Illinois suspends medical license of leading prescriber of anti-psychotic drugs

For years, Dr Michael Reinstein prescribed the powerful drug clozapine more than any other doctor in Medicare or Medicaid. His patterns were the subject of two ProPublica articles and he faces a federal civil lawsuit alleging health care fraud


Illinois medical regulators have indefinitely suspended the medical license of psychiatrist Michael Reinstein, who prescribed more of the most powerful and riskiest antipsychotic drug clozapine than any other doctor in the country.

The decision by Illinois' Department of Financial and Professional Regulation, signed Friday, suspends Reinstein's license for a minimum of three years, at which time he can apply to have it reinstated.

The state's medical disciplinary board recommended the sanction in May after determining that Reinstein, 71, received "illegal direct and indirect remuneration" from the maker of generic clozapine; did not consider alternative treatments for his patients; and disregarded patients' well-being because of potentially life-threatening side effects of the drug. Reinstein's motion for a rehearing was denied Friday, making the matter public.

Clozapine is approved to treat patients who don't respond to other medications. But it can have dangerous side effects, including seizures, inflammation of the heart muscle, and a drop in white blood cells. The drug is considered particularly dangerous for elderly patients.

Reinstein's prescribing patterns have been explored in two ProPublica reports.

In 2009, ProPublica and the Chicago Tribune detailed how he had prescribed more of the antipsychotic clozapine to patients in Medicaid's Illinois program in 2007 than all doctors in the Medicaid programs of Texas, Florida and North Carolina combined. Autopsy and court records showed that, by 2009, at least three patients under Reinstein's care had died of clozapine intoxication. At that time, Reinstein defended his prescription record, arguing that clozapine is effective and underprescribed.

Last year, as part of an investigation into Medicare's failure to monitor problem prescribers, ProPublica reported that Reinstein prescribed even more clozapine in Medicare's prescription drug program for seniors and the disabled. We found that the program continued to let him prescribe even after the U.S. Department of Justice accused him of fraud and Illinois' Medicaid program suspended payments to him.
Reinstein's attorney did not return a phone call or email seeking comment. An outgoing message on Reinstein's cell phone said, "Due to a personal emergency I will not be working as of today. I will return to work as quickly as I can."

In their response to the medical board's accusations, Reinstein's lawyers invoked his right against self-incrimination.

The state of Illinois has the authority to permanently revoke a doctor's license, but typically only does so for sex crimes or assaults on patients, a spokeswoman said by email.


When a doctor's license is indefinitely suspended, as is the case with Reinstein, the doctor must apply after a set time to return to practice; the state's approval is not automatic.

The federal fraud lawsuit against Reinstein is pending in U.S. District Court in Chicago. In a November 2012 news release announcing the case, the government said that Reinstein "received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes."

Prosecutors allege that Reinstein's prescribing decisions were motivated by money and perks from pharmaceutical companies. He allegedly switched patients from one brand of clozapine to another based on money and other enticements he received from a drugmaker.

In March, Teva Pharmaceutical Industries Ltd., the maker of generic clozapine, agreed to pay more than $27.6 million to settle state and federal allegations that it induced Reinstein to prescribe the drug.

Reinstein's prescribing of clozapine appears to have declined after the 2009 articles about him. From 2007 to 2009, he wrote an average of 20,000 Medicare prescriptions annually for clozapine and a brand-name version, FazaClo. That figure dropped to about 8,000 in 2012, according to data obtained by ProPublica.




Nagesh Kini

3 years ago

India also needs a Department for Financial and Professional Regulations to overcome the tardiness of our various regulators.

Raw material supply continues to be a constraint for steel industry

The iron and steel industry is going through a crisis of raw material supply, which, due to lack of adequate despatches from domestic miners, is being imported at high cost


The iron ore prices in the international market have been falling in the last couple of years and are currently in the range of $92-$95 per tonne. Imports by China have also reduced. But main supplies from Australia and Brazil have continued to hold the market, which was traditionally dominated by low grade iron ore, obtained from Goa. The Chinese had mastered the art of a high grade ore mix from both the above countries.


Chinese have, in the absence of low grade iron ore supplies from Goa have reconfigured their blast furnaces to make steel, as the uncertainty has continued for the last two years. Goa mining operations of this low grade iron ore, which has a capex of 20 mt (million tonnes), are expected to resume once the rains stop. E-auctions of ready stocks are continuing to trickle into the market.


As against the 14 mt of iron ore that Sesa Sterlite used to mine in Goa before the ban, they may now be producing about 3 mt to 3.5 mt.


The Goa State Assembly proposes to hold comprehensive discussions on the guidelines that will form the backbone of the mining industry in the state on 18th August. Chief Minister, Manohar Parrikar, has indicated that the mining leases which are currently under suspension may be handed over to their traditional owners, as the state government is not interested in taking them over (or even auctioning them).


In the meantime, due to the uncertainty associated with the mining industry, it has been reported that 55 barges, generally used for carrying iron ore in Goa, out of the 525 in operation, were sold to buyers from Gujarat, Maharashtra, West Bengal and Karnataka.


It may be recalled that, the Supreme Court had imposed a ban (in 2012) on Karnataka iron ore pellet exports. Earlier, the apex court had said that "iron ore and its products will be sold by NMDC only through e-auction to steel and associated industries which are dependent on iron ore from Karnataka. No middlemen/ traders will be eligible to participate in the e-auction and no export will be permissible."


This was in response to an appeal submitted by miners, including KSPL Ltd and the government-owned KIOCL and NMDC Ltd. These companies had contended that as there was a domestic market for pellets produced by them. Still, they were being forced to operate at 50% capacity.


In a later development, during the recent visit the Iranian Mining Minister, had shown keen interest in importing iron ore pellets manufactured in Karnataka, as their own domestic supply was of much poorer quality. It may be remembered that Iran has a running rupee account with UCO Bank in Kolkata and has a substantial credit balance. He showed serious interest in obtaining these iron ore pellets from KIOCL (formerly also known as Kudremukh Iron Ore Co Ltd). Since the requirement of 20 mt, spread over five years, is large, and can help the industry, the matter has now been taken up at the Central Government level, according to CMD, Malaya Chatterjee. Any assistance would enable them to kill two birds with one stone. Low grade iron ore can not be consumed by the steel industry. Also, the pellet makers were having idle capacity.


The iron and steel industry is also going through a crisis of raw material supply, which, due to lack of adequate despatches from domestic miners, is being imported at high cost.


This industry also needs urgent attention of the government to resolve these issues, to save the industry and to reduce the prospect of unemployment.


(AK Ramdas has worked with the Engineering Export Promotion Council of the ministry of commerce. He was also associated with various committees of the Council. His international career took him to places like Beirut, Kuwait and Dubai at a time when these were small trading outposts; and later to the US.)


Nifty, Sensex will push higher, subject to dips – Wednesday closing report

Nifty has to stay above 7,700 for the upmove to continue


On Tuesday we had mentioned even if Nifty gives up some gains on Wednesday, it may push higher over the coming days. Although the domestic indices managed to close in the positive for the third consecutive session, the trading on the bourses today was quite volatile. The market sentiments may have been affected by the weak data of July consumer price inflation and June factory output, given after-market hours on Tuesday.


The data from Japan and China may have added to intraday weakness. The market was supported by a stronger opening in Europe and expected firmness in the US markets.

The S&P BSE Sensex opened lower at 25,861 and NSE's CNX Nifty too opened in the negative at 7,717. Sensex moved between the range of 25,792 and 25,973 and closed at 25,919 (up 38 points or 0.15%). Nifty moved between 7,696 and 7,757 and closed at 7,740 (up 13 points or 0.16%). The NSE recorded huge volume of 99.39crore shares. India VIX rose 2.19% to close at 13.7625.


Among the other indices on the NSE, the top five gainers were FMCG (2.19%), Pharma (0.95%), IT (0.82%), MNC (0.35%) and Auto (0.10%). The top five losers were Realty (5.42%), Smallcap (3.34%), PSU Bank (3.20%), Media (3.10%) and Nifty Midcap 50 (2.37%).

Of the 50 stocks on the Nifty, 19 ended in the green. The top five gainers were HCL Technologies (2.89%), ITC (2.79%), Hindustan Unilever (2.45%), HDFC (2.36%) and Sun Pharma (2.28%). The top five losers were Bhel (6.51%), Bank of Baroda (4.51%), DLF (4.10%), Coal India (3.47%) and Hindalco (3.40%).

Of the 1,593 companies on the NSE, 350 companies closed in the green, 1,201 companies closed in the red while 42 companies closed flat.


Nomura has raised the BSE Sensex target to 30,310 by end of August 2015. Nomura also mentioned that the cyclical pick-up in growth is being ignored by the market obsessed with bold policy and reform moves by the new government.

Commerce and Industry Minister Nirmala Sitharaman said on Wednesday that the NDA government will not 'entertain' foreign direct investment in multi-brand retail.

The Indian government on Wednesday said it will come out with a new natural gas pricing formula by 30th September keeping in mind the interest of investors and public.

Hindustan Unilever (2.49%), which last week hit its 52-week high was today among the top two gainers in the Sensex 30 pack. It has clarified with regard to a news item that it has decided to reorganise the home and personal care business into two separate businesses i.e. Home Care and Personal Care Businesses, to ensure focus on the growth drivers for each of these businesses. However this is an internal restructuring within the company and it does not involve any demerger, hiving off or any other similar corporate action.

BHEL (6.57%) was the top loser in the Sensex 30 stock. It has posted weak June 2014 quarter result; the net profit of Rs465.43 crore has fallen to Rs193.50 crore for the quarter June 2014. Sales decreased from Rs6,458.12 crore to Rs5,154.97 crore for the relevant quarter.

Eicher Motors (11.66%), hit its 52-week high on the BSE today, was the top gainer in ‘A’ group on the BSE. It posted good June 2014 quarter result. The net profit for June 2014 was Rs133.24 crore as compared to Rs52.62 crore for the quarter ended June 2013. Sales increased from Rs381.82 crore for the quarter June 2013 to Rs746.19 crore for the quarter June 2014.

Unitech (17.14%) was the top loser in ‘A’ group on the BSE. The Central Bureau of Investigation has started a fresh inquiry into the Rs1,700-crore land deal between Tata Realty and Unitech in 2007.

US indices closed Tuesday higher. Except for NZSE 50 (0.02%) and Straits Times (0.06%), all the other trading Asian indices closed in the green. Seoul Composite (1.02%) was the top gainer.

China's industrial production slowed slightly in July and investment showed signs of weakness, official data showed today, 13 August 2014. Value-added industrial output in China rose 9% in July from a year earlier, edging down from a 9.2% on-year increase in June, data from the National Bureau of Statistics showed. Retail sales in China increased 12.2% in July from a year earlier, slowing from a 12.4% on-year increase in June.

Fixed-asset investment in non-rural areas of China rose 17% in the January-July period compared with the same period a year earlier. The rise in the closely watched indicator of construction activity was also slower than the 17.3% increase recorded in the January-June period.

Japan's economy contracted sharply in the second quarter after a sales-tax increase in April sent household spending tumbling, which economists said could pressure the government to take additional stimulus measures. Real gross domestic product, the total value of all goods and services produced in the economy, shrank 6.8% in the three months through June on an annualised basis from the previous quarter.

European indices were trading higher. US Futures too were trading in the green.


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