Throwing Good Money After Bad Docs: The Relationship between Physician Gifts and U.S. Department of Health and Human Services Exclusion

Importance: The opioid epidemic resulted in 42,000 deaths in 2016 alone. Understanding the link between opioid pharmaceutical gifts and adverse physician behavior could improve efforts to prevent physicians from playing a role in opioid misuse and abuse.

Objective: To determine the association between opioid-linked monetary payments from drug manufacturers and incidence of physician sanctions (excluded from participating in federal programs by the U.S. Department of Health and Human Services (HHS)). We hypothesized that receiving any opioid-linked payments will increase the probability of receiving an HHS exclusion.

Design: We extracted all records from 2014 to 2017 CMS Open Payments data listing an opioid as the reason for payment. Payment records were merged with a longitudinal database of all active physicians in the U.S. using sequential name and address matching. All HHS sanctioned physicians were identified. We estimated difference-in-means tests and regression analyses across sanctioned and non-sanctioned physicians.

Participants: HHS excluded physicians randomly matched to an equal number of physicians who were not sanctioned. Sampling and analysis were repeated 100 times.

Results: Between 2014 and 2017, 1,526 physicians received HHS exclusions; 767,103 active physicians were not sanctioned. We found that 5.7% of excluded physicians received some opioid payment, while only 3% of the non-excluded physicians received any payments. Twice as many excluded physicians received gifts for fentanyl and “other” opioids compared to non-excluded physicians. Results from year- and geography-adjusted logistic regressions found that receipt of any opioid (OR=1.379, p=0.00002), hydrocodone (OR=1.083, p=0.0117), fentanyl (OR=1.640, p=0.0025) and “other opioid” (OR=1.760, p=0.0001) were all associated with a greater odds of receiving an HHS exclusion.

Conclusions and Relevance: Physicians who receive monetary gifts from opioid manufacturers were twice as likely to be excluded for adverse behaviors. These findings render new understanding on the consequences of financial incentives flowing from manufacturers to physicians, especially in the midst of the opioid epidemic.