A.D.H.D. Startup Executives Accused of $100 Million Fraud in Adderall Scheme

By https://www.sandiegopsychiatricsociety.org/author
June 21, 2024

Patients using Done or similar telehealth platforms may experience disruptions in care, health officials warned.

New York Times

By Dani Blum

June 13, 2024

Tens of thousands of patients with attention deficit hyperactivity disorder nationwide could face disruptions to their care after two executives of a major telehealth company that distributed A.D.H.D. drugs were indicted on charges of health care fraud.

The Department of Justice announced on Thursday that the chief executive and the clinical president of Done, the telehealth company, had been arrested and accused of participating in a scheme to distribute Adderall and other stimulants for A.D.H.D. to patients who did not need the medications, and to bill insurers for these drugs.

Done was one of several telehealth companies that became popular during pandemic lockdowns in 2020, when the government relaxed restrictions around online prescriptions for controlled substances such as Adderall. Those looser regulations meant that clinicians could prescribe medications virtually without first conducting an in-person evaluation. From 2020 to 2021, stimulant prescription fills rose by more than 10 percent among some age groups, according to data from the Centers for Disease Control and Prevention.

“These defendants exploited the Covid-19 pandemic to develop and carry out a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose,” Attorney General Merrick B. Garland said in a news release.

In a statement released Tuesday, Done said it would continue normal operations and would do “everything we can to ensure stable care for our patients.” The company said it “strongly disagreed” with the charges.

The charges come amid ongoing shortages of Adderall and another stimulant, Vyvanse. The C.D.C. said that as many as 50,000 patients across the nation who rely on Done or similar telehealth platforms to obtain stimulant medications may be affected.

“There are a lot of people who are going to be struggling without consistent medication,” said Margaret Sibley, an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. 

The Justice Department claimed that Ruthia He, Done’s chief executive, and the company’s clinical president, David Brody, had built the business in part by spending tens of millions of dollars on “deceptive advertisements” posted on social media platforms such as Facebook and TikTok. Done’s posts frequently featured young people “discovering” on camera that they had A.D.H.D. One video, posted on TikTok the day before the arrests, portrayed the point of view of a Done client: “You started seeing a Done provider for your A.D.H.D.,” text overlaying the post read, “and became a whole new person, who uses her A.D.H.D. as a superpower.”

Prospective patients took a minute-long assessment to evaluate if they should be treated for A.D.H.D. The company connected patients virtually with clinicians who could then diagnose them and prescribe medication for A.D.H.D. In some states, patients were able to see providers in person or get medications delivered directly to them.

“It’s marketing a short quiz in exchange for a diagnosis or a stimulant prescription,” said Olivia Little, a senior investigative researcher at the nonprofit organization Media Matters for America, which has researched the advertising practices of A.D.H.D. treatments startups. Ms. Little said that Done had 160 ads active across Facebook and Instagram as of Thursday evening.

Federal officials claimed that the company had limited the information available to Done’s prescribers and told providers to prescribe stimulants to patients who did not qualify. The providers were also required to keep initial patient consultations to under a half-hour, the Justice Department said.

That approach seemed to promote “as many prescriptions as possible and as many diagnoses as possible, rather than making it about the patient,” said Dr. Nicole Hadeed, a clinical assistant professor at Michigan Medicine.

These charges mark the first time the Justice Department has criminally prosecuted drug distribution related to telemedicine prescriptions through a digital health company. Another telehealth company that gained popularity during the pandemic, Cerebral, has previously faced similar accusations of pressuring clinicians to prescribe A.D.H.D. drugs. 

The C.D.C. recommended that people who are running low on their current prescriptions schedule an appointment with a health care provider as soon as possible. If A.D.H.D. goes untreated, people are at a higher risk of developing a drug or alcohol use disorder as well as injuries in car crashes or other accidents. Some patients experience withdrawal if they stop taking medication suddenly. For many, symptoms can rebound without medication — they may struggle to focus at work, complete day-to-day tasks or engage socially.

“A lot of people just think about A.D.H.D. as kids with behavioral issues,” said Dr. Daniel Dickstein, the chief of the division of child and adolescent psychiatry at McLean Hospital. “The reality is, attention is everything.”

The ongoing drug shortages have already created challenges for those patients, he said. “Short term, we’re playing this game, essentially monthly, to try to find medicine,” said Dr. Dickstein. “More medium to long term, I don’t know how we end this crisis.”

The C.D.C. warned that seeking out stimulants through illegitimate channels carried risks, including that the pills may be counterfeit or contain fentanyl. The C.D.C. recommended that clinicians prescribe naloxone, an overdose-reversal drug, to any patient who obtains A.D.H.D. medications outside of the health care system.


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