Medicare Compliance & Reimbursement

You may not be immune from TAP marketing fallout.

If you received free samples of Lupron prior to the recent Department of Justice settlement with TAP Pharmaceuticals, your billing practices may still end up under the microscope.
     
Dr. G. Craig Kiser, an Oregon urologist, will pay the government more than $200,000 in restitution to settle allegations that he improperly billed Medicare and Medicaid for 23 free samples of the prostate cancer drug he received from the manufacturer. Although Kiser received only $10,000 from federal payers, he is liable for triple damages and a penalty of $11,000 per claim under the False Claims Act, Oregon Attorney General Hardy Myers said Nov. 9.
     
Earlier this year, TAP settled allegations that it encouraged physicians to submit claims to the government for free samples of Lupron. TAP was required to provide a list of all Oregon physicians who received free samples from sales representatives. Kiser was singled out when investigators noted a major spike in the number of free samples delivered to his office over a several month period, Hardy said.
     
Dr. Kiser, who denies the specifics of the allegations, will be allowed to continue to participate as a Medicaid and Medicare provider. A compliance agreement requires the physician to have written policies in his office governing the receipt, storage, use, inventory and financial disposition of drug samples. In addition, all employees must be trained on these procedures.
     
Lesson Learned: Investigations into how free samples of Lupron were handled continue to plague doctors.