High-Prescribing Chicago Psychiatrist Faces Federal Fraud Suit

The U.S. Attorney for the
Northern District of Illinois filed a federal fraud lawsuit today against a Chicago psychiatrist profiled by ProPublica and the Chicago Tribune in 2009 for his voluminous
prescribing of antipsychotic drugs to nursing home patients.

In a news release, the government says that Dr. Michael Reinstein
“received illegal kickbacks from pharmaceutical companies and submitted at
least 140,000 false claims to Medicare and Medicaid for antipsychotic
medications he prescribed for thousands of mentally ill patients in area
nursing homes.”

ProPublica and the Tribune reported in 2009 that Reinstein
prescribed more of the risky antipsychotic clozapine to patients in Illinois’
Medicaid program in 2007 than all of the doctors in the Medicaid programs of
Texas, Florida and North Carolina.

The government accuses Reinstein of billing Medicare and Medicaid for managing his
patients’ medications, “knowing that he did not engage in substantive
evaluations of his patients’ medical and psychiatric conditions to properly
manage their medications,” the U.S. attorney’s office said in its release.
“Instead, he allegedly prescribed medications to his patients based on his
receipt of kickbacks from pharmaceutical companies.”

Prosecutors allege that Reinstein’s
prescribing decisions were motivated by money and perks from pharmaceutical
companies. He allegedly switched patients from one brand of clozapine to
another based on money and other enticements he received from a pharmaceutical
maker.

Before August 2003, the
government alleged, Reinstein prescribed Clozaril, brand name for clozapine made by Novartis, which
paid him to promote the drug.

When the drug went off
patent in 1998, the lawsuit says, Reinstein resisted
attempts to switch his patients to cheaper, generic versions. But when Novartis
stopped paying Reinstein in 2003, the lawsuit says,
he switched his patients to a generic version made by IVAX Pharamceuticals.

That company had agreed to
pay him a consulting fee, pay his nurse to speak on the drug’s behalf and fund
a research study at an affiliated institute, according to the lawsuit.

“While generally only four
percent of schizophrenia patients who were prescribed antipsychotics received
clozapine, during the time Reinstein was allegedly
accepting kickbacks from IVAX, more than 50 percent of his patients were
prescribed IVAX’s clozapine,” the U.S. Attorney’s office said in its news release.
“At one nursing home, Reinstein had 75 percent of the
400 residents on IVAX’s clozapine.”

Ivax paid other perks to Reinstein and his associates, including airfare,
entertainment expenses, a fishing trip, a boat cruise and a golf outing, the lawsuit
says.

In 2006, Reinstein began switching to clozapine made by a different
company but moved some patients back when he received additional perks and
funds, the lawsuit says.

In an interview, federal
prosecutor Eric Pruitt would not comment on whether his office would pursue
criminal charges against Reinstein or whether any
legal action would be taken against the pharmaceutical companies that allegedly
paid the physician kickbacks.

A call left at the office
of Reinstein’s attorney was not immediately returned.

The 2009 investigation by
ProPublica and the Tribune showed that Reinstein’s
high prescribing had serious consequences for his patients. Autopsy and court records showed that by 2009 at least
three patients under Reinstein’s care had died of
clozapine intoxication. One of them, a 50-year-old man, had five times the
toxic level of clozapine in his blood when he died, according to his medical
records.

Reporters
determined that, based on his Medicaid prescribing alone, Reinstein
he would have to work 21 hours a day,
seven days a week to see each of his patients for 10 minutes. Research has
found that the typical U.S. psychiatrist sees about 35 patients per week; Reinstein was seeing 60 each day, he wrote in an audit
report in 2007.

In the
2009 investigation, Reinstein strongly defended his
reliance on clozapine, saying the medication is underprescribed
and is the most effective in its class for schizophrenic patients.