What is a Physician Kickback, and What Should It Matter to Me
What Exactly Are Physician Kickbacks, and Why Do They Matter to What They Prescribe Me?
When you visit a doctor, you trust that their recommendations—whether for medication, medical procedures, or specialist referrals—are based purely on your health needs. However, a troubling practice known as physician kickbacks can sometimes interfere with this trust.
What Are Physician Kickbacks?
Physician kickbacks occur when doctors receive financial incentives, gifts, or other benefits from pharmaceutical companies, medical device manufacturers, or healthcare providers in exchange for prescribing specific medications or services. These incentives can come in various forms, including:
- Cash payments disguised as "consulting fees" or "speaker honorariums"
- Expensive meals, travel, and entertainment
- Stock options or employment for family members
- Referral fees for directing patients to certain labs, imaging centers, or hospitals
Kickbacks are illegal under the federal Anti-Kickback Statute, but enforcement can be difficult, and violations still occur.
Proof That Kickbacks Happen
Numerous lawsuits and investigative reports have exposed the prevalence of kickbacks in the medical field:
- Novartis Kickback Scheme: A whistleblower lawsuit revealed that Novartis paid doctors thousands of dollars in speaking fees, meals, and other incentives to prescribe its medications. Some doctors even had family members hired by the company to maintain their loyalty in prescribing specific drugs ([ProPublica](https://www.propublica.org/article/pay-to-prescribe-two-dozen-doctors-named-in-novartis-kickback-case)).
- Dollars for Docs Investigation: A ProPublica analysis of federal data showed that three-quarters of doctors in five common specialties received payments from drug companies. The investigation found a direct correlation between payments and an increased likelihood of prescribing brand-name drugs instead of generics, which are often just as effective but significantly cheaper ([ProPublica](https://www.propublica.org/article/now-theres-proof-docs-who-get-company-cash-tend-to-prescribe-more-brand-name-meds)).
- Opioid Crisis and Kickbacks: Pharmaceutical companies like Insys Therapeutics were found guilty of bribing doctors to prescribe opioids such as Subsys (a fentanyl-based painkiller), even when it was not medically necessary. This contributed to the opioid epidemic, leading to unnecessary patient addiction and overdose deaths.
Why This Matters to You
1. Increased Costs:
Brand-name medications, often promoted through kickback schemes, can cost 10 to 20 times more than their generic equivalents. If your doctor is influenced by a financial incentive rather than your medical needs, you may be paying significantly more for medication than necessary.
2. Health Risks:
Kickbacks can lead to overprescription or inappropriate prescriptions. If a drug is pushed on you due to financial incentives rather than medical necessity, it could cause harmful side effects, addiction, or other complications. The opioid crisis is a tragic example of how financial incentives influenced doctors to prescribe highly addictive drugs unnecessarily.
3. Erosion of Trust:
Knowing that three-quarters of doctors have received some form of payment from pharmaceutical companies can make patients skeptical about whether their doctor’s advice is truly in their best interest. This loss of trust can lead patients to second-guess legitimate medical advice, delaying treatment and worsening health outcomes.
How to Protect Yourself
- Ask Questions: If your doctor prescribes a brand-name drug, ask if a generic is available. Be bold enough to take information into your doctor's office that shows a history of other physicians being paid to prescribe those drugs, and call them on the carpet about it.
- Use Open Payments Data: The Physician Payment Sunshine Act requires drug and device companies to disclose payments to doctors. You can check your doctor's payment history at [Open Payments](https://openpaymentsdata.cms.gov/).
- Seek a Second Opinion: If a prescribed medication or treatment seems unnecessary or overly expensive, getting another doctor's perspective can help ensure the recommendation is medically justified.
Final Thoughts
Physician kickbacks are not just an ethical issue—they directly affect your wallet, health, and trust in the healthcare system. While laws exist to prevent this practice, enforcement is challenging, and violations still happen. As a consumer, staying informed and asking the right questions can help you make the best healthcare decisions for yourself and your family.
Would you like help checking a specific doctor’s payment history or finding more affordable alternatives to a prescribed medication? Let me know how I can assist!
For more information on this topic, here are several articles from reputable sources. Sadly, this list is not all-inclusive because this issue is SO PREVALENT, that I can't list all of the articles here.
https://www.businessinsider.com/what-drugs-are-doctors-paid-the-most-to-promote-2015-1
https://hsph.harvard.edu/news/opioids-doctors-prescriptions-payments/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11107028/
https://today.uconn.edu/2019/07/study-more-pharma-money-more-gabapentin/
