California Insurance Commissioner Dave Jones has filed an insurance fraud complaint in a California state court against AbbVie Inc. alleging that AbbVie gave illegal kickbacks to health care providers to prescribe HUMIRA.
The case, filed under the California Insurance Frauds Prevention Act, alleged that private insurers have paid out $1.2 billion in HUMIRA-related pharmacy claims, making this the largest alleged health insurance fraud case in department history.
According to the complaint, AbbVie offered cash, meals, drinks, gifts, trips, and patient referrals as well as professional goods and services to physicians to induce and reward HUMIRA prescriptions. According to the complaint, the professional goods and services included free insurance processing and prior authorizations, gifts of medical practice management hardware and software, and even marketing assistance.
Commissioner Jones said, “Pharmaceutical companies know financial inducements are illegal, and patients depend on their health care professionals for straightforward honest information about their care and medication risks. In this case, patient care was traded for $1.2 billion in ill-gotten gains.”
The allegations of AbbVie's alleged misconduct were brought to the attention of the department by a whistleblower. The whistleblower is a registered nurse employed by AbbVie in Florida. The nurse continues to be a party to the action and is represented by Rachel Geman, Robert Nelson, and Jason Lichtman of the law firm of Lieff Cabraser Heimann & Bernstein, LLP.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].