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.
Sometimes prescribed higher doses than recommended
In the letter, Motan 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 through AHS's Health Link with 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.
AHS spokesperson Kerry Williamson said patients and others who wish to make a complaint about Motan should contact 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.
In a statement, the Alberta College of Pharmacy (ACP) said it received a complaint in 2019 about the conduct of Glengarry Pharmacy's owner and their interactions with Motan. The college launched an investigation, which ended in January 2020.
"The pharmacist involved acknowledged their conduct in the matter and ACP required changes in the pharmacist's conduct and in the operation of the pharmacy to ensure that the public is protected," spokesperson Barry Strader said.
ACP named the pharmacy licensee and owner under investigation as Doris Chung.
Patient feels like she was used
Kaitlyn Blair was a patient of Motan's for all of 2016 and 2017 spending nearly $30,000 out of pocket for her treatments. She said she developed ovarian hyperstimulation syndrome.
"I couldn't work, I could barely move. My feet were so swollen, my stomach," Blair said.
Blair said she doesn't know if Motan prescribed her higher doses than she should have taken. But she said he told her she had a better chance of getting pregnant with the high doses he prescribed.
After reading the letter Monday, Blair said she felt like she was used.
"I want him to know how almost mad I am, that he would make something so personal so disgusting at the same time," she said.
Another former patient, Shannon Frew, said she saw Motan many times between 2015 and 2017. She said she feels betrayed by his admission.
Frew said she did not get sick from any of her treatments and does not know whether Motan prescribed higher drug doses than recommended.
She said she maxed out her insurance plans and by the end was paying for her treatments. Now Frew wonders if it all was medically necessary.
"Where does that leave us? It leaves us questioning: did we need to take all those drugs? Did we need to spend all that money?"
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