conduit of sorts between patients and their doctors.
According to the complaint, AbbVie gave illegal kickbacks to doctors for more than four years, between 2013 and August 2018. During that time, private insurers processed more than 274,000 claims for coverage of Humira treatment for California patients, paying out nearly $1.3 billion. According to the insurance commissioner, this may be the largest health insurance fraud case in the state’s history, if the allegations are true.
The whistleblower in this case was employed as a nurse ambassador for more than a year, who was tasked with going to homes of patients prescribed Humira and helping with insurance authorizations and paperwork. According the suit, the patients were led to believe the nurses were an extension of their doctor’s office – not employees of the company manufacturing the drug they were taking. The nurses were allegedly told to not only keep the patients on Humira, but also to refer all questions and concerns back to AbbVie, not the prescribing physicians.
The doctors benefited from the provision of these services, as they did not have to dedicate additional staff to assisting patients with insurance authorizations and other follow-up questions.
“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 dangerous drug at any cost,” said California Insurance Commissioner Dave Jones.
“AbbVie 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, and these resources are beneficial to patients dealing with a chronic condition,” AbbVie said in a statement. “They in no way replace or interfere with interactions between patients and their healthcare providers.”
A good portion of the complaint is redacted, largely in the portion covering the “classic kickbacks,” as there are a large number of “Does” as defendants, and other third parties.
The lawsuit is seeking not only injunctive relief against AbbVie and assessment of three times the amount of each claim, but also an additional $10,000 for each fraudulent claim.