Sammies nominee helps root out health care fraud

Sara M. Bloom’s commitment to justice and public service is being recognized in a big way.

Bloom is a finalist for a Service to America Medal in Justice and Law Enforcement for her work that led to the largest health care fraud settlement in history.

As Chief of Affirmative Litigation at the District of Massachusetts U.S. Attorney’s office, Bloom led a four-year investigation into Pfizer’s illegal promotion of four prescription drugs for unapproved uses. She ultimately uncovered that Pfizer had been paying kickbacks to doctors to encourage them to make off-label prescriptions.

The Justice Department says this cost Medicare and Medicaid “hundreds of millions of dollars” in fraudulent claims.

The Sammies award honors Bloom for her “tireless” work on the case, which ended in Pfizer agreeing to pay $2.3 billion in fines and penalties.

The 25-person case team working under Bloom is also recognized for the award.

Bloom says she credits whistleblowers for her success in the Pfizer case.

“There are checks and balances, but it simply can’t catch the kind of deception in how the data is presented to doctors on a day-to-day basis by the sales force without some way of getting behind all that, which is what the whistleblowers really provide.”

She says this is because there often is not a paper trail other than the prescription itself.

“The issue is really that physicians are free to use drugs for unapproved uses if they find that it is in the best interest of the patients health . . . but the company is not supposed to be promoting [a drug] off-label, they are supposed to go through the FDA approval process before they go out and encourage people to use it for an unapproved use.”

She says that means that insider information is important to understanding how the game is being played.

“One of the real challenges of these types of investigations is actually trying to figure out how to focus it so that you can pull it together, instead of getting lost in all of the evidence,” she says.

Despite the challenges, Bloom says these kinds of triumphs are what she loves about federal work.

“As a believer that government can do good, you have to make sure that it is actually doing good, and that the money isn’t being wasted.”

It’s this attitude that led Phillip Coyne, an agent with the inspector general’s office at the Department of Health and Human Services, to call her “relentless,” and a “tremendous advocate for taxpayers, Medicare and Medicaid beneficiaries and average Americans.”

But Bloom says it’s all just part of being a public servant.

“I think making sure that the large corporations and the people with a lot of influence in our society are still answerable to the law is really important in making it a fair system,” she says.

The Service to America Medal is an award recognizing excellence in federal civil service. It is given out annually by the Partnership for Public Service.

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