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Drugs companies are defrauding healthcare systems, conference hears

Pharmaceutical companies are among those deliberately defrauding healthcare systems throughout Europe, a conference in London heard this week. 
 
More than 150 delegates from 20 of the 25 European Union states attended the two day event looking at fraud and corruption across the European healthcare system. Although delegates considered everything from health tourism (where individuals from one country go to another to receive free or cheap health care) to how to identify fraud, a recurring concern was the blatant fraud by some drug companies. 
 
"In any country, pharmaceutical fraud is a big problem," said Marieke Koken-Vossestein, head of the department of claim control at the Zorgverzekeraars Nederland (a Dutch department that develops antifraud policies across all health insurance schemes in the Netherlands). 
 
The fraud can range from doctors claiming for work they have not done through to drug companies who bribe doctors by paying them for switching patients to a new drug. 
 
Professor Peter Schonhofer of the Institute of Pharmacology, Bremen, said the fraud included not being able to view data from clinical trials submitted to the German regulatory body, the Federal Institute of Drugs and Medicinal Products. 
 
"If they have information they don't tell us it," he told the BMJ . "We don't have access to relevant data." 
 
That could mean therapeutic decisions were inappropriate—but because the relevant data were covered by a commercial confidentiality clause, those outside the institute could never know how appropriate the treatment was. 
 
He also cited what is euphemistically called a "drug use study," whereby a doctor is paid anything from €200 (£140; $250) to €500 for transferring a patient from one drug to another and then filling in a form to say what they have done. 
 
"We know that the pharmaceutical industry in German has spent €1bn a year for such drug use studies. And it is not just in Germany. In Italy, GSK [GlaxoSmithKline] spent €28m over a 12 year period just for doctors to provide a signature." 
 
State investigations of bribery by drug companies are becoming increasingly common, with two cases in the last year alone (BMJ 2004;328:1333). 
 
In the United Kingdom tighter antifraud measures have led to ongoing legal action against the manufacturers of warfarin and penicillin. 
 
Jim Gee, chief executive of the Department of Health's NHS Counter Fraud and Security Management Service, said they had evidence to suggest the existence of a price fixing cartel. Six pharmaceutical companies are allegedly involved in fixing the price of warfarin, costing the NHS £28m; seven are allegedly involved in keeping the price of penicillin high, costing the NHS £30m. 
 
The Serious Fraud Office has yet to decide whether criminal action should be pursued on these cases, and the civil cases have yet to be heard. 
 
The NHS Counter Fraud Service is also pursuing a further £100m for alleged price fixing of a generic version (ranitidine) of Zantac when the patent for that drug expired. 
 
"Clearly these companies operate in the other countries too," Mr Gee said, suggesting that other European countries might also have been similarly defrauded. 
 
Mr Gee said the NHS had done a great deal to try to tackle fraud and that although other countries had health insurance based systems, from what those delegates had told him, the level of fraud was as bad, if not worse.