Celgene accused of Medicaid fraud, misrepresenting cancer drugs, kickbacks to doctors
OLYMPIA — Attorney General Bob Ferguson recovered nearly $750,000 in Medicaid reimbursement this week from pharmaceutical company Celgene Corporation for promoting medications to treat conditions they were not approved for, including certain types of cancer. The company is also accused of paying kickbacks to doctors for prescribing the medications and helping them change billing codes to ensure Medicaid would pay for their use.
Off-label marketing, fraudulent billing and providing kickbacks to doctors are all violations of the Medicaid False Claims Act.
“I will not tolerate schemes that put profits before patients.” Ferguson said. “My office is committed to cracking down on those who endanger patients for the sake of their bottom line.”
From April 2000 to June 2015, Celgene marketed and sold medications Revlimid and Thalomid for conditions the FDA had not approved. The company promoted the medications by making false or misleading statements in medical literature and clinical studies, as well as other medical resources.
Celgene promoted Thalomid for the treatment of multiple myeloma before its approval in May 2006. The FDA does not allow either medication to treat brain cancer, leukemia or prostate cancer, yet Celgene promoted them as acceptable treatments for these conditions, among others.
When prescribing Revlimid and Thalomid, Celgene directed doctors to change patients’ diagnosis codes to ensure Medicaid paid for the medication. Celgene paid physicians kickbacks for prescribing the medications, a violation of the Anti-Kickback Statute.
Celgene is also accused of encouraging more physicians to prescribe the high-cost medications by contributing to organizations that provided co-pay assistance to patients.
Revlimid or Thalomid was prescribed to 224 Washingtonians during the time period that Celgene allegedly conducted these illegal practices.
The initial investigation was triggered by a whistleblower, resulting in yesterday’s agreement with the federal government, 28 states and the District of Columbia.
Washington state will receive $742,578. After returning the federal share — Medicaid is jointly funded by the state and federal governments — Washington’s Medicaid program will receive $368,192.
Senior Counsel Carrie Bashaw of the Washington state Medicaid Fraud Control Unit handled the case for Washington.
Medicaid Fraud Control Unit
The Attorney General’s Medicaid Fraud Control Unit protects the state Medicaid program from fraudulent claims by health care providers through civil and criminal investigations and prosecution. Additionally, the unit monitors reports of abuse and neglect at Medicaid-funded nursing, adult family and boarding homes. Their work provides valuable assistance to local law enforcement in investigating and prosecuting crimes committed against vulnerable adults.
The Medicaid False Claims Act, passed by the Washington Legislature in 2012 and renewed in 2016, broadened MFCU’s mission by allowing it to bring civil cases. Washington’s civil enforcement actions under the state’s Medicaid False Claims Act returned $3 to the state’s Medicaid program for every $1 the state spent on enforcement.
The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Visit www.atg.wa.gov to learn more.
Brionna Aho, Interim Communications Director, (360) 753-2727; firstname.lastname@example.org