The Hefty Medicare Price Tag for the Off-Label Prescriptions

Recently,  the US Department of Health & Human Services Office of Inspector General found that, in the six-month period from January through June 2007, an astounding 51 percent of Medicare claims for atypical antipsychotics were off-label. This amounted to over $116 million in Medicare funds.

Further focusing on the off-label use of antipsychotics in nursing homes, the OIG determined that 83 percent of Medicare claims for atypical antipsychotics for these residents were associated with off-label use; 88 percent were associated with the condition specified in the FDA boxed warning.

So why are so many nursing homes turning a blind eye to the antipsychotics’ black box warnings? What is pumping this water uphill? Could it be companies marketing off-label? This OIG report comes on the heels of Congressional scrutiny and a chorus of legal actions from State Attorney Generals, accusing the drugmakers of improperly marketing antipsychotics.

Some off-label marketing schemes regularly influence the prescribing habits of physicians. While the coffers of pharma companies fill with tainted funds, patient safety and government healthcare programs suffer.

For more information about qui tam law and pharmaceutical fraud, contact Nolan and Auerbach, P.A.