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 that scheme.
Patients who saw Dr. Tarek Motan between August 2015 and November 2017 at the Lois Hole Hospital 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.”
Motan said the drugs were dispensed and sold to patients at Glengarry Pharmacy, 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 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.
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.
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,” he 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 Health Link if they have questions or concerns.
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 Health Professions Act prevents the college from confirming or denying any complaint investigations 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.
University of Calgary health law associate professor Lorian Hardcastle said both regulators should investigate the scheme. She said Motan’s admission is rare and raises concerns about not only the financial conflict of interest, but the quality of care he provided to patients.
“It is expected that above all, physicians will have their interest in mind and that that interest won’t be influenced by finances or other things,” she said.
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