HHS Inspector General on speaker programs: nearly $2 billion in three years, "skeptical about the educational value"

Speaker fees are the biggest line in the Open Payments file for psychiatry. This is the federal fraud regulator's own description of the arrangement.

Significant findings

The Office of Inspector General of the Department of Health and Human Services issued a Special Fraud Alert on speaker programs on 16 November 2020. It defines them as "company-sponsored events at which a physician or other health care professional makes a speech or presentation to other HCPs about a drug or device product or a disease state on behalf of the company," where "the company generally pays the speaker HCP an honorarium, and often pays remuneration (for example, free meals) to the attendees." Its figure: "In the last three years, drug and device companies have reported paying nearly $2 billion to HCPs for speaker-related services," from Open Payments 2017 to 2019 under the same category that dominates the psychiatry file in this library.

It summarises what settled and litigated cases alleged: companies "selected high-prescribing HCPs to be speakers and rewarded them with lucrative speaker deals (e.g., some HCPs received hundreds of thousands of dollars for speaking)"; "conditioned speaker remuneration on sales targets"; held programs at "wineries, sports stadiums, fishing trips, golf clubs, and adult entertainment facilities"; served meals where "the average food and alcohol cost per attendee was over $500"; and invited repeat attendees and "friends, significant others, or family members."

Its position: "OIG is skeptical about the educational value of such programs." It notes that "HCPs can access the same or similar information provided in a speaker program using various online resources, the product's package insert, third-party educational conferences, medical journals, and more," which "further suggests that at least one purpose of remuneration associated with speaker programs is often to induce or reward referrals."

The suspect characteristics it lists: little or no substantive information presented; alcohol available or a meal above modest value; a venue "not conducive to the exchange of educational information (e.g., restaurants or entertainment or sports venues)"; many programs on the same product with no new information; repeat attendees; attendees with no legitimate reason to be there; sales or marketing choosing the speakers, or choosing them "based on past or expected revenue"; and pay above fair market value or "that takes into account the volume or value of past business generated."

Worth asking

The alert is about intent, not a ban: "the lawfulness of any remunerative arrangement, including speaker program arrangements, under the anti-kickback statute depends on the facts and circumstances and intent of the parties," and its list "is illustrative, not exhaustive." Speaker fees were 56 percent of every dollar paid to US psychiatrists in 2024 and 63 percent for the sixty best paid. The regulator that prosecutes kickbacks has said in writing what it believes this category of payment often buys.