What? A case of fraud, kickbacks, and unethical behavior in Chicago? I’m shocked!
Not really. But I am really disgusted. And pissed. I’m pissed because the victims in this alleged crime are Chicago’s very own nursing home residents – one of the most vulnerable populations in our community.
You may have seen in the news that Dr. Michael J. Reinstein was recently sued in a federal lawsuit for accepting kickbacks from two different drug companies. Those companies make the brand-name and generic versions of clozapine – one of the most dangerous antipsychotic medications around.
The lawsuit also alleges that Dr. Reinstein committed monumental fraud when he submitted over 140,000 false claims to Medicaid and Medicare for antipsychotic medications he had prescribed on the basis of kickback incentives rather than medical need. He’s also alleged to have submitted over 50,000 claims for monitoring the health status of patients taking these drugs when the feds state that he failed to properly do so.
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Having worked as a mental health consultant in nursing homes, I know all too well the dangers of antipsychotic medications when prescribed to older patients – particularly nursing home residents and those with dementia. In the case of clozapine, it can have serious side effects such as seizures, fainting, and heart enlargement. But it doesn’t stop there. People taking clozapine must be monitored extremely closely because the drug can cause a serious blood condition resulting in flu-like symptoms and sores in the mouth and throat. No wonder the drug boasts five “black-box” warnings.
A few years ago, a joint investigation by the Chicago Tribune and ProPublica found that in 2007, Dr. Reinstein ordered more prescriptions for clozapine than all of the doctors in Texas combined. They also found that his propensity for feeding his patients clozapine was linked to three nursing home deaths. The government cites that at one time, more than half of Dr. Reinstein’s patients were taking clozapine, including 300 out of 400 residents at one nursing home alone.
Are you mad yet?
While clozapine may provide some benefit to people with chronic schizophrenia or other psychotic disorders, it is rarely used for this purpose in nursing homes. Instead, the drug is often improperly used to treat behavioral symptoms of dementia that, in many cases, could be effectively and more safely managed with better staff training and environmental, non-drug interventions.
Or in some cases, perhaps it’s just all about the money.
It will be interesting to see what happens to Dr. Reinstein. Since the federal lawsuit was filed, the Illinois Department of Healthcare and Family Services has suspended Medicaid payments to the psychiatrist, and the Illinois Department of Financial and Professional Regulation has filed a formal complaint against Dr. Reinstein that could affect his medical license.
Here’s the take-away from this horrific story: If your loved one is in a nursing home, continue to be vigilant about his or her health care! In most cases, the doctors, nurses, and staff members have your family member’s best interests in mind. But disturbing stories like this one illuminate what can happen all too easily if we don’t keep tabs on what’s happening within the nursing home’s walls.
Be vigilant. And be an advocate for those who cannot speak for themselves.