Nuedexta Prescribing Psychiatrist: Speaker Fees, Patient Referrals and a Missed Report

The Nuedexta lawsuit alleged a speaker-program kickback scheme: an Alabama nursing-home psychiatrist accepted more than $400,000 in payments intended to induce prescriptions for residents without pseudobulbar affect. The government alleged that a drug sales representative helped fill the physician’s appointment schedule, and the prescriptions reached Medicare and Medicaid. Paid talks with no audience were one part of the arrangement. Access to residents was another. An integrity agreement later required independent review of the physician’s claims.

The Justice Department announced the False Claims Act lawsuit. The physician entered that agreement with the Department of Health and Human Services Office of Inspector General and paid a penalty for failing to submit its first annual report.

What the Speaker Payments Allegedly Bought

The government alleged that manufacturer payments rewarded prescribing through a speaker program that delivered little value as education. The complaint described approximately 178 presentations from 2015 through 2019. According to the government’s complaint, the manufacturer supplied the presentation materials and prohibited the physician from changing them or adding his own clinical experience.

The company’s own attendance records, the complaint alleged, made the arrangement harder to explain. In November 2016, the company allegedly paid a $2,000 speaker fee for a presentation in Decatur, Alabama, for which its records showed no attendees.

Sometimes, the complaint alleged, the audience was a company employee. The complaint described a $2,400 presentation in St. Louis where the only documented attendee was a local sales representative. The next day, that representative attended the same presentation three more times. For the St. Louis talk, the company allegedly supplied the material, supplied the audience and paid the speaker.

The complaint also alleged more than $36,000 in presentation expenses. A talk did not even have to happen: the complaint identified $15,550 in speaker fees for canceled presentations that were not given.

The government’s allegation was that the physician’s prescribing was what made this relationship valuable. The attendance sheets, canceled events and restrictions on his own medical input explained why the government challenged the stated purpose of the fees.

Referrals Reached the Nursing Home Before the Physician

Patient referrals were another alleged form of payment. The government said the relationship began with the manufacturer providing valuable referrals in return for Nuedexta prescriptions. The physician’s practice manager allegedly sent his monthly schedule to company salespeople, who could visit nursing homes ahead of him and persuade staff to refer residents.

The complaint quoted a sales representative’s account of the physician’s willingness to prescribe:

The representative also reported that prescribing had declined when he stopped visiting the homes to generate referrals. He proposed resuming those visits using the physician’s schedule. In this account of nursing-home kickbacks, access to patients had value alongside the speaker checks. The sales visits allegedly helped build the practice. The resulting prescriptions built drug sales.

The Resident’s Chart Told a Different Story

The prescribing allegation concerned residents who lacked the condition the drug was approved to treat. The complaint described pseudobulbar affect as involuntary, sudden and frequent episodes of laughing or crying. The government’s announcement said Nuedexta had not been shown safe and effective for other forms of emotional lability associated with Alzheimer’s disease and other dementia.

The complaint followed one resident’s care in detail. At a follow-up visit, the physician recorded no new symptoms and left his impressions of depression and anxiety unchanged. A later order added both pseudobulbar affect and Nuedexta. The government alleged that nothing in the intervening medical record showed the resident had developed symptoms consistent with that diagnosis.

A later visit listed Nuedexta among the resident’s medications but, according to the complaint, did not mention a pseudobulbar affect diagnosis, involuntary laughing or crying, or whether the drug had helped. The complaint alleged that, after a hospital discontinued the drug, the physician ordered it restarted when the resident returned to the nursing home.

The government’s account connected the diagnosis added to the chart, the prescription, the follow-up notes and the drug claims paid through Medicare Part D. The alleged cost fell on residents given medication for a condition they did not have, and on taxpayers paying the bill.

What Medicare and Medicaid Paid for the Prescriptions

The complaint alleged that Medicare paid more than $6 million for Nuedexta prescriptions written for the physician’s patients from 2015 through 2019. Alabama Medicaid paid more than $800,000 during the same period.

According to the complaint, the physician accounted for approximately 20% of all Nuedexta prescriptions written for Medicare beneficiaries in Alabama during that period. In 2015, his patients accounted for more than half of Medicare’s total Nuedexta expenditure for Alabama beneficiaries. The concentration matters alongside the clinical allegations: the government traced both extensive prescribing and a resident’s chart that it said did not support the treatment.

The drug claims in this complaint ran through Medicare Part D and Medicaid. The alleged influence began with the prescribing decision before those claims reached the programs.

The Integrity Agreement Required Independent Review

The physician’s integrity agreement took effect on August 29, 2023, with a three-year term. Its opening states that the physician was entering a settlement agreement with the United States at the same time.

The agreement required an independent reviewer to examine the physician’s Medicare fee-for-service claims for medical necessity, supporting documentation and correct coding and payment.

The prescription question followed the reviewer into the chart. If a sampled claim’s medical records showed that the physician had prescribed medication, the reviewer had to determine whether that medication was medically necessary. A claim without supporting documentation had to count as an error and an overpayment.

The annual report had to include the review reports, the physician’s responses, corrective action plans and documentation of required refunds. This is the practical work behind an integrity agreement: checking the paid service against the clinical record, then reporting what the review found and what changed.

A Missed Report Brought a Separate Penalty

On April 17, 2025, the physician paid a $74,000 penalty for failing to submit the first annual report, according to the Office of Inspector General.

The agreement required a report showing what the independent review found and how the physician responded. The first report never reached the government when required, and that failure brought its own bill.

Speaker Records, Schedules and Charts Connect the Nuedexta Case

This case brings together records that ordinarily sit in different places: manufacturer speaker payments and attendance sheets, a practice manager’s schedule, nursing-home referrals, residents’ clinical notes and prescription claims. The complaint used those connections to explain both the alleged inducement and the resulting government payments.

Avanir Pharmaceuticals’ separate civil resolution in 2019 included $95,972,017 for federal claims concerning alleged inducements to prescribe Nuedexta and promotion for dementia-related behaviors in long-term-care facilities. The physician-side allegations show the arrangement from inside the practice and the home, where sales visits, referrals and prescribing met.

For someone who recognizes those connections in suspected health care fraud, we assess the payment relationship and the clinical and billing evidence together. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Saw How the Prescriptions Started

Sales representatives, practice managers and nursing-home healthcare staff can see why a physician’s calendar fills up or why a speaker keeps getting paid. Talk with our whistleblower experts about the prescribing arrangement. We work with you to build your strongest whistleblower case around those decisions, bring in pharmaceutical fraud whistleblower lawyers who understand nursing-home prescribing, and stand beside you throughout the case.