An Edmonton fertility doctor admits he took part in a drug kickback scheme for more than two years and at times prescribed his patients higher doses of fertility drugs than was medically advised as part of the scheme.
Patients who saw Dr. Tarek Motan between August 2015 and November 2017 at the Lois Hole Hospital for Women fertility clinic received a letter this month in which the doctor admitted his actions. Alberta Health Services (AHS) helped distribute the letter.
“While I was working at the fertility clinic, I had entered into a financial rebate arrangement with three pharmaceutical companies,” Motan wrote.
He said he paid for fertility drugs such as Gonal-F, Puregon and Menopur from three companies “without obtaining proper authorization and approval from AHS or my regulatory college.”
“In return, I received monetary rebates from these companies that I placed into an account which I administered for education.”
The letter didn’t identify the companies and AHS refused to provide that information.
Motan said the drugs were dispensed and sold at Glengarry Pharmacy in Edmonton, where he directed his patients.
“As part of the arrangement, a portion of the rebate monies was paid to Glengarry Pharmacy,” he wrote. Motan said he did not tell his patients, clinic staff or AHS about the scheme.
Motan, who still works at the fertility clinic, has not responded to an interview request.
A Glengarry Pharmacy employee, who identified himself only as Eric, said he could not comment on the letter and told a CBC News reporter to contact Alberta Health Services before he hung up the phone.
Sometimes prescribed higher doses than recommended
In the letter, Motan also admitted that “on occasion,” he prescribed high doses of fertility drugs to patients, including from the outset of treatment.
He said he believed it would help them but also acknowledged it may have put some patients at risk of adverse effects, including ovarian hyperstimulation syndrome, a condition where the ovaries swell and leak fluid into the body.
“That approach was contrary to the medical product literature that recommended doses be individualized for each patient and that patients be started on lower doses,” Motan wrote.
“In addition, the higher doses meant that patients also experienced higher cost, and prescribing the higher doses of some of the drugs resulted in higher rebate amounts.”
The letter told patients they can contact a call line available through AHS’s Health Link if they have questions or concerns.
Patients can complain to regulatory body
Alberta Health Services declined an interview request and did not address questions about the kickback scheme, saying it “can offer no further comment or specifics about this matter.”
“However, action has been and continues to be taken,” spokesperson Kerry Williamson said in a statement. He said patients and others who wish to make a complaint about Motan can do so through the College of Physicians and Surgeons of Alberta.
A college spokesperson said overprescribing medication and profiting from those prescriptions is a breach of its standards of practice, but the province’s Health Professions Act prevents the college from confirming or denying that any complaint investigations are underway.
“That said, inquiring into situations like this is [the college’s] responsibility as a regulator,” Jessica McPhee said in a statement. The Alberta College of Pharmacy has not yet responded to a query from CBC News.
Lorian Hardcastle, a health law associate professor at the University of Calgary, said both regulators should investigate the scheme. She said Motan’s admission is rare and raises concerns about not only a financial conflict of interest but the quality of care he provided to patients.
“It is expected that above all, physicians will have [patients’] interest in mind and that that interest won’t be influenced by finances or other things,” she said.
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