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Warner Chilcott HIPAA Lesson Revisited – Mass. Physician Convicted of Criminal Violation

Back in late 2015, we blogged about the interesting twist in the $125 million Warner Chilcott settlement that a Massachusetts physician had been criminally charged with violating the Health Insurance Portability and Accountability Act (HIPAA). See HERE for that previous post.

That physician has now been convicted of the HIPAA violation, as well as an unrelated charge of obstructing a federal health care investigation. The US Attorney’s Office in Boston made the announcement late last month.

The Warner Chilcott settlement involved illegal drug promotion. Specifically, sales reps were accused of flagging patient medical records with product brochures and filling out the provider’s prior authorization forms in advance for specific patients. All of this required impermissible access to patient records. The physician’s criminal liability stems from providing these sales reps with access to her patients’ records. In some cases, the reps were even allowed to take the records home with them!

We are often reminded through settlements with the HHS Office for Civil Rights that HIPAA violations are taken seriously and can include hefty fines and corrective action plans (see HERE, HERE and HERE for just a few examples). This case serves as fair warning that intentional misuse of protected patient information can lead to jail time. When this physician is sentenced, she could be looking at up to a year in prison, a $50,000 fine, and a year of supervised release. If you picture a sales rep combing through your personal health issues in his or her living room to determine whether you might be a sales target, it shouldn’t be so surprising that this conduct can rise to the level of criminal liability.
 






Warner Chilcott HIPAA Lesson Revisited – Mass. Physician Convicted of Criminal Violation

Back in late 2015, we blogged about the interesting twist in the $125 million Warner Chilcott settlement that a Massachusetts physician had been criminally charged with violating the Health Insurance Portability and Accountability Act (HIPAA). See HERE for that previous post.

That physician has now been convicted of the HIPAA violation, as well as an unrelated charge of obstructing a federal health care investigation. The US Attorney’s Office in Boston made the announcement late last month.

The Warner Chilcott settlement involved illegal drug promotion. Specifically, sales reps were accused of flagging patient medical records with product brochures and filling out the provider’s prior authorization forms in advance for specific patients. All of this required impermissible access to patient records. The physician’s criminal liability stems from providing these sales reps with access to her patients’ records. In some cases, the reps were even allowed to take the records home with them!

We are often reminded through settlements with the HHS Office for Civil Rights that HIPAA violations are taken seriously and can include hefty fines and corrective action plans (see HERE, HERE and HERE for just a few examples). This case serves as fair warning that intentional misuse of protected patient information can lead to jail time. When this physician is sentenced, she could be looking at up to a year in prison, a $50,000 fine, and a year of supervised release. If you picture a sales rep combing through your personal health issues in his or her living room to determine whether you might be a sales target, it shouldn’t be so surprising that this conduct can rise to the level of criminal liability.
 






The Warner Chilcott settlement involved illegal drug promotion. Specifically, sales reps were accused of flagging patient medical records with product brochures and filling out the provider’s prior authorization forms in advance for specific patients. All of this required impermissible access to patient records. The physician’s criminal liability stems from providing these sales reps with access to her patients’ records. In some cases, the reps were even allowed to take the records home with them!
 






The Warner Chilcott settlement involved illegal drug promotion. Specifically, sales reps were accused of flagging patient medical records with product brochures and filling out the provider’s prior authorization forms in advance for specific patients. All of this required impermissible access to patient records. The physician’s criminal liability stems from providing these sales reps with access to her patients’ records. In some cases, the reps were even allowed to take the records home with them!
Old, very old news.
 












Warner Chilcott District Managers Sentenced for HIPAA Violations and Healthcare Fraud
Home»HIPAA News»Warner Chilcott District Managers Sentenced for HIPAA Violations and Healthcare Fraud
Posted By HIPAA Journal on Oct 31, 2016

The United States Attorney’s Office for the District of Massachusetts has announced three former district managers of the pharmaceutical firm Warner Chilcott have been sentenced for violating the Health Insurance Portability and Accountability Act and committing healthcare fraud.

The offenses date back to 2011, when Warner Chilcott launched the osteoporosis drug Atelvia®. The drug was not covered by many insurance companies due to a generic alternative being available. Coverage would only be provided if prior authorizations were filled out by physicians.

In an effort to drive sales, Landon Eckles, a mid-Atlantic district manager in the osteoporosis division of Warner Chilcott, directed certain sales representatives to fill out prior authorizations for the drug, even if physicians refused to do so. Completing those prior authorizations required the representatives to access the protected health information of patients; a violation of HIPAA Rules.

Patients diagnosed with osteoporosis also had Atelvia® brochures added to their medical charts to remind physicians to prescribe the drug. According to the Department of Justice, Eckles received a bonus of $60,000 in 2011 as a result of the scheme.

In November last year, Eckles pleaded guilty to violating HIPAA Rules and wrongfully disclosing PHI. He faced a maximum prison term of 10 years with three years of supervised release and a fine of up to $250,000. Last week, U.S. District Court Judge George A. O’Toole, Jr., sentenced Eckles to a year of probation and fined him $10,000.

Timothy Garcia, a district manager for the San Francisco Bay area, pushed his sales representatives to complete prior authorizations for Atelvia® when physicians were reluctant to do so. Garcia also “stressed the importance of concealing the misconduct of his sales representatives,” according to the Department of Justice. Garcia also received a bonus of $60,000 for boosting sales, in addition to being promoted to senior district manager. Garcia was sentenced to serve eight months of home confinement by U.S. District Court Chief Judge Patti B. Sari last month. He is also required to forfeit $21,500 in payments.

New York City and Long Island district manager Jeff Podolsky also directed sales representatives to fill out prior authorizations for Atelvia® and its predecessor Actonel® for physicians who prescribed the drugs. He also submitted false clinical justifications as to why those specific medications were required by patients. Those activities saw Podolsky become the top grossing district manager for Warner Chilcott and resulted in him receiving a $100,000 bonus and a promotion. According to the DOJ, as a result of Podolsky’s actions insurance companies paid at least $200,000 for Atelvia® and Actonel® prescriptions.

In July last year, Podolsky pleaded guilty to conspiracy to commit healthcare fraud. On Oct. 11, 2016, Chief Judge Sari sentenced Podolsky to serve 8 months of home confinement, pay a $10,000 fine, and forfeit $28,237.