A former pharmaceutical district manager will be sentenced in July following a guilty plea to criminal HIPAA violations for a fraud scheme involving pharmaceutical company Warner Chilcott, which was sentenced to pay $125 million on April 15 to resolve allegations involving illegal drug promotion and paying kickbacks to physicians.
Landon Eckles, who earlier pleaded guilty to wrongful disclosure of individually identifiable health information, is one of several former Warner Chilcott employees being prosecuted. The scheme involved promoting the osteoporosis medications Atelvia and Actonel by illegally marketing the pharmaceuticals and paying physicians to prescribe the company’s products.
Warner Chilcott submitted false, inaccurate, and misleading prior authorization requests to federal healthcare programs for both drugs. Because Atelvia had poor insurance coverage in Eckle’s district, many insurance companies required prior authorization before they would cover Atelvia.
The U.S. Department of Justice (DoJ) alleged that Eckles told certain sales representatives to fill out Atelvia prior authorizations if physicians refused to fill them out. Prior authorization request contains protected health information (PHI) including biographical data and information about the patient’s medical condition. To fill out the forms, Eckles and several sales representatives “accessed patients’ protected heath information in violation of the HIPAA law and regulations that safeguard privacy of confidential health records,” the DoJ said.
Prosecutors say Eckles and a sales representative also accessed patients’ medical charts.
Eckles is due to be sentenced July 26, according to court documents. He faces up to 10 years in prison, there years of supervised release, a fine of $250,000, and exclusion from the Medicare program.
HIPAA violations become criminal cases when they involve egregious wrongdoing rather than misinterpretations of the rules or small slips. Though criminal HIPAA cases are “relatively rare,” they will continue to be prosecuted with similar intensity as the Warner Chilcott violations. This case demonstrates that criminal HIPAA violations are being handled with the same severity as comparable fraud schemes and criminal activity in any other industry.
