WITH PHARMACEUTICAL company dollars going into continuing medical education reaching more than $700 million in 2002 (see Data Report, page 11), it should be no surprise that federal scrutiny of how those dollars are spent is also on the rise. While the U.S. Attorney's Office in Boston would not confirm or deny any ongoing investigations, an article in the Boston Globe earlier this summer said that investigators, led mainly by the U.S. Attorney in Boston, were sending out subpoenas to the nation's top academic hospitals.

According to the article, federal prosecutors are trying to determine if the educational grants given to medical centers from pharmaceutical companies are influencing their physicians' prescribing habits, which would be illegal under federal anti-kickback laws. And there's a lot at stake — hospitals convicted of violating these laws would lose their ability to treat Medicare patients, representing a potentially devastating loss of income. According to the Globe article, attorneys believe the subpoenas were aimed more at gathering information than cracking down on any specific institution, although the evidence they gather could be used for criminal or civil legal actions against the hospitals or the companies providing the grants.

The investigations come on the heels of the Office of Inspector General's pharma compliance guidance, which was released in final form this spring. Because hospitals are often pharma customers as well as accredited CME providers, they may be of greater interest to the federal watchdogs, and the large teaching hospitals seem to be the handiest targets for probing. Says one CME provider, who prefers to remain anonymous, who's worked for both large and small hospitals, “Definitely the large, academic institutions are being singled out. There really is no scrutiny at small, solvent hospitals.”

Regardless of their visibility to investigators, many hospitals began to tighten their policies long before the final OIG guidance came down. For example, last year the department of medicine at Massachusetts General Hospital began disallowing pharma-sponsored meals during resident luncheon lectures, and Tufts — New England Medical Center began to require the docs on their formulary committee to disclose any drug company relationships last year as well. Salem Hospital in Salem, Ore., also has been proactive, instituting a policy that disallows industry reps from attending any educational activities their company is supporting with an unrestricted grant. “We do not even want the perception that a speaker might bias his/her talk because a supporting rep is in attendance,” says Salem's CME coordinator Patricia Cozad. “Actually, our CME activities are not open to any industry reps, not even non-supporting ones.”

Eliana Silva, CME coordinator, Physician Education Department — Conference Center, with Kaiser Permanente South Bay/Harbor City Medical Center in Harbor City, Calif., says her hospital also takes self-policing seriously. “We have strict rules, and if drug reps violate our rules, they are suspended from visiting the medical center from three months to indefinitely,” she says. “One company had all its reps suspended for 12 months.”

But despite the hassle, no one is saying that pharmaceutical educational grants are going away any time soon — nor that they should. As one hospital's attorney told the Globe, “The fact that grants are going on, I don't think there's anything wrong with that. The government's concern should be whether the grant is tied to sales, and that's where the proof [of wrongdoing] is lacking.”

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