nuedexta prescription bottles
CNN  — 

One physician had his prescription pad taken away after he repeatedly failed tests assessing his competency.

Another was banned from treating mentally ill inmates and accused of endangering nursing home patients by prescribing excessive dosages of medications. 

At least three others had criminal convictions for illegal prescribing.

Avanir Pharmaceuticals paid nearly 500 doctors to speak or consult on its drug, Nuedexta, between 2013 and 2016, according to government data. Through a review of the top prescribers and top paid physicians in this group, CNN identified a dozen who have been disciplined by state medical boards. These offenses included the harmful treatment of nursing home residents and “grossly negligent acts” involving the inappropriate prescribing of dangerous and addictive drugs – resulting in probation, suspension, fines and revoked licenses.

Original investigation: The little red pill being pushed on the elderly

Nuedexta is approved by the Food and Drug Administration to treat a rare condition marked by uncontrollable laughing and crying, called pseudobulbar affect (PBA). But in a recent investigation, CNN found repeated examples where state regulators discovered doctors had prescribed Nuedexta to dementia patients, purportedly for PBA, when it was actually being used to control unruly behaviors. This medication has experienced a massive jump in sales in recent years, propelled by prescriptions to nursing home residents for whom the drug may not be necessary or even safe. After CNN’s initial report, the Los Angeles city attorney announced that it was launching a probe into Avanir, examining whether the company broke state or federal laws in the sale, marketing or prescribing of Nuedexta. The city attorney said it will likely examine certain doctors paid by the company as part of this.

Former Avanir employees say that the company’s speaker program, where Avanir seeks out physicians and pharmacists to present about the drug to everyone from medical colleagues to nursing home employees and administrators, has been essential to its growing success. 

Between 2013 and 2016, Avanir and its parent company, Otsuka, paid doctors nearly $14 million for Nuedexta-related consulting, promotional speaking and other services, according to government data. Paying doctors for promotional speaking is legal and is defended as a way for experts in their fields to share important experience and information about medications, but it’s long been a controversial practice.  

When asked about the doctors CNN identified as having disciplinary records, Avanir said in a statement that it works with experienced and knowledgeable doctors to “advance effective treatment options for people suffering from central nervous system disorders,” a category that includes Alzheimer’s disease.

The company noted that it complies with all legal requirements when doing this and said it has a system in place to screen the physicians it works with.

Avanir Pharmaceuticals, based in Aliso Viejo, California, is the maker of Nuedexta.

“Our medical department has in place a robust physician-verification system, which we continually work to refine, to determine if a physician has been disbarred, accurately represented his or her qualifications, and continues to maintain his or her fitness for practice,” Avanir said in a statement. “We also rely on the judgments of medical boards, who have responsibility for determining whether a physician is fit to practice and may maintain a medical license. We stand proudly by our work and are dedicated to the patients we serve.”

At least one of Avanir’s speakers is currently under federal government investigation, accused of accepting kickbacks in exchange for prescribing Nuedexta. 

According to a letter obtained by CNN, the federal government is investigating Cleveland neurologist Deepak Raheja for fraudulently diagnosing patients with PBA in order to secure Medicare coverage for off-label use and increasing