A few months ago, an Illinois psychiatrist was suspended indefinitely from practicing because of his alleged abuse of an antipsychotic drug called clozapine. Dr. Michael J. Reinstein prescribed clozapine to more than half of his patients at nursing homes as well as mental health facilities. Clozapine is used to keep patients sedated when they become irritable or violent – many of them suffer from dementia or other ailments, and antipsychotic drugs such as clozapine are used to hold them down. Such drugs can be considered an unacceptable form of chemical restraint that advocates have fought against in recent years in favor of more humane methods that avoid drug dependency.
Constant drug use by patients as prescribed can put them in a stupor and can hasten their mental and/or physical demise. Clozapine adversely affects the immune system by diminishing white blood cells, and can cause heart inflammation, seizures, and problems with the blood, as well as dizziness and lightheadedness. As we profiled earlier in this space, clozapine itself is one of the most dangerous types of antipsychotic medications, and is considered “a risky drug of last resort.” Historically, Dr. Reinstein was alleged to have prescribed more clozapine in a single year (2007) than all medical providers in the large state of Texas combined, and has had patients die in the past while on substantial doses of clozapine.
Charges, Guilty Plea and Settlement
Reinstein was also accused of taking about $350,000 in kickbacks, including gifts (like travel and dinners) from a clozapine manufacturer, Teva Pharmaceuticals, which is against the law. Teva already settled with the government over those kickback allegations. The government also sued Reinstein for taking kickbacks to prescribe clozapine, and for submitting possibly more than 140,000 false claims (overbilling) for reimbursement for these treatments from the federally funded programs Medicare and Medicaid. This type of Medicare/Medicaid fraud is prosecuted civilly and criminally under the False Claims Act, and such allegations are very serious. In recent news, Reinstein, already dealing with a suspended license and a civil suit from the government for taking kickbacks and committing medication fraud, has been charged criminally by the United States for taking kickbacks from the clozapine drug maker.
As reported by the Chicago Tribune, the criminal charges have been brought on a single kickback worth $2,000, but the government was reportedly looking to take back approximately $600,000 worth of “ill-gotten gains stemming from clozapine prescriptions.” Just days ago, Reinstein pled guilty to the federal charge of accepting kickbacks for prescribing clozapine against the Medicare and Medicaid Anti-Kickback Statute. His sentencing date is as yet unscheduled, but the please agreement includes a recommendation of 18.5 months behind bars. Along with the guilty plea, Reisnstein settled the civil case with both the Justice Department and the State of Illinois (which later joined the federal government in that suit) for $3.79 million, settling claims that he accepted kickbacks to prescribe clozapine and then submitted an astounding amount of false claims for reimbursement.
This case demonstrates the importance of cracking down on Medicare and Medicaid fraud, as well as companies and medical providers engaging in kickback schemes. This is an illegal way to “get rich” at the expense of patients who are not prescribed what they need or do not receive the appropriate treatment because doctors are prescribing medications as part of the kickback scheme. This case also highlights the abuse of federal taxpayer dollars through reimbursement claims. And above all, it puts the spotlight on the abuse of medications for chemical restraints, and how we must continue moving toward alternative methods.
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