Purdue Pharma and Practice Fusion: The Guilty Plea Over an EHR Opioid Prompt

The Purdue Pharma Practice Fusion guilty plea concerned paid opioid recommendations, alongside a $2.8 billion civil False Claims Act settlement covering Purdue’s wider conduct. The settlement gave the United States a claim in Purdue’s bankruptcy. In its November 24, 2020 guilty plea, Purdue admitted paying for a software prompt intended to increase its opioid sales, knowing those payments were unlawful. A drug company bought influence over a recommendation inside the doctor’s clinical tools.

What Are Some Examples of Kickbacks in Healthcare?

Purdue’s payments to Practice Fusion are a concrete example of kickbacks in healthcare: a pharmaceutical manufacturer paid a software company to install a prompt intended to steer prescribing toward its products.

The U.S. Attorney’s Office for the District of Vermont led the investigation of Purdue’s payments to Practice Fusion. The payments ran from April through December 2016.

The intended products were OxyContin, Butrans and Hysingla, which the government described as Purdue’s extended-release opioids. The arrangement sought referrals, recommendations and orders for those products. It reached into the choice of treatment through the software the prescriber was using.

What Law Prohibits Payments for Patient Referrals?

The federal Anti-Kickback Statute was the law behind Purdue’s guilty plea for conspiring with Practice Fusion to pay for opioid recommendations. The law reaches payments intended to induce orders or recommendations involving items or services payable by federal health care programs.

The recommendation matters here. The money went to the company that could put a prompt in front of the doctor, and the desired result was more prescriptions. For an insider reviewing a sponsorship agreement, that connects the commercial terms to the clinical feature: who funded it, what the software was supposed to recommend, and what the sponsor expected to gain.

Purdue Admitted the Purpose of the Payment

Purdue’s board chairman spoke for the company at the plea hearing. He admitted that one purpose of the prompt was to increase Purdue’s extended-release opioid sales and that the company knew it was unlawful to pay for arranging or recommending those prescriptions.

That admission gives the payer’s own account of intent. The company acknowledged the sales purpose in court. A clinical feature and a pharmaceutical sales objective had become parts of the same transaction.

Practice Fusion’s Separate Admission

Practice Fusion had already admitted its side under a deferred prosecution agreement announced on January 27, 2020. In the government’s account of that criminal resolution, the vendor solicited and received payment to use its electronic health records software to influence opioid prescribing. The announcement described the payer as a major opioid company. Purdue’s later guilty plea identified the manufacturer directly.

The Other Counts Show the Wider Sales Campaign

In the same guilty plea, Purdue admitted misleading the Drug Enforcement Administration to increase its manufacturing quotas and paying two doctors through its speaker program to induce more opioid prescriptions. The U.S. Attorney’s Office for the District of New Jersey and the Justice Department’s Consumer Protection Branch investigated those other counts.

The software arrangement gave the sales campaign another route to the prescriber. A speaker payment reached a doctor directly. The Practice Fusion payment reached the software that could influence a doctor’s recommendation.

A Clinical Recommendation With a Commercial Buyer

Clinical decision support can put a recommendation into the treatment workflow. The Justice Department’s account of the criminal information against Practice Fusion described an opioid alert financed by the drug company’s marketing department and designed with its input. The vendor promoted the expected return on investment in terms of additional opioid prescribing.

We see the absurdity in what the buyer was promised: a return from more opioid prescriptions, delivered through software used to care for patients. Clinical advice, bought by the sales department.

The broader civil allegations against Practice Fusion made the product decisions concrete. Pharmaceutical sponsors allegedly participated in choosing the guidelines, setting the criteria for when an alert appeared and, in some cases, drafting its language. The government alleged that the alerts did not always reflect accepted medical standards. For a product manager or clinical informaticist, those are recognizable decisions about what gets built and what a clinician sees.

A 2022 Vassar College senior thesis, A Panacea or a Problem? Electronic Health Records and the Complicated Politics of Its Stakeholder Network, describes the competing interests of patients, clinicians, vendors, insurers, pharmaceutical companies and researchers around EHR data.

The screen in the examination room reflects choices made across those relationships. Here, Purdue’s admission identifies the particular commercial interest that reached the recommendation: increasing sales of its opioids.

When the Deliverable Is More Prescriptions

A separate Vermont whistleblower complaint alleged that sponsors paid to increase prescriptions, echoing the sales purpose Purdue admitted for its payment to Practice Fusion.

Bay v. Clinovations, complaint, paragraph 143

A Whistleblower Case About Paid Recommendations

The government alleged that Practice Fusion’s opioid kickback arrangement tainted claims to federal health care programs. That connects the sponsor’s payment and the software recommendation to the public money behind the prescriptions.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For someone who recognizes a paid clinical intervention inside another business, we work through the sponsorship, software decisions and payment claims with you.

You Know What the Sponsor Bought

If you saw a drug sponsor shape an EHR recommendation, talk with our whistleblower experts about the payment behind the prompt. We build the case with you around the sponsor’s demands, the product decisions and the claims, and bring in healthcare fraud whistleblower lawyers who understand paid clinical recommendations. We stay beside you through the case, with your knowledge of the business at its center.