The Wednesday morning keynoters at the National Task Force on CME Provider/Industry Collaboration conference focused on Washington, D.C.'s view of CME. As John Kamp, PhD, JD, Coalition for Healthcare Communications said in his introductory remarks, "It's all about the money in Washington." I'd venture to say a lot of it is about the money elsewhere, but I'll stick to the subject at hand for now.
Kamp explained that most of the dollars in the federal budget go to Social Security, Medicaid/Medicare/VA benefits, and the Department of Defense. "If you're a member of Congress, you don't save money on defense in a time of war. You don't mess with Social Security, and you don't mess with Medicaid/Medicare or VA benefits." So where do our Congressmen and women look to save money? Kamp said, "The F word in Washington isn't a four-letter one—it's fraud. Fraud, waste, and abuse is what Washington looks to root out."
He then introduced Dan Donovan, senior investigative council, U.S. Senate Committee on Finance. You know, the folks who recently sent out the letters to pharma companies asking them to detail all things related to CME, led by Sen. Chuck Grassley of Iowa. Fortunately, Dan started out on a reassuring note: "We're not trying to kill CME." He said that agencies under his committee's jurisdiction range from the Department of Homeland Security to Social Security, but their main focus is on Health and Human Services. They work with DHHS, DOJ, U.S. attorneys, Medicaid fraud control, state attorneys general, whistleblowers, and companies that come in to rat out their competitors to root out fraud and abuse of the healthcare system. But hearings based on results are fairly rare, he said, due to the huge time and expenses involved. More often, the Finance Committee deals with request letters, such as the ones they sent out about educational grants (for background on these letters, click here, here, and here). "If we don't get cooperation through letters, we turn to subpoenas and conduct interviews."
He also flashed several quotes from U.S. Attorney Michael Loucks, including, "Our focus is going to continue to be on allegations in the pharmaceutical industry." Loucks currently has 150 civil pharmaceutical cases pending in 35 districts nationwide, Donovan said, and he's seeing an increasing growth in off-label promotion cases. "Given Medicare Part D, the focus will remain on the pharmaceutical industry," he said.
So, what they've learned to date from the letters sent to pharma is that most companies are following the PhRMA Code and OIG Guidance. "The difficult part is teasing out what happens in reality as opposed to what's on paper," he said. The 23 pharma companies who received the letters spent $1.47 billion in 2004 on educational grants, a 20 percent increase over 2003, he said. "Substantial financing may compromise independence," he warned. "When you review payments down to the $100 level, you can see reps in certain regions giving out $100 educational grants."
He wrapped up by saying, "We would like to hear from you and better understand what you h ave to say about these issues."