Drug Switches May Lead To Doctor Punishments

BOSTON -- For the first time, the American Medical Association is warning that doctors who switch their patients off brand name drugs, including Lipitor, and onto generics could face criminal and civil punishment.

NewsCenter 5's Janet Wu reported that the warning from the AMA comes after numerous inquires from physicians nationwide. The AMA's answer could not be more clear.

A physician accepting payment from an insurer in exchange for moving a patient from a brand name to a generic drug could potentially face both criminal and civil liability exposure under the federal anti-kickback statute.

The penalties are as much as five years in prison, with criminal fines as high as $25,000 for each violation, civil penalties up to $50,000 and exclusion from federal programs, such as Medicare in the future.

Rep. Peter Koutoujian said as Chairman of Health Care and as a patient on cholesterol medication, he wants tougher state laws governing doctors getting financial benefits for switching their patients' medications.

"We want to know that the decision is being made in our best interest. And if there are incentives being offered to the doctor, while that decision might be in our interest, how can we truly trust that decision?" Koutoujian said.

While the practice earlier this year in Michigan of doctors receiving $100 from Blue Cross for each patient they switched off Lipitor to a generic drug has never been practiced in Massachusetts, doctors in the Bay State who switch enough patients off brand names receive a financial reward at the end of the fiscal year.

Dr. Jerome Kassirer, former editor of the New England Medical Journal, has written extensively on the relationship between doctors and big business.

"Doctors, since the passage of Medicare, have become accustomed to getting a fee for everything they do," he said. "Doctors seem to believe that they are entitled to all this largesse from industry."

But despite the AMA warning, Dr. Thomas Lee, CEO of Partners Community HealthCare, continues to defend the practice by doctors because it also saves patients money.

"We support the use of pay-for-performance contracts that reward providers for improving quality and efficiency. We think this approach is far better than simply shifting more costs onto consumers," Lee said in a statement.

The AMA said that any physician's first priority must be the patient's health and the best medical practices available to treat it. It said it was not aware of any doctors being prosecuted under the federal anti-kickback statute for switching patients off brand names.

Meanwhile, it was revealed last week that Blue Cross Chief Executive William Van Fassen was rewarded with more than $16 million in retirement pay even though he did not leave the company. He remains chairman of Blue Cross/Blue Shield.