Joint Complaint Filed Under the California Insurance Frauds Prevention Act
On September 18, 2018, Lieff Cabraser and California Insurance Commissioner Dave Jones sued AbbVie, Inc. for violations of the Insurance Frauds Prevention Act (“IFPA”) by providing kickbacks to healthcare providers throughout California relating to sale of the immunosuppressive drug Humira. Humira, used to treat arthritis, colitis, and other diseases, is a widely-prescribed drug that led the list of top-selling pharmaceutical products until its 2016 U.S. patent expiration, having global sales of $16 billion in 2016 alone.
The lawsuit, filed in California Superior Court in Alameda, California, alleges that AbbVie engaged in a far-reaching scheme to maximize profits and the number of prescriptions of Humira via “classic” kickbacks—including cash, meals, drinks, gifts, trips, and patient referrals—as well as more sophisticated kickbacks, including professional services to physicians to induce and reward Humira prescriptions. These kickbacks saved time and money for doctors and their staff.
The Complaint further alleges that AbbVie deployed so-called “Ambassadors” directly into patients’ homes, ostensibly to provide a helping hand, but in fact—and cynically—to provide valuable services to benefit health care providers, ensure prescriptions were filled, and deflect patient concerns. Unfortunately, AbbVie directed its Ambassadors to avoid patient questions about risks for the dangerous drug.
“It’s sobering that a powerful drug like HUMIRA has not been prescribed on its own merits, informed by individualized risk-reward assessments for individual patients. California ratepayers, to say nothing of vulnerable patients, deserve healthcare free from the taint of costly kickbacks,” said Lieff Cabraser partner Rachel Geman, who represents the relator in the case.
Humira has FDA boxed warnings (commonly referred to as “black box” warnings) because of its risks of causing death by cancer or infection. Before injecting Humira, patients deserve medical advice that is free from any motive other than their best interests. Instead, providers whom AbbVie has targeted for its scheme are prescribing more Humira to Californians. And, AbbVie’s insertion of its own non-neutral medical workers into patients’ homes acted to interfere with the proper flow of doctor-patient communication relating to care and prescriptions, all to the benefit of AbbVie.
Plaintiff-Relator Lazaro Suarez worked for AbbVie via a sub-contractor as an Ambassador from 2013 to 2014. Mr. Suarez’ work earned him recognition and awards. As a valued Ambassador for AbbVie, Mr. Suarez was in an advantageous position to observe over time that the true focus of the Ambassador program was maintaining and increasing AbbVie’s profits. As a Nurse, Mr. Suarez ultimately felt compelled to blow the whistle on AbbVie’s fraud.
The lawsuit alleges that AbbVie knowingly employed runners, cappers, steerers, and others to perform or obtain services and benefits under contracts of insurance for claims, and aided, abetted, solicited, and conspired to knowingly present or cause false/fraudulent claims for injuries and treatment under insurance in violation of the California Business and Professions Code and for inducement of health care benefit false claims in violation of the California Insurance Code and California Penal Code. In this action, Mr. Suarez and the Department seek equitable and injunctive relief to end the kickbacks, as well as three times the amount of each claim for compensation pursuant to contracts of insurance made for Humira in California between 2013 and August of 2018, as well as attorneys’ fees, expenses, and costs, and all other relief to which the Court finds the state of California to be entitled.
About Lieff Cabraser
Lieff Cabraser represents whistleblowers who uncover fraud on the government in a wide range of False Claims Act cases, including Medicare and healthcare fraud, defense contractor fraud, securities and financial fraud, insurance fraud, and many other false claims. Unlike many firms, we have the resources, experience, and skill to appropriately investigate even the largest and most complex matters and pursue them all the way through trial. Since 2009, we have recovered over $260 million for our whistleblower and qui tam case clients and billions of dollars in litigation involving pharmaceutical products.
Lieff Cabraser Heimann & Bernstein, LLP