California Insurance Commissioner Files Fraud Complaint Against AbbVie


Illinois-based AbbVie is under fire from California’s Insurance Commissioner over allegations of a kickback scheme to support sales of blockbuster rheumatoid arthritis treatment Humira in the state.

On Tuesday, California Insurance Commissioner Dave Jones filed an insurance-fraud complaint against AbbVie in Alameda County Superior Court. The complaint alleges that AbbVie “gave illegal kickbacks to health care providers” to prescribe Humira. The complaint says the providers were compensated “far in excess of the amount that they would have prescribed this… drug absent the illegal kickbacks. The complaint also calls Humira, AbbVie’s biggest revenue driver, “an expensive and dangerous drug with potentially deadly side effects.”

According to the complaint, AbbVie engaged in a “far-reaching scheme” that included both classic kickbacks, such as compensation in the forms of cash, meals, drinks, gifts, trips and patient referrals. Also, the complaint said the scheme include “more sophisticated” kickbacks, such as “free and valuable professional goods and services to physicians.” The professional goods and services included free insurance processing and prior authorizations and gifts of medical practice management hardware and software. Additionally, the complaint alleges that AbbVie also offered marketing assistance to the providers, which, as the complaint adds, saved the providers “valuable staff time and resources.”

Jones said pharmaceutical companies know that “financial inducements” are against the law. Jones said patients depend on their physicians for straightforward information about their healthcare and the medications they take. However, Jones said those doctors traded patients care for “$1.2 billion in ill-gotten gains.”

“AbbVie spent millions convincing patients and healthcare professionals that AbbVie Ambassadors were patient advocates - in fact, the Ambassadors were Humira advocates hired to do one thing, keep patients on a dangerous drug at any cost," Jones said in a statement.

Jones further went on to allege that AbbVie “inserts its own personnel directly into the homes of patient.” In his complaint, Jones said following the prescribing of Humira to a patient, the company sends nurses, which AbbVie calls “Ambassadors,” to the homes of the patients. The nurses, Jones said, represent themselves as an extension of the doctor’s office, rather than a representative of AbbVie.

The complaint says that private insurers in California have paid out $1.2 billion in Humira-related pharmacy claims. That amount makes this the “largest health insurance fraud case in department history,” according to the Insurance Commission’s statement. In his complaint, Jones said the Ambassadors are trained to send patient complaints directly to AbbVie and not the patients' treating physicians. Additionally, Jones said the AbbVie Ambassadors avoid discussing the risks of Humira and only tout the efficacy of the medication.

“At no cost and considerable gain to the physician's office, AbbVie nurses provide pharmacy and insurance authorization assistance, open enrollment resources, paperwork help, advice on insurance products, and other services, all of which provide a substantial value and save physicians' time, money, and resources. The catch is AbbVie only provides the Ambassadors as long as the physicians continue to prescribe AbbVie's drug instead of selecting another course of treatment,” Jones said.

Jones said the complaint sprang out of information a whistleblower provided his office. The whistleblower is one of Abbvie’s Ambassadors, a nurse employed in Florida, Jones said.

BioSpace reached out to AbbVie for a response to the complaint but has not yet heard back. We will update when AbbVie responds to our inquiry. In 2017 Humira generated more than $18 billion for the company – about two-thirds of its total revenue.

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